Hear from nurse practitioner and patient advocate Marla Bass as she gets JobShadowed.  

What do you do for a living?

I am a family nurse practitioner presently establishing a practice as an independent patient advocate.

How would you describe what you do?

The field of patient advocacy is still quite new and open to interpretation. As a doctorate-prepared nurse practitioner, my specialty is medical advocacy. In other words, I help individuals and families understand and optimize their health care and their medical conditions. If they have a new diagnosis, I might help them research what it means, what their treatment options are, and who will help them achieve the best outcomes.

If someone is anticipating a surgery or a hospitalization, I will get them up-to-speed on what it will entail, how to prepare, I will help them remain safe while in the hospital by being personally on-site at times, and I will make sure their discharge is smooth and error-free.

These are just a couple of examples! It entirely depends upon the individual’s health situation and what they and their family need. It can be as short as a one-time chart review and consultation, or as complex as helping someone travel out-of-state to see a particular specialist or surgical team. Some people like to be accompanied to physician visits, so they don’t have to worry about asking the “right” questions or be concerned about forgetting to mention something pertinent. They also don’t have to be worried about not understanding instructions or catching everything the physician is saying during that 10- or 15-minute visit, because I am responsible for that, as well. And then I can relay everything to family and friends afterwards, if the individual wishes.

What does your work entail?

It is a combination of bringing my skills as an experienced health care provider and researcher, mixing in the abilities of a diplomatic communicator, while being able to act as a good friend/daughter/sister who will go to bat for you and who can be your personal pit-bull in the medical arena if it comes to that. And it does, at times.

What’s a typical work week like?

Generally, I might be meeting with new clients, giving a presentation on a topic such as how to advocate for one’s self or on how cancer survivors can develop a survivorship care plan, and of course, working with existing clients.

How did you get started?

It was a lovely April day and I was thinking about clients I sometimes saw in an internal medicine practice for whom the 15-minute office visit just wasn’t serving them well. Either their questions weren’t answered fully, or I wasn’t convinced they understood what was going on with them, or their medicines or therapies weren’t working for some reason. There were pieces of the puzzle missing, and I wanted to know why and to fit the puzzle together properly for them.

What do you like about what you do?

I love giving people confidence in health care and empowering them to take more control of the health care system when possible. It’s all about getting rid of that deer-in-the-headlights look they have when they enter a clinic office or a hospital. What do you dislike? I loath anyone or anything that intimidates or frightens health care consumers.

How do you make money/or how are you compensated?

Some day we will have the research that will demonstrate that using a patient advocate saves everyone money. But until then our services are entirely private-pay, which is to say out-of-pocket.

How much money do Patient Advocates make?

I’ve seen a figure that says the range nationally is $75-250 a hour. I have seen more companies charging in the $100-200 an hour range.

How much money did/do you make starting out as a Patient Advocate?

$100-150 an hour, depending upon whether there was going to be an ongoing need of the client, or if it was a more time-limited commitment. Note that this was affected by being in a part of the country (Minnesota/western Wisconsin) that had absolutely never heard of this area of expertise, so the learning curve for the public was steep.

What education, schooling, or skills are needed to become a patient advocate?

There are folks with backgrounds in nursing, medicine, and social work doing this. I’m sure there are those with other backgrounds, as well, but I would want to see a minimum of some kind of university-level preparation in a health care profession. The social workers might specialize in helping clients with insurance issues or residential options, whereas I specialize in medical advocacy because I am a primary care provider to this day. (I will always maintain a clinical practice on the side both because I love it and to maintain my board certification as a family nurse practitioner.)

I wouldn’t want to depend on a social worker or former music therapist-turned-patient-advocate for the knowledge of pharmacology or physiology that my background gives me. But they could probably rattle off the top five chemical dependency clinics in an area off the tops of their heads, while I’d have to spend more time researching something like that, for example.

What is most challenging about what you do?

Keeping abreast of medical research and cutting-edge therapies.

What is most rewarding?

Knowing that I helped someone achieve peace of mind and/or more physical comfort and well-being.

What advice would you offer someone considering this career?

Have a solid grounding in some area of medicine, even if it’s something like medical case management, otherwise you’ll be the one with the deer-in-the-headlights look when trying to mediate between the orthopedic surgeon, the oncologist, your client who is also a corporate vice-president, and the client’s son who is a patent attorney, for example.

How much time off do you get/take?

I am still relatively early in the establishment of my practice, so patient advocacy is not yet taking 40 hours a week, over and above my clinical practice time. But I am a big believer in maintaining good quality of life, so I anticipate making sure I ultimately have adequate time off.

What is a common misconception people have about what you do?

That I’m doing the same thing as the hospital case managers, but I want to charge more for it and not be reimbursed by insurance. Also, physicians tend to think that patient advocates are trying to harm them. Quite the opposite is true, because I can extend their influence beyond the exam room, by making sure their rationale and their instructions are understood by the patient and followed appropriately.

What are your goals/dreams for the future?

To have people know we’re out there and how we can help them. That’s a good start.