No clinic. No exam room. He goes to the encampments.

Tony Menacho is a PA working in family medicine and street medicine, and he founded Sacramento Street Medicine to bring care directly to people living unsheltered around the city.

What struck me most is how little of this is about prescriptions. It starts with showing up repeatedly until people trust you, and a huge amount of the work is psychosocial: connecting someone to housing, to food, to a phone number that will actually answer. The medicine happens once the relationship exists.

If you want to see what this profession can look like outside of a traditional practice, Tony's work is worth hearing about.

What we cover:

• What street medicine is and how Tony practices it
• Founding Sacramento Street Medicine
• Providing care in encampments
• Building trust with people who've been failed by the system
• The psychosocial side of care that goes past treatment
• What this work gives back to the providers doing it

Resources:

Free Application Timeline: https://www.thepaplatform.com/services/free-application-timeline

PA Program Map: https://www.thepaplatform.com/pa-platform-map

Pre-PA Counseling: https://www.thepaplatform.com/services/pre-pa-counseling

Pre-PA Academy: https://prepaclub.thepaplatform.com/landing/academy

Mentioned in this episode:

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Alright, guys, for today's episode, prepare to be inspired.

I am talking to Anthony Menacho, who is a PA who works in family medicine and also street medicine.

And I am so excited to share about his passion and job with you.

Welcome to the Pre PA Club podcast.

If you want to learn how to become a physician assistant, you're in the right place.

I'm your host, Savannah Perry.

Let's get to it.

Hey, guys, thanks so much for tuning into the podcast.

This is your host, Savannah Perry.

I am a dermatology PA the creator of the PA platform and the creator of this podcast.

And we've officially been doing this now for three whole years, which is crazy, but really cool.

All right, before we jump into today's episode, I have a new sponsor for the podcast I wanted to tell you about.

You may have heard me talk about the page before, but the Physician Assistant College Admissions Test by Exam Master is a new exam that's being used by PA schools as an admissions prerequisite.

This specialized exam covers prerequisite subjects needed for physician assistant school, including anatomy, physiology, biochemistry, microbiology, and more.

The PA Cat website contains resources for candidates who are preparing to take their exam.

Registration for the PA Cat is now open for both in person and online test taking.

For more information on taking the PA Cat, visit padcat.com for more information and we'll have a link for that in the description.

Feel free to listen to the podcast episode and read our blog about the PA Cat if you want to learn more.

All right, now we can get to today's interview and I think y', all, like, I just felt so inspired after listening to this.

So Tony is amazing and just has a really cool.

Like, we didn't even really talk about his Pre PA story that much because what he actually does in street medicine is so, so cool.

So I think you're gonna get a lot out of this interview.

I will tell you up front, we had some technical Internet issues.

So I've never like, cut and cropped a podcast as much because it kept going out.

But the overall message is there.

You're gon like, you're just gonna feel like, renewed in what you want to do.

So, like, if you've ever heard, you know, I want to help people, this is someone who's actually helping people.

And so I just love it.

But it's a great, great interview.

So after talking to Tony, you know, you'll hear in there.

I asked, you know, how can we support you and what you're doing when you're in California I'm in Georgia.

Like, what can we do?

And so they're trying to get his organization, Sacramento Street Med, up and running.

We have come together to schedule a virtual shadowing event where we're going to talk to Tony.

You're going to submit your questions for him, and we're going to talk more about his practice as a family medicine PA and in street medicine.

So that will be on September 10th at 8pm Eastern.

That's a Thursday night if you want to sign up for that.

We are doing it donation based.

So it's a $5 donation.

If you want to, you know, buy more spots to donate more.

That is awesome.

All of the proceeds of this go straight to Sacramento Street Med as they're starting their big funding push to get official nonprofit status.

So if you go to prepaconference.com it's up on there.

The link is in the description.

And I hope that we see you there next week.

But we'll get into our talk with Toni.

I hope you enjoy this.

Sure, sure.

So my name is Tony Menacho.

I'm practicing family medicine and street medicine pa.

I went to school at the Kent School of Medicine of USC's PA program for three years.

I just graduated last year.

And then after graduating, I started a street medicine organization called Sacramento Street Medicine.

And since then, we've kind of taken off.

Now we're going to be transitioning into practicing medicine.

I do that on the side of actually practicing family medicine.

So that's my piece of doing street medicine and family medicine.

But, yeah, I absolutely love what I do.

I also mentor students.

I've mentored hundreds of students, spoken to thousands of students across California like ucla, UC Berkeley and Stanford and USC and all these different places.

And that's definitely a passion of mine.

So, yeah, I'm interested in the street medicine.

That's not.

When you first said, I was like, okay, that's not something you can do a fellowship for.

What exactly does that mean?

So street medicine is essentially caring for the homeless.

And, you know, there's different ways of actually, you know, doing this.

Most people think that you're just, you know, going to the shelters or you're going to like here with COVID we start.

They started doing this motel medicine kind of deal and you're kind of.

They're kind of putting people in the, in the motels and then, and then.

But street street medicine is different.

Street medicine is actually going to the people.

Okay, so we go.

So, you know, I have, right now we have about eight outreach teams that do about 14 to 16 visits a month.

And we go to places like under bridges along the river, you know, into encampments all over Sacramento.

And so, you know, it's one thing.

It's one thing to start a mobile clinic.

It's another thing to do, like shelter, you know, caring at shelters, but actually going to the people and meeting them where they're at, where we make the biggest difference.

And so even right now, you know, there's a lot of, like, legalities to kind of jump through.

So we're.

We're getting.

We're getting our nonprofit status.

I'm applying for to be a free and charitable clinic through HRSA to actually encampments and then connecting people to primary care.

Okay, that is really cool.

So.

And I know we're like jumping way ahead, but I just have so many questions.

So I'm assuming, like right now this is like, that's all free care that you're providing to them.

Yeah, totally.

This is all free, I think.

Yeah, I was actually doing them.

I was doing the math, like the numbers.

Yeah, I mean, I put in basically.

We put in basically almost like a full time week of work into street medicine for me, kind of bigger picture things right now with the organization kind of up, up, starting in the middle of COVID really.

But so I'm kind of like doing the paperwork stuff that nobody wants to do and getting those things rolling.

But I also do outreach on the.

Every weekend, basically one or two times a week while my teams are doing their.

Their thing.

And.

And.

But yeah, it's all free.

It's all free.

And yeah, we're gonna be a free and charitable clinic.

A free and charitable clinic.

But like, we're gonna be going to the people.

Yeah.

Free of charge.

Okay, how does that work as a pa do you have a physician who's on board with this or.

Yeah, it's a beautiful thing.

So I had the vision of actually creating the organization.

Street Medicine started back in Boston, actually, and Dr. Jim Withers and Dr. Jim O' Connell started street medicine, and they've been doing this thing for a long time.

Well, one of their proteges is Brett Feldman and Corinne Feldman.

They're like street medicine experts.

They were trained by Jim Withers and Jim O', Connell, and they're PAs and.

And they had their own street medicine.

Org in Philadelphia, actually.

Like, the specific town was called Allentown.

But they got recruited by USC to start the first street medicine team in skid row, which is like Skid row is, if you're not familiar, is like one of the most densely populated homeless populations in the country and in the world, really.

And so they started that Stream Medicine team at usc.

My brother, who's my twin brother, who actually went to PA school with me, actually did a lot of work with them, and I got to work with them a little bit when I was at usc, but through their guidance and their stewardship, I guess you would.

I was able to come here and do the thing here with Sacramento Street Medicine.

And all you need, really, is a medical director.

Okay, So I. I serve as the executive director of Sacramento Street Medicine, but my medical director, who's a total.

A total, like, badass, if I can say it.

Yeah.

MK.

MK.

Dr. MK Orsalac.

She's amazing.

And.

And we work together and we, you know, we tackle things, and it's just all good, man.

It's a.

That is so cool.

Like, yeah, that is.

And, yeah, I mean, that's amazing that you have that support and kind of guidance and mentorship.

So before you went to PA school, was this something you were already interested in or you kind of just found that passion once you got to PA school?

So, like, I've always been, like, a very, like, mercurial type of student.

Like, always, always, always, always.

Even as an undergrad before, you know, I wanted to go to medical school initially and then PA school, and then I was thinking, like, oh, maybe I do a PhD or whatever.

But, like, I knew that I wanted to do something outside of the clinic and that I wasn't.

I wasn't going to stay in the clinic.

And so.

And it's part of the thing of, like, mentoring students.

I always mentioned students on my free time and doing these things.

And so when I got into school, in a school, I think I was always.

I was always looking for that.

I was always looking for that piece to, like, fulfill what would fulfill me outside of clinic, because I knew I wasn't going to stay in clinic.

In fact, that's why I chose USC versus other schools, because I felt like the quality of my education would matter when I would want to go out into the community and make partnerships and build relationships, and they would see where you come from, and it's kind of a talking point.

And so along the journey, I came across street medicine.

My brother actually did a fellowship with Dr. Jim O' Connell in Boston.

He came back and was telling me all about it.

I got into it, and I was like, man, this is, like.

It's like, addicting.

They say it's like a drug.

They say street medicine is like a Drug because you get so addicted to being out there and helping the people and then being so grateful and.

And very little.

What's so funny is like, it's called street medicine.

But very little of it is street medicine.

Like a lot of.

Sorry.

Very little of it is actual medicine.

It's a lot of it is the psychosocial aspect of just like hearing people out, hearing people's stories and getting to collaborate and advocate.

And I mean, I can't tell you how many times I've been reached out to, just as the director of this organization in this community to support an initiative on behalf of the homeless population.

Because, like, I'm going out there and nobody else is.

There's very few people else going out there.

And it's something as simple as like a cooling station, like we were doing.

They wanted to pass these cooling stations because the heat has been so bad in Sacramento.

So they reached Sacramento because the heat was so bad.

And so they reached out to myself and asked just to.

To speak on the effects of heat exhaustion on the homeless population.

And so I wrote that up and it was the main piece of support, letter of support that they had when they brought to the assemblyman and the assembly woman that were passing this legislation.

And it passed.

And so we have like now four or five polling stations all around Sacramento.

That has nothing to do with like street medicine.

You know, like, it's just because you're advocating on behalf of these people and we're just getting started, you know.

But.

Yeah.

Wow.

Okay, well, we're gonna talk more about it, so just because I keep having more questions.

So how is this received by the populations you're working with?

Because that's something that.

And I guess you probably have a reputation at this point, but especially at the beginning, like, I know when I was in PA school, we did a free clinic in a part of town that growing up here, I didn't even know existed.

And so it was really cool to kind of get immersed in that.

But it was pretty well established.

Like they knew, like the patients knew.

Like we come once a month, you know, to provide these services.

And they were pretty well aware of kind of the motive and what we were able to provide and all of that.

So it was pretty well received by the time I got there.

But,.

You know, in.

I work in a private clinic now in Durham and we will occasionally see patients from like a similar, like low income, free clinic downtown.

And I'm in like a very suburban, small town, Georgia.

So like, not.

I'm not in a big city or anything.

Like, it's a little different, but I feel like sometimes there's a little, like, skepticism or, like, apprehensiveness.

That's probably a better word to the motive or, like, what you're there to do.

So I just didn't know if you had experienced that or.

It feels kind of, like, welcoming with open arms or how that has been.

Yeah, it's so funny you asked that, I think, like, because reputation.

Reputation is everything.

Trust is everything.

It's not really reputation.

Trust is everything.

And honestly, I think part of it is the fact that we have an amazing team that has been out in the encampments prior.

Like, for example, the medical director, M.K.

She's been doing this work for two, three years in the encampments.

And a few of our students have been doing this for a year, year and a half.

But when we started, it's really just.

There's, like, skills, right?

Like, I think there's.

There's.

There are.

Yeah, I feel like there are.

There are, like, absolutely necessary skills that you can.

That you can gain to earn the trust and build relationships within the homeless population.

It just takes time.

You know, I think there are little tidbits of information and skills that I myself may know or MK May know that our students, you know, just.

And within each encampment, there's generally.

Within each encampment, there's generally, like, a lead or a.

Like a.

Like a person that kind of runs the.

Runs in terms of just building the relationship, but interesting, but.

But, yeah, it's an ongoing.

It's an ongoing relationship.

You know, every time.

Every time you go out, you know, like, the next time you go out, you know that this guy Eddie loves to read, and he gave you a book, and, like, you bring the book that you brought.

Or, like, maybe it's as simple as, like, sitting down and, like, playing checkers with somebody.

Like, I had a guy was just, like.

He loved playing.

He loved playing checkers.

So, like, the next day we, you know, I had a team with me, so, like, I couldn't spend too much time.

And we sat down.

We sat down and talked for a bit.

But I had said, like, hey, tomorrow I'll be here at 9.

You know, let's play a checkers game.

So we sat there and we played checkers or, you know, another one.

I was like, you know, we.

We need to get him a bike, you know.

And so, like, I went the next day, you know, like, in.

Not in, like, outreach gear or anything.

Anything with me just, you know, helping him get Helping this person get a bike.

So you're able to really just like see the needs, even if they aren't medical, and try to kind of meet those.

I feel like the other piece of it is that you never go into an encampment empty handed ever.

Like, you always have, you always have nothing.

So, you know, we may not be giving medical care right now because of, like, you know, the whole legalities of practicing medicine and all that.

But, you know, our students, including myself, make sandwiches, bring water and bring hygiene kits and, you know, do first aid when it's, when it's necessary, you know, like, and then we're connecting them to their primary care, which right now, which is what we're kind of committed to in the interim.

That's, that's, that's invaluable.

That piece is invaluable.

You know, and just by doing that and knowing that you're not there to say like, hey, getting an HMP and then doing a whole soap note on them, it's more just like, like my first question is usually like, oh, hey, are you from Sacramento?

Like, what, what brought you here?

Like, how do you like it?

You know, how do you, like, if they came from somewhere else, like, where would you prefer?

Like San Jose or Sacramento or what?

Like, they have a hat on you.

It's so much deeper.

It goes so much deeper than medicine, you know, because.

But it's a skill to build a relationship, you know.

Yeah, you've definitely got to have, you know, rapport and bedside manner and all that, all that stuff.

But it's different in different populations too.

So.

Okay, so you've mentioned a couple times students.

Is this something that like pre PA students can be involved with and volunteer with?

Like,.

Yeah, totally.

We have a lot.

Pre PA students are definitely available.

Like, literally any undergrad that wants to interact with the homeless.

We generally don't call them home.

We generally call them, you know, the people experiencing homelessness.

Okay.

I want us to, you know, collaborate with the people living outside are more than welcome.

We just ask that everybody that interacts on behalf of Sacrament Street Medicine are trained.

Yeah, we, we do outreach trainings about.

We're gonna do them probably about four or five times a year.

We just hosted like two or three and, and it talks about, like, the principles that we hope people that we hope that we, you know, believe in as an organization, whether that's harm reduction and following the principles of like, radical love and, you know, different conceptual things and how you approach outreach.

But anybody can.

Right now we have a good Amount of volunteers?

Hundreds.

Hundreds of volunteers.

And, you know, we have a team, an internal team of about 40 leaders, and that.

That's a mix of med students, pa students, and undergrads as well.

So some want to go to PA school, some want to go to medical school, nursing school, dental school, you know.

Yeah, no, that's.

That is really cool.

Are there ways that people who, let's say, don't live in Sacramento could see support what you're doing, whether they have something similar in their area that's connected or, like, any other ways that they can kind of help being not physically there?

Yeah, totally, Totally, totally.

I mean, we're always taking donations.

We always take donations, whether it's.

Whether it's mass or food or clothes or like, a big thing is, like, backpacks and, like, you know, small, like, tents that have those things, like, pretty packed up, but hygiene kits as well.

We've had organizations all across the country, like, from across the country, like, contact us and say, like, hey, is there a way we can donate?

Is there a way we can do this?

Or is there a way?

So if you just reach out to us at Sac Street, Med is our gift, is our Instagram handle, or sackstreetmedmail is our email.

Generally, our team will, like, figure something out, and then they'll kind of.

We'll.

So that's one thing, like, pre.

Like, I speak a lot of pre PA clubs, and they're always looking for ways for their members to get involved and ways that they can help in, like, other places.

And so, like, I just am really big on, like, PA involved organizations.

And so this is definitely one that they could raise money for supplies or donations, because a lot of times they'll do that for, like, membership.

Like, if you bring something, you get points or whatever.

So that's cool.

We'll definitely put all of that information in the description so they can find you.

How has.

How has Covid changed what you do?

I know we all hate talking about COVID but I feel like it's probably changed kind of what y' all do a little bit, or maybe not.

But how has it changed things for.

Sachs you Med, or for Sax, you Med?

Yeah, generally.

So generally, it hasn't really changed anything.

We wear N95s and wear, you know, proper protective equipment and that, you know, all that jazz.

But my.

My take on, like, doing things in the.

In the encampments is like, if the people we serve have to go through the things that they have to go through, then we have then, and it's our mission to, to serve them, then we should be willing to, you know, go through those same hardships or challenges to be able to serve.

And so yeah, I mean, if anything, Covid, like strengthened, strengthened us.

Honestly, to be honest, I think it was even more of a calling to do, to do this work because you know, nobody, very few people are caring for the people living outside, unfortunately, and very few are advocating on behalf of them, which is like the next step.

But, but yeah, I mean Covid really in my clinic is a little different.

You know, we, and it's kind of, it's kind of the same thing just, you know, wearing more protective equipment but, and being mindful of, you know, what you're doing and how, what you're touching and those kinds of things.

But you know, in the encampments it's, it's kind of just, you know, you just wear the N95 and you go,.

All right, well okay, I want to ask.

So I feel like a lot of people listening this are going to be very inspired to, you know, maybe go to some areas that they have never been before or try to reach different populations, which is a great thing.

And I hope that they look more into what you're doing.

But do you have any advice for someone who listens to this and is like, alright, I'm going, yeah, yeah.

So what I would advise, number one is like to one, educate yourself and become trained.

So if you're talking about, you know, you're in medicine or maybe your pre package or maybe you're not in medicine and you just want to interact with the people living outside, there are a lot of awesome resources to understand how to approach it because the biggest, I think the number one thing in street medicine in general is situational awareness and safety.

You can't care for, for anybody if you can't, if you're not, if you're not safe.

Right.

And so, and there are, there are, let me tell you, there are experts far more wise and far more like experienced than myself.

But if there's anything I would say is to educate yourself.

And there are awesome resources through the Street Medicine Institute, if that's something that you're, you're interested in on how to go about outreach if that's an initiative that you want to take on, whether you're a student or an undergrad.

All it takes is the will to do it and to have the team behind you to kind of execute it.

And Street Medicine Institute does free consultation on any new startup orgs wanting to do street medicine.

But in terms of Just, you know, doing general outreach is, you know, educating yourself, making sure you stay safe, and making sure that you're always putting the person first.

You know, we have this thing where we.

And I've kind of, like, tried to institute it just based on.

Based on, like, the mentorship we've received at USC through Brett Feldman and Krin Feldman, where it's like.

Which is like your.

You know, in medicine, we're taught, like, never stand over the patient.

Right?

Like, you always want to, like, look at.

Look at the patient.

Right?

But in street medicine, it's even more than that.

It's like everybody's below the patient.

And so the concept is like, you're at the patient's feet, you know, willing to serve regardless of what.

Regardless of what, you know, your title is, whatever.

Whatever letters are at the end of your name.

Pa, marmd, do, mph.

It doesn't matter.

You know, we're all there to serve.

And whether you're doing medicine or you're just handing it, you know, giving them a sandwich, that dynamic, that power dynamic is generally.

Is already created just from you having a home and then them not having a home.

And so being in that service position, whether you're in medicine, dental, marketing, business, or whatever, is super powerful.

And so when I take people out to the encampments, I let them know, like, hey, if I see a patient that's standing up, I'll kind of, like, maybe do, like, a little kneel, you know, or.

And generally, like, my.

My team will do the same.

You know, like, that's.

That's kind of the rule.

Like, everybody.

Every.

And generally those are just like little, little tidbits.

But you.

You start to learn, like, the.

The.

The streets.

The streets kind of teach you how to interact.

Because, you know, one in Cameron may be far different than the other, right?

Because, like, one in Kevin is.

Maybe there's a lot of substance use.

Maybe there's a lot of substance use in one.

In one encampment and the other encampment, they're spread out.

You know, they want to talk more or you.

You kind of listen.

You know, you listen and you let.

You let them decide.

And the whole concept of harm reduction is like meeting people where they're at, not, you know, just because we go to an encampment and we go to somebody's, you know, tent, for example, and we want to give them a sandwich, and they.

They don't want to answer that.

They want to open or they don't want to.

They don't want to talk.

We shouldn't feel, like, offended by that because we're just dropping.

We're dropping in on their.

On their life at a specific time and expecting them to want the help that we're giving them.

That we're giving them.

But rather it's like, oh, hey, like, they're, They're.

They're not ready, or maybe they're tired or maybe they had a bad day.

Maybe, you know, like, just because we're here.

So it.

That same concept of meeting people where they're at, and it's like what we're.

What we're all about, you know?

Yeah.

That is so cool.

It's just really neat.

And I'll send everyone your way.

So I feel like the way you describe it is similar to how I've felt either in our clinic or doing medical missions.

Especially, like, I went to Kenya to do a dermatology mission, and a lot of the patients didn't speak English.

They spoke all different language on languages, honestly.

But it was, you know, a lot of.

Kind of trying to understand where they were at and just meet their needs, which weren't always dermatology needs and kind of understanding that.

And it was funny because out of our team of 12 dermatology people, I'm the only one who brought a stethoscope because I was the only one who'd ever been on a mission trip.

And I was like, there's probably gonna be a lot of things that aren't skin related.

And so.

And it was just very.

It was really, really eye opening.

But I think what I've always taken away from those trips is, like, patients are the same no matter where, like, people are the same, patients are the same.

Like, even if we don't speak the same language or have the same living conditions or anything.

Like, we have the same basic desires and needs.

And just kind of.

That's always been a great reminder because I think sometimes in clinic it can get a little.

I can get jaded with some of the stuff that I see.

And patients just very worried about things that seem very trivial.

And so that's always been a good reminder and, like, reset, I think, to be in those different situations.

Right?

Yeah, No, I totally agree.

And I think the way you put it is totally spot on.

Like, we all have basic needs.

We all have, like, the.

We're all at the very baseline.

We're all the same.

We all have the same needs.

Right.

And within the unhoused population, it very much reminded me.

I did a mission trip right after I graduated from USC to cuenca Ecuador to do a pediatric orthopedic surgery.

And the first two days were clinic and we would see a lot of people with this like, you know, like, I think we saw like, like two or 300 people in, in two days and people were driving like 24 hours buses for days just to see her see us.

And, and it was, it was sad to see like the poverty within these, within these populations and the, in the all like the care that these people were getting.

And then, so then to go into like, then that was however many miles, you know, Ecuador is away.

But you know, I, I, it takes me like maybe 15 minutes to get to this encampment that looks relative to Lisa.

All, all those things in Cuenca that were, that are however many miles away.

I, you know, I go 15 minutes down the, down the way and it's, it's relatively identical.

And so you know, one thing I always tend to tend to go to in terms of like, in terms of like a principle in medicine is, and this goes with anybody but, but even, even more so for the unhoused are people experiencing homelessness.

Is Brett Feldman, who's a virtual mentor of mine and a mentor when I was at USD would say like he's, he's this chief medicine guru.

I mean he was, he's far, far more wise than myself.

But no, his, his piece of advice is, is that everybody approaches the, the unhoused population, people living outside with, with tough love.

Right.

And he says, you know, what we fail to realize is that these people have had enough tough in their life, you know, with traumas or whether that childhood trauma or you know, trauma of abusive relationships or neglect or what have you.

And so his thought process is, you know, we always approach it with tough love and they've had enough tough.

So let's focus on the love and, and the whole concept.

I see because in the, within the chemist themselves like you can get, you can get pretty jaded from people that aren't as responsive to what we, what we do and, and what have you.

But if you always have that concept in your mind and one, one thing I always tend to, tend to ask students that rotate with me that they see like a patient that's like non compliant in clinic, you know, like oh, they weren't taking their diabetes medication.

Oh, they're not taking, you gave them the hypertension medication and they're not taking it and this and this.

And I'm gonna say okay, it's okay.

So the question we have to ask is not why aren't you the the question that I asked them is, what else could this mean?

Right?

What else could.

What else could them not taking this medication mean?

Because maybe it's, it's like severe anxiety.

The example in the ER was that there was a patient who, when I was working in the er, there was a patient who wasn't taking their diabetes medication.

And we asked, why are you taking diabetes medication?

You're getting like, hypoglycemic episodes and so on and so forth.

She says, well, you know, my daughter has been really sick, so ultimately it's, It's a matter of her medications or mine, and I'm always going to pick my daughters.

And so, like, nobody had asked her that, you know, and then we enroll her in a program that she can get the medications for cheaper, both for her and her daughter, so that they can both be, Be, be understanding and be open to all the other possibilities.

Because there is no, There is no perfect story on the streets.

There is very few.

And far in between.

There's always a story.

There's always a reason.

Yeah, I mean, I think with.

And that's something that I guess comes with experience, just understanding that nothing is ever straightforward with most any patient.

I feel like there's a lot of, A lot of things, but like, I mean, like, I mean, like us too, like anyone.

There's just a lot going on.

But.

Yeah, but you're.

I mean, your experience is so cool.

And I feel like, I don't know, I feel like PAs, and I mean, doctors to everyone, but there's just like these few, like, passionate, like, doers, like, who go out and like, do stuff and get it done, and it's so cool.

And so I hope that this is like, super inspiring to people to look in their own communities, but also think about in the future things they may want to be involved with and start and work with to kind of, you know, try to give back and connect more with people who are different than them, basically.

Oh, are you there?

Yeah, now I'm here.

I think I'm freezing now.

Uhoh.

Hold on.

Okay.

I think we, I think we're good.

Yeah.

But no, I appreciate, I appreciate the kind words and I think totally.

I, I think, I think PA in general, like, it's that, that, that, that preconception of, like, oh, well, you're not, well, you're not a doctor.

But if you, if you are a, if you are a community leader and, and you have so many, you have so many things to offer and your community, you'll get the support, you know, like, if you are, if you are going out there and doing like you said there, there are some just doers and like, if you, if you are willing and passionate enough to like, go do the work and be consistent in doing the work and you know, you document what you're doing and you show what you're doing and then you, you speak about it anywhere you go.

People want to support people that are, that are doing good.

Whether you're.

That doesn't.

Dentist or.

Did you lose me?

Yeah, you're back.

He said that doesn't matter.

It doesn't.

It doesn't matter whether you're a dentist or a doctor or a DO or a pa. Like, what I will say is like, yeah, it helps to.

Where you, where you train at times, you know, but really what people just want to see is the work and your passion, like when you speak to them.

But are you like, passionate about like what, what you're doing, you know, and do you have the, the right intention, you know, and then the rest just follows, you know, Like I had no clue what, what it took to, to run the organization a year and a half ago.

And sometimes I feel like I still don't at times, but you're just jumping in and you're doing the work and you're passionate.

Anybody that wants to listen will hear it and so on.

And honestly, that, that's, that's why I chose pa, you know, was like the ability to, the ability to.

That's why I chose pa, like was the ability, the lateral mobility to go do so many different things both in.

Have family medicine and I'm able to do my, I'm able to do my things in family medicine.

But all.

Revenue.

I mentioned students, I mean medicine and street medicine, it's, it's.

It's something that you don't get with other, other professions.

Really.

Yeah,.

But, but yeah, I mean the, the flexibility of the PA profession is something that's so like undersold that I think that is, that is the reason why any student I say like that comes to me and says they want to go to medical school.

I like, you have to look at pa, like at least look at it, you know, because you may regret it, you know, like going into.

And there's nothing wrong with being a doctor, but if everything you want to do is in medicine and in that field, then then by all means do it.

But you.

For people that are like, go getters and want to change the community and want to do these things, like, just because you're PA doesn't mean, you can't do it.

And I feel like that's a.

That's what I've, Like, I'm a living testament of.

Because, like, the first question I get is like, oh, can a PA be an executive director of a street medicine organization?

Like, yeah, we can.

And, like, if you have the.

You have the, like, support of your.

Of your people and your team and your.

And everybody's going at it together, nobody's gonna be like, oh, but he's a pa.

He's like, no, look at his passion.

Like, he's out there with us.

He's making.

Like, he works full time.

He runs two businesses on the side of.

On the side of working full time and street medicine, and he's still making sandwiches with us before we go out to go do the outreach, which he's gonna leave, you know?

Yeah.

Like, I mean, if you have the passion.

If you have the passion, the support and the impact will follow.

And it's.

It's been.

It's been an.

It's been a pleasure.

I love Gut feeling is if your passion is there, the impact will follow.

And that may.

That may, like, lead to other passions.

Like, for me, I'm going to be starting this organization to help build up other nonprofits and other businesses in organizations for the betterment of the community of Sacramento.

And that's something I'm going to start up here soon.

But, like, I mean, on top of helping.

Plus volunteers and so on and so.

Forth, so that is amazing and really cool and I've learned a lot and really enjoy this.

So I feel like I'm, like, proud to be your colleague.

So thanks for making us look good out there.