Since 1992, Jim Withers, MD, has worked as an undercover physician, walking the streets of Pittsburgh and offering free healthcare services to people experiencing homelessness.
Dr. Withers, an internist, and a team of clinical volunteers, medical students and outreach specialists actively seek out people in need by wandering under bridges and through abandoned buildings. Dr. Withers initially dressed as a homeless person to gain their trust.
His mission transformed into a citywide program known as Operation Safety Net®, which is part of Pittsburgh Mercy Health System, an integrated, community-based system that serves more than 
32,000 people annually. In addition to running a drop-in center, a severe weather emergency shelter and helping the homeless obtain insurance, housing, legal assistance and other vital human services, Operation Safety Net has treated over 10,000 individuals since 1992 and has provided housing to more than 1,200. Dr. Withers also started Street Medicine Institute, a nonprofit organization that helps communities around the world establish programs for healthcare via walking teams, medical vans and outdoor clinics.
This fall, Dr. Withers was honored as a "2015 CNN Top 10 Hero." Dr. Withers and nine others — including an orthopedic surgeon — were chosen as Top 10 Heroes. Each received $10,000 for their mission or organization, and through a month-long voting process, viewers selected one as the Hero of the Year. Maggie Doyne was named the 2015 CNN Hero of the Year.
Here Dr. Withers discusses his definition of "street medicine," the challenges of connecting streets and traditional healthcare systems, and what it's been like to be recognized as a 2015 CNN Top 10 Hero.
Question: Could you discuss the work you do with Pittsburgh Mercy Health System?
JW: I've been with Pittsburgh Mercy Health System for pretty much my entire career. I chose it because it was a health system that had a mission basis. I found that in working with the poor and excluded, it has heightened [the staff's] identity and their standing within the community even further. It meant a lot to the people throughout the community that our system stands for that kind of work. Within the health system here, it galvanizes people regardless of whether they're doctors, in housekeeping, nursing or administration — they all seem to be happier working in a system that stands for that the greater common good.
Hospitals should look at proactive ways to work with people who are underserved as a way of building their own internal and external support.
Q: How did you decide to start Operation Safety Net and Street Medicine Institute?
JW: My start with Operation Safety Net was my teaching career. I wanted to create an opportunity for medical students and residents to see how healthcare looked from the outside for people who were excluded from traditional models of care. I wanted to have a transformational experience rather than just theory. Without going overseas, the most powerful way to make that work was to find a radically different classroom, and I thought working with the street homeless population — people who don't typically go to shelters — would be a convenient and effective way to do that. That's why I started going under bridges.
It evolved into a care delivery model — what I'd now characterize as part of the inclusion health concept, in which a population whose needs are not met has a targeted program that specifically addresses those needs.
Before creating Operation Safety Net, I worked with the issue of domestic violence in our former hospital. In a similar fashion, victims of domestic violence weren't having their needs met and, as a result, were suffering even more. Like the street homeless, the lack of care for these victims was resulting in larger costs to the healthcare system. By working to develop programs that deal with the reality of excluded individuals, we not only improve their health and learn about people-centered care, but also save enormous amounts for our health system.
Operation Safety Net became a delivery model and a culmination of dedicated staff and volunteers. As I was asked to speak in other cities and travel, I began to assist other communities to start similar programs. I named the type of work "street medicine." By 2005, I felt it was time to have our first international meeting. We held the first International Street Medicine Symposium in Pittsburgh. Currently under the Street Medicine Institute, we had our eleventh symposium this year, and it involved six representatives from six continents. It's a growing movement in a new field that promises to have a significant impact on healthcare.
Q: What are the greatest challenges and benefits involved in the work you do?
JW: There's a great deal of difficulty in connecting the reality of people experiencing street homelessness to the reality of health systems. That takes individualized care, which can be challenging because the problems are complex. In addition, navigating into the system is a very informative, challenging experience because it tends to work on its own terms instead of the terms of the people we serve.
Navigators, students and specific advocacy efforts are a natural part of street medicine. One of the key elements I developed is a street medicine consult service, which can help humanize the street homeless person to the medical staff. We believe it can also reduce hospitalizations, length of stay and readmissions.
Q: What has it been like to have been named a 2015 CNN Top 10 Hero?
JW: CNN has not just a national audience, but also a global one with incredible reach. Highlighting the transformative work we're doing in Pittsburgh and around the world presents a powerful opportunity. A lot of my awareness comes through social media. I'm grateful to have received a lot of support and encouragement from people all over the world.
I didn't actually know about the public voting process ahead of time, and it took me by surprise. At first it seemed pretty embarrassing, but it's a great way to connect with people from my childhood and old colleagues as well as those interested in advancing our important work. Together, we can make a difference.
Photos courtesy of Pittsburgh Mercy Health System and Operation Safety Net.