Fueled by the managed-care backlash and increased emphasis on patients' rights, the patient advocacy profession is emerging as a hot career.

Working in settings like hospitals, nursing homes, government agencies and foundations, patient advocates skillfully and compassionately guide patients and their families through the healthcare maze. They attempt to see situations through a patient's eyes and to use their influence for the good of the patient.

"Patient advocates are willing to stand up for the patient and make the wheels squeak," says Marsha Hurst, former director of the health advocacy master's program at Sarah Lawrence College in Bronxville, New York. Because the healthcare system is becoming increasingly complex and patients must be more proactive about their health, the field will grow, she predicts.

Help in the Hospital

More than two-thirds of US hospitals have patient relations departments, and the majority of patient advocates work in those settings. The duties of hospital-based patient advocates range from the heart-wrenching to the mundane. For example, patient advocates support families struggling to make end-of-life decisions, explain complicated billing procedures to frustrated former patients, track down lost belongings, and respond to complaints about hospital food, among many other tasks.

"Our job is to keep abreast of patients' rights, to answer patients' questions and resolve concerns, and hopefully to make changes within our facilities as they are needed," says Jean Fankhanel, patient relations manager at Loma Linda University Medical Center in California and a member of the Society of Healthcare Consumer Advocacy. "We look at our work as a ministry," she adds. "People share intimate details of their lives with us, and I look on that as quite an honor."

Fankhanel and other hospital-based patient advocates often must balance the interests of patients with the interests of the facilities that employ them. "I refer to it as sitting on a fence," she says. "We have to be able to see both sides. We try to get to the truth behind all questions or concerns, but it doesn't mean we'll always be able to find the answer the patient wants."

Emerging Opportunities

Outside the hospital, opportunities for patient advocates are blossoming, Hurst says. Graduates of the health advocacy master's program at Sarah Lawrence are now promoting patients' rights in various settings. Sara Collins, who graduated from the program in 1997, is among several alumni who work for disease-specific advocacy organizations. As the manager of federal governmental relations for the National Multiple Sclerosis Society, she educates members of Congress about the issues important to people with MS, and keeps the society's members in the loop about what's happening on Capitol Hill.

The mixture of patient advocacy and public policy makes for a challenging and fulfilling career. "It's rewarding helping people with MS access the care they need and seeing how public policy helps them," Collins says.

Other patient advocates help people lodge complaints against insurance companies or providers, monitor compliance for government agencies, and work for health-related Web sites. A few patient advocates are paid out-of-pocket by patients and families who can afford the services. According to Hurst, such "private health advocacy" is in its infancy.

How to Become a Patient Advocate

Anyone who is passionate about patients' rights can get involved in patient advocacy. However, to land a full-time professional position -- making a starting salary of anywhere from $30,000 to $55,000 -- it's usually necessary to have a background in healthcare.

Health workers with experience in nursing, medical records, admitting and the business office often transition into patient-advocacy positions at healthcare facilities, says Fankhanel. Most patient advocates have an undergraduate degree, she says. Working as a patient advocate is easier if you're familiar with medical terminology and hospital culture, she adds.

Students in the health advocacy master's program at Sarah Lawrence come from all walks of life. Many have backgrounds in community service or experience in healthcare. Some had intense personal or family healthcare experiences that made them realize patients need help navigating the system, says Hurst. Sarah Lawrence offers the nation's only master's degree in health advocacy. The program includes coursework on understanding illness from the patient's perspective, empathizing with patients and families, and bioethics, Hurst says.