A Conversation with Circle the City
Arizona Physician sat down with Circle the City’s Chief Executive Officer, Kim Despres, PhD, and Jack Palmer, MD, Associate Medical Director of Mobile Unit. They shared with us why Circle the City’s programs and services are vital to the community and the impact physicians they employ create within the organization.
LEARNING MORE ABOUT CTC
ARIZONA PHYSICIAN: Kim, can you please share with us how Circle the City began and what services it provides for patients?
KIM DESPRES: Circle the City was founded by sister Adele O’Sullivan. She is a Catholic nun and a medical doctor. She started in Phoenix as the medical director for healthcare for the homeless, which was down at our Human Services campus. Patients would be dropped off by hospitals at the campus and Sister Adele noticed that they needed further medical care, plus a place to heal. She learned to fundraise; she began literally by collecting money in a shoebox. Many people would meet her and just donate money into the shoebox, as she’s just one of the world’s most wonderful human beings. She would then take that money and help people with medicines and other resources. The shoebox eventually became a bank account with the help of her sisters, the Sisters of Saint Joseph of Carondelet. They helped her create an advisory board, which developed into a fiduciary board and that allowed for the first Resource Center to open in 2012. That resource center was a 50 bed, respite center, which is like a mini hospital specifically for people facing homelessness and that are recovering from trauma. Since 2012, we now have two medical respite centers, each with 50 beds plus two outpatient clinics. We also have five mobile medical units, one of which is a mental health mobile medical unit and two street medicine outreach teams which use back-pack medicine. Our services include outpatient care clinics which provide integrated primary and preventive health, respite care which are centers for men and women to recover from acute illnesses and/or injuries, and mobile units that provide primary and preventative healthcare through mobile teams. Other services include a hospital health navigator program, which connects patients to support services upon being discharged from a hospital, as well as street medicine, which is direct care on the streets to people who are unsheltered.
AZP: What would you say is Circle the City’s focus?
KIM DESPRES: Our focus really reflects our mission statement which focuses on providing innovative healthcare solutions to all individuals facing homelessness. We would love to end homelessness one day. Yet we know that we just need to help one person at a time. We also want to improve access to care as we know it’s so difficult for people to get to us. Many of our patients don’t drive, or even have a bike, or can’t get on a bus. Most of the time they’re walking and moving from place to place. We just want to improve access to care because once we get them in our care and we get them engaged in our services many times that leads to some type of housing.
AZP: Kim, what is it that CTC does better than other providers that are trying to help combat homelessness?
KIM DESPRES: I really think we’re really experts. At CTC we have 260 employees that are dedicated and committed, and their main goal is to provide healthcare to those that can’t easily access care. We treat the whole person, we provide any support they need, and we address all the social determinants of health. Finally, and most importantly, we make sure they have everything they need to ultimately become housed.
AZP: Share with us how patients typically find Circle the City?
KIM DESPRES: Referrals come to us through a variety of ways. We get them from hospitals, nursing homes, rehab facilities, doctor’s offices, cancer centers, even though the people we work for, those that are unsheltered. Both our outreach team and our street medicine teams encounter people in need across the county. Our outreach teams have a schedule which is posted on our website, so that’s another way people come to us.
AZP: So, Kim can you share with us how you got to CTC?
KIM DESPRES: I am a nurse by background. I’ve been a nurse for about 40 years and worked all over the valley. My previous job was as an administrator at a large healthcare system for the last 10 years. Yet, I was still searching for something that would fill my soul. My CTC story begins interestingly when my husband bought us Chinese food one day. It had a fortune cookie, and it read, “Do something for somebody less fortunate,” which resonated with me as the next day, our previous CEO, Brandon Clark, called me. We had worked together before and shared with me that he was looking for a Program Director who was a nurse and could run one of our Respite Centers. He asked if I could reach out to any colleagues, I knew that they could be interested in the job. I asked him to tell me more. He did. I was interested and even though I hadn’t worked with the unsheltered in the past, I thought the job would be amazing. I met Sister Adele and eight years later, I can honestly say this is the best job I’ve ever had, and it will also be my last.
This job fills my soul because of people like Dr. Palmer and all our providers, nurses, and our staff. You see, when people come to work for us, they know for the most part what they’re getting into, it’s not an easy job, yet it is very fulfilling helping people in our communities. That builds an automatic camaraderie amongst all of us, building a feeling like no other.
Circle the City by the Numbers:
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Founded in 2008
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15 Physicians employed
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13 Physician assistants, 11 Nurse practitioners
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Other clincal employees
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Nurses and behavioral health consultants​
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Services and programs
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Downtown Family Health Center, Parsons Family Health Center, Midtown Medical Respite Center, Downtown Medical Respite Center, Mobile Medical Units, Street Medicine
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Number of locations/mobile units and cities
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5 Mobile Medical units (they are stationed in
multiple locations across Maricopa County and
change sites daily) -
2 Street Medicine Teams
(Central Phoenix and the East Valley), -
1 Mental
Health Street Medicine Outreach Team
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Connect with Circle the City:
​circlethecity.org or call (602) 776-0776​
KEEPING THE UNSHELTERED HEALTHY
AZP: Dr. Palmer, you’re currently the Associate Medical Director of Outreach Medicine at Circle the City. Tell us what some of the medical challenges do you see those unhoused are facing in Arizona?
DR. PALMER: Our patients face innumerable challenges medically. From social determinants of health problems, our patients experience a wide swath of issues, including access to medical care, access to transportation to get to medical care, plus things that you and I may take for granted, like transportation and medical care. In an increasingly technological healthcare system where you and I can get quick access to things like MyChart through our phones, a lot of our patients don’t have phones or even internet access to access appointment information or even lab results. Many of our patients lack transportation or easy access to get their medication at pharmacies. Of the issues surrounding being unhoused, things like safety, exposure to elements like heat & cold, access to quality healthy foods, are all challenges for our patients. These issues are eye opening, and we spend most of our time in our visits with patients overcoming barriers to care as well as trying to remove those barriers to them receiving quality medical care.
AZP: What are some of the diseases or medical conditions that you and your team see as most suffered by the unhoused population?
DR. PALMER: The hardest medical conditions we see our unhoused patients suffering from are conditions related to the elements, especially here in Arizona. Just last summer you probably saw a lot of stories about heat related illnesses. Those illnesses in our patients are predominately around things like dehydration, heat stroke, and heat exhaustion, which have led to several heat related deaths.
Other things we see are burns and infections related to bad wounds from heat exposure. Those are challenging, so we provide a lot of wound care during the summertime. We also see cold exposure issues in the wintertime as well too. It gets quite cold at night here, so we provide resources from our mobile units, which include warm clothing. Beyond those issues, our unhoused population suffers from the same issues the rest of the Arizona population faces including high blood pressure, diabetes, heart disease, and emphysema. Yet, they face a tougher time fighting certain aspects of disease because of a lack of access to quality foods, safety, shelter, and substance addiction. Substance abuse is a very big problem for a lot of our patients. Being exposed to many of our patients’ substance abuse has given me a much bigger appreciation in combatting it. It’s important to tackle it while we are helping our patients with their other problems.
AZP: How did CTC come to offer mobile medical unit healthcare to CTC patients?
DR. PALMER: We started with respite centers and clinics that are traditionally more brick & mortar. Yet, we have been very astute in recognizing that it’s challenging for our patients with social determinants of health issues to come find us. We recognize that we need to get to the patients. That’s one of our values and our motto is to meet patients where they’re at. Through different avenues of funding and fundraising, we began our first mobile outreach clinic, and we have now expanded to five mobile outreach vans. We also now have three street medicine teams using smaller vehicles for accessing patients in locations which our larger mobile units can’t reach them.
AZP: It seems like you went from being a traditional mortar and brick non-profit to incorporating mobile units to now even seeing patients wherever they may be. So, it seems you’re obviously seeing the real need for street medicine?
DR. PALMER: Yes, absolutely. Street medicine is a concept that’s been around for a while. It isn’t necessarily a novel idea at this point to what to what we’re doing. It has a major advantage is we meet patients where they’re at, as many patients struggle with so many things. Most of our patients’ primary concerns are where they are sleeping, what their next meal might be, or how they are going to stay safe. Many times, their medical needs are lower on their priority list. So, at CTC we try to be where they are and help them overcome their medical care barriers like a doctor’s visit. Another advantage of street medicine is that during these visits we perform what we call an integrated care model of care. As a physician, I work with my medical assistant and a psychologist who is a behavioral health consultant as we try to help both medical and mental health needs within our patient population. In some instances, we even bring along health navigators to help our patients with resources. There aren’t many disadvantages to street medicine, yet a major challenge is that unhoused patients are often forced to move from their current locations to multiple locations, making them difficult to find should they have chronic illnesses. That makes treating them difficult as new zoning laws or even the police can clear them of areas, we treat them at new locations we may not know they’ve been displaced to, and we lose patient contacts we worked hard to build. Waiting to see if they return isn’t necessarily a disadvantage but a challenge. As we must decide whether they will work on their way back or if we must go find them.
AZP: Dr. Palmer please share with us why you decided to continue your career at CTC?
DR. PALMER: My medical journey began in emergency medicine. My wife, who is an internal medicine physician, and I moved out here to Arizona in 2020, while COVID was peaking, to Circle the City. It has really been an incredible journey for me before and during my time at CTC. I had really felt the pull to join an organization like this one for several years. I really wanted to find a type of practice of medicine that would give me more patient continuity, more patient exposure, and a little bit more fulfillment than I was getting in the emergency room. Don’t get me wrong, I still love emergency medicine. I think as ER doctors we make a big difference in patients’ lives and do great work. But practicing emergency medicine for over 15 years, I felt a pull for different styles of practice. During my time at Valleywise Emergency Department, I had contact with health navigators and social workers, which led me to learn more about CTC and its work with the unhoused community.
So, when I saw a job opportunity present itself, I investigated it a little bit more and then I met with our current and sadly leaving CMO, Dr. Sandoval. I had a lot of trepidation about the work, being that I was an emergency medicine physician coming into a space that is predominantly primary care. But Kim and Dr. Sandoval made me feel very comfortable. They reassured me that even though I would experience a somewhat tough transition, they both thought I could handle it. They let me do some shadowing on a couple of the mobile outreach units, which is where I thought I’d be the best fit. Then I just took the leap of faith… it’s been the right type of practice environment for me.
I love our patient population. I’ve always gravitated to working with an underserved population. So, I truly get a lot of fulfillment out of both working in the ER and here. This has been the single best move I’ve ever made in my entire career as it’s been a move I made with intention. I feel that it’s the happiest I’ve ever been in 15 years of practicing medicine.
CHALLENGES AND THE FUTURE
AZP: Are the current reimbursement models working for organizations like yours?
KIM DESPRES: Well, we’re quite lucky that Arizona is a Medicaid expansion state. So, about 80% of our patients have Medicaid, that’s fabulous. We are currently able to bill Medicaid, Medicare Advantage and even some private insurance which is around another 10%. The final 10% of our patients are uninsured. Yet, we take anyone that walks in! We don’t turn away anybody. We would love to have more funding for both our uninsured and under-insured populations. We do a significant amount of fundraising and grant applying each year, probably close to $3M a year to pay for services for the final 10% of our patients.
AZP: What changes do you think you would like to see happen so that your organization can help more people?
KIM DESPRES: I think better funding or more funding for our uninsured and underinsured patients. CTC can spend $30 — $40K a month on uninsured patient medications and that’s all out of pocket. Should the government help more like during COVID, which has now gone away, we could really help all our health centers with more patients.
AZP: Kim, you’re currently the CEO of Circle City. What are some of the challenges that you see facing the organization?
KIM DESPRES: We have reimbursement challenges working for those that are unsheltered as many are uninsured or underinsured. Also, recruitment can be a challenge. I think medical providers like physicians and nurses are obviously difficult to recruit. We work with a very special population that we care for, and our team must really know what they’re getting into. Plus, I know that nurses across the country on average are aging and many will be retiring soon making it harder to recruit them.
AZP: What does the future hold for Circle the City?
KIM DESPRES: It would be great to say that one day we’ll all be shut down, but I don’t think that’s possible. We have currently received a large grant from the county to open the East Valley Medical Respite Center. We are hoping the Center will house about 100 beds. We’re also in negotiations now for some land and we’ll be being built from scratch. We hope construction can begin early in 2025. So, that’s what I think our biggest goal is right now. We have a pretty prominent presence in Central Phoenix but not in the East Valley. We hope this building will help change that. â–