Donna Smith was only four years old when she had a life-saving surgery to repair a complex congenital heart defect—and her parents’ health insurance saved them from any resulting financial hardships. She adds, “The health care system provided more answers than questions and helped guide my parents from diagnosis to recovery. The year was 1960. A lot has changed since then.”

Fast-forward to her professional career.

For 30 years, Donna had managed health insurance plans for employees of small and large employers. During that time, she saw the negative impact that plan cost increases and complexities had on the people the plans were supposed to help. So she tirelessly worked to correct their health care bills or get them proper insurance benefits.

These experiences—coupled with navigating the current health care system for her aging parents—opened Donna’s eyes to the possibility of an advocacy career. She had often wondered, “What happens to people who don’t have someone like me to help them fully understand their needs?”

Once Donna began to pursue a career in health advocacy, she wasn’t alone: Her husband, Wade, who had gone to law school and had worked in various aspects of the health care industry, also registered for our Health Advocacy program. Donna and Wade completed the program in April 2016 and October 2016, respectively, and they have since opened Capitol Healthcare Advocates in Roseville, Calif., where they live.

Curious about her switch to this burgeoning field, I asked her a few questions about this career change.

From the early influence with your own health issue to your work in human resources and insurance plans, it sounds like becoming a health care advocate was a natural career progression for you. But was starting your own business ever a career goal?

It was not until the last 10 or so years of my HR career that I began to consider starting my own business. I wanted to see if I could use the skills and knowledge obtained in corporate America to directly improve people's lives. Plus, I wanted to help and be part of my community through my work.

Why come to Extension when you live so close to Sacramento? 

Even though my home is in Roseville, on weekdays I was living in the Bay Area working for Kaiser Permanente in Oakland. And during that time, I was also trying to find a field of work that would help me achieve the goals I mentioned earlier. Because I had taken a couple of UC Berkeley Extension’s nonfiction writing courses before, I read through the catalog looking for a possible career choice. That’s when I came upon the Health Advocacy program. This seemed to be a perfect combination of my lifelong fascination with and admiration for the health care industry and my professional experience. My husband, however, did make the weekly drive from Roseville. He was simply committed to achieving this goal with me.

Your husband also has a career arc that seems to naturally lead to health advocacy. Did our program play a role in your decision to combine both of your talents and personal interests in the field? 

Yes, definitely. Initially, I was concerned a successful health advocacy business required a clinical background. However, when I spoke with instructor Joanna Smith about this during Introduction to Health Care Advocacy, she assured me that the field was diverse enough to encompass nonclinical specialties. With Joanna’s guidance and support, Wade and I realized we could combine what had really been our independent career tracks to create our business.

It sounds like Joanna Smith was a big influence. Were there other instructors who gave you this type of support?

My husband and I agree that Joanna and her introductory course had the biggest impact on what we do now. She and that course set the tone for the entire program. Joanna continues to be a valuable resource and professional colleague. 

Second only to Joanna's class was Ethical and Legal Issues in Health Care with Jim McCabe.  This class was so informative and engaging; I didn't want it to end.

Finally, never choosing the easy path, we selected Marketing Strategies for Entrepreneurs and Small Business Owners, taught by Kathryn Gorges, as our elective. This course was invaluable as it opened our eyes to an entirely new world of online marketing. Kathryn provided us with an enormous amount of information I still reference, and our homework was all about getting our business set up online. In fact, I used a lot of that work when I created our Capitol Healthcare Advocates website. It was a hard course and totally worth the time and effort.

Now that you’ve been running your small business for a year now, could you give an example of a typical day?

As this is my "retirement job," I choose to only work about three or four hours a day. Days typically include time spent on Facebook posts and, most recently, blog posts for our website; researching articles on current insurance billing issues in order to stay on top of the field; in-person networking through Chamber of Commerce events and other avenues of potential referrals; and, of course, working on specific client matters.

What do you consider a success story as a health advocate?

Earlier this year, I was also studying for the first-ever national Patient Advocate Certification Board exam, which I am very happy to say I passed! That is a personal success story. But for our clients, the best success stories are those in which I can negotiate a reduced bill from providers.  This can sometimes takes weeks—provider networks can very challenging to navigate—and every situation is different. However, when we can get a bill cut in half (as I did just a couple of weeks ago for one client), it is very rewarding.

Do you have any advice for students thinking about pursuing the field? 

The field is very diverse, which allows for people from a variety of backgrounds to establish their business. However, the field is still so new that we health advocates must be prepared to spend a lot of time educating people about what we do.

A big part of the challenge is reaching people just at the time they need our services. Unlike services such as financial planning or personal care treatments that could be a spur-of-the-moment or impulse purchase, people either need what we offer or they do not. Ideally, networking occurs with individuals who have access on a continuous basis to people who are likely to need our services.

An equal challenge is convincing people it makes sense to pay for our services when they will often say they have a friend or family member "who can do that for free," not understanding that that person likely doesn't have our experience or expertise. Also, the Alliance of Professional Health Advocates provides their members a wealth of excellent information about the business side of health care advocacy.

Finally, the journey of establishing and running this business will bring you into contact with a number of dedicated, smart professionals, which adds significantly to the richness of this helping-the-community experience.

Does health care advocacy sound like a career for you? Share your thoughts in the comments.