An elderly person who doesn't know his name is abandoned in an emergency room. A cancer patient can't work and is behind in his rent. A teenager has just given birth and has nowhere to live.

For medical social workers, dealing with such crises is an average day's work. While clinicians treat patients' physical health, medical social workers -- also called healthcare social workers -- address the often-overwhelming array of psychological and social issues related to illness.

"The situations medical social workers deal with are as different as the patients themselves," says Nancy Campbell, MSW, LISW, a director of social work at a large university-affiliated medical center in Ohio. "No two days are ever the same."

Medical social workers are hired by acute-care hospitals, long-term-care facilities, hospices and home-care providers, says Karyn Walsh, ACSW, LCSW, a senior policy associate for bereavement and end-of-life care at the National Association of Social Workers. The demand for medical social workers in all these settings will remain strong as the population ages, families remain geographically distant and people live longer with chronic illnesses, such as diabetes and heart disease, Walsh says.

Support Structure

Depending on the complexity of a patient's needs, a medical social worker could spend a few minutes on his case -- or a few weeks or months, Campbell says. For example, a medical social worker could quickly arrange a cancer patient's transportation to and from chemotherapy, only to discover that the patient is having a hard time coping with his illness. At that point, the social worker would find support services for the patient, Campbell says.

"It's always hardest working with the folks who are really alone in the world and don't have support systems in place," Walsh says.

Walsh began her medical social work career in discharge planning at an acute-care facility and then spent eight years helping to manage the illnesses of patients at a children's hospital that specialized in cancer and bleeding disorders. "It was an intense, emotional job," Walsh says. "I witnessed a lot of suffering and dying and death, but also a lot of successes." Good outcomes, whether that meant seeing a patient going into remission or dying at peace with minimal suffering, were all the rewards Walsh needed to keep from burning out.

Doctor-Patient Go-Between

Compassion, sensitivity and the ability to respond well under pressure are prerequisites for a career in medical social work, Walsh says. In addition, medical social workers must be flexible and creative in their approaches to solving problems. "You've got to be able to go with the flow," she explains. "Healthcare environments are very intense and fast-paced."

Medical social workers also need to be able to speak the language of their healthcare colleagues and their clients, Campbell says. "You need some knowledge of medical terminology, [because] doctors use a lot of abbreviations and medical terms," she says. "You will oftentimes be the go-between between the physician and the patient, so you need to make things understandable in lay terms." To improve her medical fluency, Campbell took some medical terminology courses early in her career.

Options for Specialization

Campbell and Walsh encourage those considering careers in medical social work to shadow someone in the field or volunteer in a hospital or hospice to gauge their comfort level working in such intense environments. Some healthcare facilities hire and train social workers with bachelor's degrees, but most prefer applicants with a master's in social work (MSW), Walsh says. Most MSW programs have healthcare tracks that include internships -- called field placements -- in healthcare settings.

Social work itself can lead in many directions, Campbell notes; however, even within the narrower field of medical social work, social workers can, through continuing education, specialize in areas such as oncology, mental health, substance abuse and acute intervention.

"Some medical social workers love a particular area and don't want to do anything else," Campbell says. "But many work in different areas throughout their careers, and that's exciting."