This is a question – or a statement – I hear frequently from those who wish to be independent health or patient advocates who are considering which business formation they need to set up to be independent.*
After considerations of LLCs, or S-Corps or others, they tell me they want to establish a non-profit, then ask me if we offer resources to help them.
Fay is one such advocate wannabe. She asked, “Do you have any advice for establishing a non-profit or not-for-profit agency to help patients?”
Unfortunately, her question was being asked for the wrong reasons.
Why?
When asked why they think a non-profit is the right answer for them, I hear a handful of replies:
- “So many people need help but can’t afford to pay for help. Establishing a non-profit would mean I don’t have to charge them.” (A fair statement – and a solid answer, but requires a follow-up – see below.)
- “I have only ever done advocacy as a volunteer, so I want to keep doing it that way.” (Also a fair statement, but not helpful to this advocate – see below.)
- Fay’s reply to me was the one I hear most often: “I hate asking for money, so if I set up a non-profit, I won’t have to.” (A fair assessment of ask-for-money fears, but a ridiculous overall statement about business formation.)
The point being… almost every advocate-wannabe who asks about setting up a not-for-profit organization believes that will mean she can deliver advocacy services at no cost to the patient. She may also believe, then, that she can continue doing advocacy work as a volunteer – because she will still get paid by the non-profit organization.
The problem is, those who think a non-profit is the cure to the “asking for money” aspects of business, haven’t yet thought of this question: Where will the non-profit organization get ITS money? The leap not made is that a non-profit is just as much a business as a profit-making business is.
Both require business skills; both require asking for money.
Here’s Where Fay Went Wrong
To begin with, there is no “business” in volunteerism for advocates. So far as I know, there is no existing non-profit that is raising funds in order to pay advocates except in some very localized situations. (For example: some churches pay nurses and advocates to help parishioners.)
Secondly, developing a successful non-profit requires similar business skills to those needed in profit-making businesses. The only real difference is how the financial records are budgeted and kept. In many ways, running a non-profit is more difficult than running a for-profit company because of the way record-keeping must be done.
Non-profits have to ask for money just as much (or maybe more so) than profit-making ventures do. The difference is, they don’t ask for money directly from a client. Instead, they must ask for donations to help someone else who they (probably) don’t know. Further, for start-ups, they must ask donors to support an advocate who has no proven track record for running any sort of business yet… so, in effect, they are being asked to take a leap of faith that the advocate can do the work, probably for someone they don’t know, while having few or no business skills. That is far more difficult than asking a patient or caregiver to pay for services directly.
Fay represents the wishes of many of you: You love to advocate. You don’t understand business. You hate asking for money. You just want to get paid for the work you love to do.
I get that! Believe me, I do. I too am passionate about my business and hate to ask for money! If I could give away all my books (instead of selling them to you), or provide free memberships to APHA, or could afford to teach workshops all over the country and not charge you a dime, maybe we would all be happier…
Or would we?
Because – that’s the other side of this. If your desire is just to advocate, but not deal with business… if your desire is just to volunteer and not to charge for your services… if your desire is to simply give away your services…
Then do NOT expect to get the satisfaction from professional advocacy you think you will get.
If you do find satisfaction – then great! And from time to time, that might happen.
But first – unless you can go on indefinitely with no income, then volunteering will not be sustainable.
Even more so, expecting people will be satisfied with your service, and appreciate you because you have given away your expertise, efforts, and farm of knowledge will usually result in the opposite. With no skin in the game (meaning, there is no time or money investment on their part), human beings tend to have unfair and unrealistic expectations. They tend not to appreciate, they tend not to use their own efforts to improve, and sometimes they will even argue, whine, and become insistent (even belligerent!)
That doesn’t help anyone – not you OR the patients who need you.
I do understand that starting a business is hard. (You know what “they” say: If it was easy everyone would do it!) That’s why APHA and its family of support activities does everything it can to help you.
But establishing a non-profit doesn’t make it any easier.
If you want REAL satisfaction – then make the effort, start your business, learn the skills you need (like asking for money) and reap the rewards of happy, healthier clients, and the income you deserve.
Read more:
- 8 Ways Your Practice May Be Like the Giving Tree
- When Passion and Reality Collide
- Try These Baby Steps: Learning to Ask for Money
*Those advocates who have accomplished several successful years of practice may decide to build a non-profit arm of their companies – a foundation, or some fundraising vehicle to support their work with patients / caregivers who can’t directly afford their help. With business skills firmly established, and with their for-profit companies supporting their work, they may well succeed.
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Good post Trisha! ….as we all know nothing is free. I do hope that some advocates explore the non-profit route as that would open up the area to those who are financially stressed.
But I agree, non-profit does not take away the need for financing. Fundraising is a challenge that takes expertise, a solid plan and the ability to show a return on investment and for investment, someone will make in your company.
I agree, Anne. I would love to see non-profits who can help patients who can’t afford advocates, but certainly need access. But we need to walk before we run – thus we don’t want people starting something like a non-profit without truly understanding what they are doing.
Miss Trisha,
Your insights are so poignant and true. One of the many superb points you made that resonates with me is how the nature of a person who loves being a patient advocate conflicts with the necessary behavior of honoring one’s own time and expertise enough to charge what it is worth. I didn’t realize that others battled that like I do. Now I understand more fully why APHA wants to help patient advocates who work for hire. I’m glad I read this post before I did any professional advocacy. It is hard to backtrack when you start off with incorrect habits.
Trish, you have it exactly right. I started by feeling guilty because these people were dirt poor and nobody else would help them. If I asked them to make calls or gather records they rarely could for a number of reasons. I told them right from the start that I would be the brains but it was for free so they needed to be taking responsibility for gathering. Once I began requiring a retainer after explaining what I could do to help them, and a flat fee. People really can come up with money for things they deem valuable. My fee has increased as my experience has grown. It’s rewarding to use my expertise to help. My knowledge and experience is valuable.