Physician's assistant Ryan Smith runs Heritage Health's new school-based mobile medical clinic, a rolling clinic that primarily serves rural areas of Kootenai County. A developer of Heritage's "street medicine" program, Smith brought with him an intuitive understanding of the importance of taking health care out to the community as well as providing in-center care. He's passionate, practical and savvy beyond his years.

As a kid, what did you think you'd be doing when you grew up?

My first choice was professional ice hockey. I'd played junior hockey for many years and I still play center for a men's hockey league.

There's a long and winding road separating hockey players and physician assistants. How did you get where you are today?

When I was in school at NIC (North Idaho College), I worked as a student athletic trainer. Since my background was sports medicine, I started thinking then that maybe I'd be a physical therapist.

After NIC, I went on to finish my undergraduate studies at Colorado State. By the time I graduated from CSU, I realized I probably wouldn't be going into pro hockey or physical therapy and decided to become a physician assistant.

When Heritage hired you three years ago, what did you think you'd be doing?

Family practice was my intent and shortly after starting here, Mike Baker (Heritage CEO) said he wanted me to develop a homeless healthcare program and that was how we started our "street medicine."

We developed this program where I'd go out with our outreach team to the transitional houses, tent encampments, under the bridges and the transitional motels.

I had a great outreach worker in Patty McGruder. We started working out of my car and we stocked it with two tackle boxes. One was full of meds, one full of paperwork, a stethoscope, bandages.

We never carried controlled substances, just medications like antibiotics, blood pressure meds and diabetes meds.

What was the initial goal of the street-medicine program?

It was transitional primary care. We helped give them access to care - seeing me out there and developing that needed relationship between patient and provider. My street name, my nickname, was "Doc Ryan."

Two or three days a week we'd travel and do all the homeless shelters and street medicine - Fresh Start and St. Vincent de Paul - and the other days we were back at the office.

Did homeless people then come in to Heritage itself for treatment after first seeing you on the street?

Absolutely. They walked here, rode the bus, bicycled and found rides. Once that trust was developed and they could see I was the guy that was actually going to them, they realized I could be a peer. They realized we could give them hope and reassurance.

What kinds of things did you do out there as a street healer?

A little of everything. Sometimes it was coughs and colds, sometimes depression and anxiety and sometimes companion animal letters. In the homeless population, companion dogs are sometimes used as protection in addition to companionship. That letter could help a lot of people when they got housing or when they wanted to take the bus.

And then there were people with problems like pneumonia or COPD (chronic obstructive pulmonary disease).

To switch over from the acknowledged violence of pro hockey to the more compassionate world of community healthcare, what kind of emotional adjustment did you make?

I think it's always been there for me - that compassion. I'm a helper at heart. It never really mattered whether people had money, I knew they needed someone to trust.

I definitely had some sad days where there weren't things I could provide them. Say I got them medication for depression - maybe I gave them Zoloft - is their supply going to stop abruptly because I couldn't get more for them?

I'm there to play a piece in all these peoples' lives. I want to give them that hope and reassurance that things are going to be OK, that they're not alone.

When did your car-as-clinic get replaced by the Coeur d'Alene Rotary bus?

During the homeless program, I was seeing patients in places like on street corners, inside a closet at Fresh Start and behind my car. There was no privacy for them.

In 2012 Heritage made a presentation to Cd'A Rotary and got a $15,000 grant from them which we used to buy a motor home which became our 34-foot homeless mobile medical clinic.

When did you decide to swap driver's seats from the 34-foot homeless bus to Heritage's 37-foot brand new school-based mobile medical clinic?

When Mike Baker got a federal grant for the new clinic this year - it's the first of its kind in Idaho - I went to him and said I'd like to be the guy to develop that program.

We'll be going to Rathdrum, Twin Lakes, Spirit Lake and Athol with it and the goal is to give people better access to care - to be at all 11 schools at least once a month, depending on the needs at certain schools.

I'm excited about this. We'll be able to make appointments for acute and preventative care, sick kids, faculty wellness physicals - it's family practice. We're not the school nurse. We're a separate medical facility that just happens to be parked at local schools.

How did you feel when you were no longer "Doc Ryan" for the homeless community? Do you still worry about your patients there?

I miss the homeless - I already do. I developed relationships with these people as well as having developed a program.

I'm currently co-medical director for Fresh Start and I'll definitely always be around in the community. The school-based health center is a big deal for me - a big transition - and I really had to consider before doing this.

Are you surprised where you are now?

When you're young, you have this thought of who you're going to be when you're older and things never turn out how you think they will.

I never imagined being in charge of a school-based mobile medical clinic back in the same school district - Lakeland - that I had graduated from years before.

Any dreams for the future?

I just want to keep on being a provider who's, hopefully, someone people can look up to and be a role model for. I want to do something for the kids.

On a personal level, I'd love to eventually have two or three kids of my own.

Back when I was in school, there was this question whether medicine was an art or a science. At the time, I tried to play both ends, but I really believed it was mostly a science. As I worked for Heritage, I realized it wasn't always about the science, it was about how you treated people.