Michael Hole’s idea for a social service mashup seemed especially unlikely: What if his low-income clients could get tax and financial services while waiting for an appointment with their child’s doctor?
But Hole, MD/MBA ’14, saw the logic immediately. “Doctors ask people sensitive questions all the time, about mental health, about sex, about alcohol,” says the Indiana native. “We should be asking them about how much money they make, too, because we know it matters to people’s health.”
Income is inextricably linked to whether his patients have access to healthy food and shelter, as well as the safety of the neighborhoods they live in. Says Hole: “Those are the social drivers of health, and I am building organizations to address those root problems.”
Hole has been called a “street pediatrician.” In one of his many roles at the University of Texas at Austin, he see patients onboard Children’s Health Express, a mobile medical clinic that serves families experiencing homelessness, in addition to teaching graduate courses on U.S. public policy, human-centered design, and civic entrepreneurship. With his students, he started Good Apple, a grocery delivery company that helps people suffering from food insecurity. Amid the COVID-19 pandemic, he launched Main Street Relief, a nationwide volunteer corps that helps small businesses survive and move forward from economic crises.
Another of his initiatives is StreetCred, which partners with the IRS and other community agencies to help families file taxes, maximize tax refunds, set up savings accounts, set financial goals, and build budgets, credit, and wealth — all during their visit to the pediatrician. His role with StreetCred landed him on Forbes magazine’s “30 Under 30” list, and the four-year-old organization has returned more than $8.5 million to more than 4,000 low-income families. Hole says the work feels especially important since the birth of his first child, Evelyn, in April.
How does one become a “street pediatrician?”
People’s zip code affects their health more than their genetic code does. In the clinic or hospital, I wasn’t always able to see the full picture of what was affecting my patients’ health — whether there was a grocery or pharmacy near their home, whether their neighborhood had clean air. Too often, my patients’ families had a hard time getting to the clinic or other social services because they lacked transportation. So as a “street doctor,” my team and I care for people where they live. We take our services to them, rather than assuming it’s easy for them to get to us. If you want to solve a problem, get as close as you can to the people facing that problem and build the solution alongside them.
So how do you get closer to people?
We travel to homeless shelters, food pantries, schools, and other places looking for the children and teens who are highest risk and hardest to reach. When you see a family of five living in a motel room with a single bed, and they’ve got their canned food stacked in the corner, and their refrigerator is two-by-two-foot … you can send them to the food pantry to get fresh produce, but where are they gonna store it? Where are they gonna cook it if they don’t have an oven or a stovetop? It frames the problems a bit more. It allows you to develop deeper understanding and more empathy and to co-build smarter, more elegant solutions together with clients.
Tell us about the moment when you first connected the ideas of pediatrics and financial services?
In 2015, a single mom came into my clinic with a newborn and a toddler and asked me if I knew of a place she could get her taxes done. The backdrop to all of this is that I’d done an internship at the federal affairs department of the American Academy of Pediatrics, where I was tasked to look at the various anti-poverty government programs to figure out which ones had the biggest bang for the buck on child poverty rates — and therefore on child health. What kept coming to the top was the earned income tax credit. So I understood that tax refunds matter to people’s health, and to children’s health in particular.
So when this single mom asked you about it…
I referred her to a free tax-prep site in Boston. She took two buses and a train across town, with her newborn and her toddler, only to find that it was closed because the hours listed on its website were out of date. This tenacious mom went back the next week, but didn’t have the right paperwork with her. She came back to my office the following week for her newborn’s two-week-old visit, and waited on me for 30 minutes. She said, “Wouldn’t it be nice if we could just do my taxes while I’m here?” That question sparked the idea for StreetCred.
How has StreetCred grown and evolved since you piloted the program in 2016?
We were at nine sites in five states last tax season. When COVID-19 struck, we adjusted and moved to mostly virtual services. But we already knew the franchise model wasn’t getting us to the volume of folks we hoped to serve as quickly as we wanted, so we created an open-source toolkit and built a coalition of medical and financial services organizations across the U.S. that work together to share best practices as they try to integrate financial services into health systems. That coalition is now 38 organizations in 23 states and Washington, D.C. With virtual services available now, I am interested to see how this might allow us to grow more quickly and reach America’s rural communities, like where I grew up.
What’s the biggest factor that convinces patients to seek financial advice in medical offices, clinics, and hospitals?
Trust. A pediatrician’s office is a trusted, frequented place. When you have kids, you’re going back and forth regularly, so we have these very regular touch points. And you have your doctor telling you that money matters to health and that poverty makes you sick. We can write a prescription for financial coaching, tax refunds, or a savings account just like any other prescription, because we know they make people healthier.
Your basic assumption is that financial help and services are available but underused.
That’s right. About one in every five families eligible for the earned income tax credit is not taking advantage of it every year. That’s because taxes can be confusing and intimidating, or maybe because an untrained family friend who does their taxes misses a piece of information they need to claim a refund. Also, many for-profit tax-prep companies charge hundreds of dollars for tax prep and skim money off the top of people’s refunds. They also make errors, causing delays in refunds or worse. There’s a whole host of reasons why people are not getting the money they’re depending on to make ends meet.
Your LinkedIn profile photo shows an exultant little kid in flying goggles and cardboard wings. Explain.
Children dream big, and they’re optimistic. I think we could all learn from that, especially nowadays. And it’s important, especially as an entrepreneur, to learn like a child — diving in full of curiosity, trying new things, stumbling, and learning fast from mistakes. My life’s work is aimed at making children’s lives better. I’m a pediatrician, a professor, and an entrepreneur because I believe that every kid, if you give them the support they need to grow up healthy and get a good education, can reach their potential, especially in the United States. Zip code and your parents’ income and the kind of house you live in should not determine what you can achieve in your life.
You’ve helped launch other programs. One delivers healthy food to low-income families. Another helps small business owners affected by the pandemic navigate federal aid and generate new revenue. You’re advising a group of students connecting seniors with teenagers through an online platform to combat loneliness. And you’re launching a scholarship fund for babies born into poverty. Are you ever intimidated by the scope of those problems?
I’m aware these are huge, huge issues. Everything my teams and I create is with an eye toward scaling up. But I’m driven by one of the lessons from Stanford GSB, or I should say from Nike: Just do it. Build coalitions, believe in underdogs, and stay in the arena. If you make one person’s life better, that’s wonderful. And if you’re able to expand impact to 100 lives, that’s even better. And if it’s a model that can be scaled across the country, like StreetCred or Main Street Relief, then gosh, what a privilege to serve even more people in need. We’re all in this together.
Where does this impulse to help come from?
When I was very young, my father was a police officer dedicated to protecting my home state, and my mom was a volunteer caretaker for the elderly and dying. I learned that service to community was really important, that a meaningful life includes service to others. I remember watching my mom sit for several hours combing the hair of an old woman in our neighborhood, holding her hand, feeding her, humming songs to her. I was so proud of my mom, so fulfilled, because of the difference she made in that one person’s life. I wanted to bring my dad’s sense of duty and my mom’s compassion for the sick and vulnerable to my work.
Are there any particular experiences, professors, or books from your time at Stanford GSB that you found especially helpful?
So many, especially the touchy-feely stuff. One of the big lessons in the Interpersonal Dynamics course was embracing vulnerability, which is important to building trust and rapport with my patients, my students, and my startups’ clients and customers. Heck, it’s important to my marriage and closest friendships. I also took a course called Managing Difficult Conversations, and a lot of them were medically focused. How do you tell parents about their child’s terminal diagnosis, for example? For me, I’ve been part of those conversations many times. It’s amazing how some of those lessons translate — how my education there has percolated into both personal and professional life, both in medicine and in business.
You and your wife recently had your first child. How has that affected the way you approach your work?
It makes every interaction with a patient or a client a bit more real. I can see Evelyn in the face of a little boy who is experiencing homelessness, or hunger, or has had a really bad diagnosis. That tugs at the heartstrings even more than it used to. Before Evelyn, I thought I was a compassionate doctor and fired up to change the world, and now I have to change that world, because it’s the one she’s going to be living in. It makes everything more important, more urgent, than it used to be, and it makes me a better doctor, a better teacher, a better entrepreneur, and a better leader.