Chad Holmes, DO, FACEP, is a member of the emergency medicine faculty at John Peter Smith Hospital in Forth Worth Texas, and is the director of the newly created street medicine fellowship. In this interview he discusses details of the fellowship, the clinical experience, and life in Fort Worth, TX. 

Interviewed by Bailee Jacobsen, DO, 2nd year emergency medicine resident at Loyola University Medical Center

Edited by Kian Preston-Suni, MD, MPH

Additional information is available at https://ies.healthcare/careers/street-medicine-fellowship/

Dr. Chad Holmes: cholmes@ies.healthcare

Jennifer Bullard: jbullard@ies.healthcare 

Can we start by telling us a little bit about yourself, and what drew you to become the program director of this fellowship?

I had always had an interest in street medicine, but took a bit of an indirect route into the field. A little bit of background on myself, I went to medical school at West Virginia School of Osteopathic medicine along with my wife, we both went into emergency medicine, and both did our residency training in Columbus Ohio at Doctors Hospital. We are both from the Dallas-Fort Worth area, so after residency we wanted to come back home, and after residency we both got jobs at John Peter Smith Hospital (JPS). It is an academic, level I trauma center with high acuity and high volume (about 125-130,000 patients per year) county hospital. We have been at JPS for a little over 6 years now, and we had a rotator through the ED from the family medicine program and he started talking about the street medicine program, and I was like wow, this street medicine program that we have here that I know nothing about sounds very relevant to our program in the ED. I volunteered a few times to do some medical outreach, and it was an incredible experience. You are exposed to a whole new world, first hand on the streets and it seemed incredibly relevant to emergency medicine, especially at a county hospital when you consider setting up follow up, discharge plans, etc. At that time, there were no other ED attendings involved in the program, and I kind of took it and ran with it.  People started to see the utility of having a more permanent position for an ED physician within the street medicine team so that morphed into a more dedicated position for me and that is where I am at now. One of my first goals for the role was to incorporate street medicine into our EM resident education. I think it is very valuable to teach empathy within emergency medicine and maybe influence the way they act or treat patients experiencing homelessness they may see in the ED. 

We started an elective in street medicine through the residency and the idea of a fellowship came to be. There is one other street medicine fellowship in the country that I know of in Pittsburgh, and we will be the first that is focused on an EM specific track. We have the infrastructure for it and with approval from the GME we are excited for our inaugural fellow July 2021. 

This is the first EM street medicine fellowship, can you speak a little bit about how you envision this will look? 

The fellow would be an ED attending, employed by our EM physician group, they will be overseeing residents, APPs, etc.  The way we have it structured, the fellow will work about 60 hours clinically per month and 60 hours per month of everything street medicine (i.e. administration, research, clinical outreach). They will also take on the role of being the resource/ ED champion in the department for questions about homelessness, resources, shelters, etc.  

Can you describe some qualities or experiences you will be looking for in potential applicants?

We are looking for someone who already has a grasp on what street medicine is and how it fits into the overarching social medicine umbrella. Ideally, someone with experience on a medical outreach team, teaching at shelters, global medicine experience, etc.  Probably not someone who is jumping into street medicine for the first time.  Street medicine is a lot to learn and has a lot of complexities. We do not have specific requirements, but we are looking for someone with experience and a passion for working with patients experiencing homelessness. 

Are there any specific requirements needed to be eligible for this fellowship?

Just emergency medicine board certified or eligible is the only requirement to apply to our program. We will require a CV, 2 LORs, and a letter of intent. 

Can you describe the application process for your fellowship? 

Since the fellowship is through our physician group, we will be utilizing our physician recruiter for application processing. Her name is Jennifer Bullard, (contact: jbullard@ies.healthcare ). Anyone who is wanting to apply is more than welcome to reach out to her and she will guide the applicant through the process and what is required. 

What opportunities do you feel this fellowship will provide to graduating fellows?

The fellow will be able to take the skill set they develop over the course of the year and go in a lot of different directions.  We will have core street medicine foundational things, but there will also be a lot of flexibility into honing skills into what they want.  We can tailor the schedule into what the fellow is interested in, which is what makes this fellowship a very unique opportunity.  

What makes Fort Worth, TX an ideal location for this fellowship?

Fort Worth is a pretty cool, under the radar city. I am unsure how much I want to tell you guys because I am afraid the secret might get out ☺.  We are a part of the greater Dallas metro area, we are about 30 mins away. Fort Worth has a very cool western vibe. There is an incredible trail system for biking and hiking, usually around the Trinity River. The downtown area has lots of parks and walking areas, there are multiple world-renowned art museums, and very close to Dallas with a train station that connects the two with a stop at the Dallas Cowboys stadium and Texas Rangers stadium. 

For the street medicine fellowship, sadly, we have a pretty significant homeless population in Tarrant county. There are over 2,000 people experience homelessness in Tarrant county which like most big cities is probably severely underreported. We have a great need for street medicine here. 

Any additional information or advice for potential applicants?

I would say go for it. The first fellows are going to have a great experience as they will help form the program as we move forward. If you have a little bit of interest, please reach out to me, or go ahead and apply and we will see what happens.