Here are samples of some inquiries I have received from people wanting to be advocates. See if you can guess what they all have in common:
I want to help Medicaid patients find doctors who will take their insurance.
We plan to help children with mental health issues find the help they need.
I want to help young girls who find themselves pregnant find the social services they need to get them through their pregnancies.
I want to work with churches and senior centers to help their members and attendees understand their medical care.
I want to help lymphoma patients with shared decision-making about their treatment.
I want to help children in _____ County who have neurological disorders. (The county named is in a poor, rural part of a southern state.)
One thing they have in common is that everyone of them has a noble and worthwhile mission. They have developed missions that come from each inquirer’s heart. There is no doubt there will be people who need them and who they can help.
But that one thing they have in common is also the one thing that will cause them to fail in private practice, too.
How so?
They will fail in private practice because there will not be enough paying business to keep them afloat.
To be clear – if they want to do these things as volunteers, on their own time, at their own expense, some may be very successful! Certainly those folks they hope to help can use their help. For those of us with money trees in our backyards (or sufficient savings) to allow us to be advocates without the need for income from the work we do will find plenty of people who can use their help.
But in order to be in business – a real business that provides you with an income – you need to provide services that people will pay you to do, and pay you enough to cover all your expenses plus income for you, too.
If you don’t perform services with a clear-cut, willing and able payer, then you will not succeed in private practice. Period.
I try to be politely honest when people approach me with these ideas. I want them to know I admire their noble causes, and I hope there is a way for them to perform these services. But I also ask them who they expect will pay them to perform those services. Without someone to pay them, they can’t – or at least shouldn’t – try to start a business.
Often they will reply to me with a hoped-for response. For example, when children need help, they often believe parents will pay for the services. And that’s true – they might! But are there enough of them who can afford to pay? This takes a little bit of market research. In the case of the children with neurologic disorders, I asked, are there enough children with neurologic conditions in your rural area to begin with, and of those children, are there enough families who can afford to, and are willing to pay you? In both cases, the answer was no.
Sometimes the question that needs to be asked is whether the would-be advocate has the chops for being hired to start with. Will the person who needs them see that the advocate can bring enough value to be worth paying for? Helping lymphoma patients, or helping with shared decision-making both require direct experience with the actual service. Someone who has weathered lymphoma (or has been a caregiver for someone with lymphoma) might be off to a good start, but will have to prove him/herself. Shared Decision Making definitely requires some sort of clinical/medical/scientific background to be able to help patients truly understand their options.
Sometimes people with these wonderfully generous and noble ideas think there is someone else who will pay them to advocate for those who can’t afford to pay. In most cases, that just isn’t possible or true. For previously explained reasons, insurers won’t (and shouldn’t) pay for these services. The government has no vehicle to pay for these services. Maybe churches or synagogues? Even employers? Those might be possible options, but all that must be closely researched before the first business card is printed.
The bottom line here is that the one thing that will cause your private practice to fail will be the lack of people who can or will pay you to do your work for them. There may not be enough people who need your services, or there may be plenty of people who need them, but can’t or won’t pay you for them.
Without willing and able clients, you cannot succeed without that money tree, trust fund or sufficient savings to keep you afloat.
A reality check – never pleasant, but definitely important. Before you go into private business as an advocate, be sure you have enough able and willing-to-pay clients to make it worth your efforts.
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