Compliance Conversations Podcast: The Realities of a Compliance Career

Do you have any career regrets? I sat down with my fellow compliance professional and friend, Brian Burton, to chat about ours. This episode of Compliance Conversations is part three of a six-part “Pathways to Compliance” series where we talk about regrets, big lessons learned, and a snapshot of our nine-to-five. In the last episode, we talked about job interviews and salary expectations. In this episode, we bring you right into the office with us.

Tune in to the most recent episode of Compliance Conversations with CJ Wolf, MD, “Compliance Pathways Part 3: Regrets, Redo's, and the Realities of a Compliance Career,” for an honest and informative dialogue on what it's really like to spend your days in compliance. This episode is for folks looking for a new career and seasoned professionals alike. In this episode, we cover:

• • A snapshot of a compliance officer’s unpredictable day
  • Career regrets and wisdom gained
  • Tips to help you understand if compliance is right for you

Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I am CJ Wolf with Healthicity and today’s guest is Brian Burton, the Chief Compliance Officer for Healthicity. Welcome Brian.

Brian: Good morning, CJ, and good afternoon or evening to those who may be listening to our podcast.

CJ: Yeah, I guess if people have trouble sleeping maybe just listen to these soft, calming, compliance voices at night [laughs]. No, I don’t think that’d be such a good idea. Welcome Brian, we’re glad to have you and we’re going to continue with our series of talking about careers in compliance. We thought it’d be interesting to just ask each other. Brian and I both come from different compliance backgrounds and it’s always interesting to hear how people ended up in compliance. We’ve talked about it in prior podcasts. Today, we thought we’d take it to the next level and talk about some additional questions and one of the questions that we get a lot is:

Question: Describe your average day?

CJ: This is especially a question I get from people who are transitioning to compliance from another career. Maybe, they have clinical background or legal background or accounting background and they what to know what is the average day like and I think that’s going to vary from place to place. Let me ask you, Brian, first:

Question: What’s your average day like?

In past positions, what’s your average day been like?

Brian: CJ, I think that’s a great question. It’s almost going to sound like a cliché but at least from my experience there has been no average day in the world of compliance as a professional. I think that is what draws me into the work so much. It seems to be almost controlled chaos. You might go from a HIPAA issue to a regulatory compliance issue to billing and coding to an HR matter that loops into compliance. From my experience that’s the most exciting part about being a compliance professional is there is no average day. I think as compliance professionals we have to have that personality and almost that attitude that we are willing to accept that input, think about it carefully, and then provide consistent thought or advice based on the evidence or facts that we have.

CJ: Absolutely.

Brian: Sometimes for me that might be a project oriented audit or something of that nature. You might be spending several hours focused on an audit; you might be in the midst of that audit and get a hotline call that requires your immediate attention. So, the ability to be dynamic and flexible becomes instrumental to the success of the position.

CJ: Absolutely. For me, some of the things that constitute a big portion of my day, and it depends on if you’re entry level, or an analyst, and you are doing the day to day work. Like you are mentioning audits and policy review, hotline review, incident management and, maybe if you are in a more outward facing role like education in compliance department or a manager. A lot of what we do in compliance on a daily basis is communicating with stakeholders so our job is to manage the day to day operations of the compliance program. The way you do that is to secure partners within the organization that will be on the same page as you. Meetings are part of it but communicating and often, I don’t want to say pushing the agenda, but being an evangelist or a cheerleader for the compliance agenda where we are often trying to convince people of the importance of compliance, especially people who might not be aware of it. A lot of interdisciplinary teams, an average day might include interacting in healthcare, interacting with providers, doctors occasionally, working with management so your practice manager or department manager, and working with IT. You just work with everybody. I often tell people when you get into a compliance role, I think this is also true if you’re in the auditing department, you get really good exposure to all the other departments in the organization.

Question: Did you find that to be true Brian?

Brian: Absolutely, and I think for those who want to listen to some of our previous podcasts we’ve done on the subject, my start to compliance was really project oriented and then triage and hotline calls. And to your point that its dependent on the volume of calls a workplace will get, you may only get a couple of those a month. But to your point, CJ, you find yourself communicating with every functional area of the organization. Whether it is clinical staff, financial, operational, executive management, compliance becomes almost a central figure within the organization as all of those internal departments have questions for us. How do we manage this activity as it relates to the compliance program?

CJ: Yeah, and the questions that are clear cut, black and white answers aren’t the ones you typically get in a day because most people know those and  there’s not a lot of debate. I think there’s a reason we have full time careers in compliance, because we’re often making judgement calls and applying principles of rules and regulations to specific scenarios. The other thing that I was thinking about was I also spent quite a bit of time reading regulations and trying to interpret them. Not from a legal standpoint, we work closely with legal and it’s important to understand those legal ramifications but once you understand those it’s important to recognize the people you’re going to be teaching and training and communicating intermediate new regulation to are not typically the lawyers. So you have to translate legalese into; what does this mean for a nurse on the floor? What does this mean for a pharmacy tech? So understanding your colleagues’ jobs, what motivates them, what will convince or motivate them to want to follow, or not follow, all these rules and regulations. So, a lot of reading and analysis that strategizes the best way to roll out this communication.

Brian: Yeah, I couldn’t agree more and your thought caused me to think back and sometimes we are trying to determine regulatory requirements and then how does that apply to our organization? So, there may be a new regulation but the first question is, is it applicable to us? Do we offer this service or have this condition present in our environment to make this condition applicable to us? And then, provide the education, to your point CJ, down the street, all the way down to every employee that it may impact.

CJ: Absolutely, and I think what you just described Brian is the seven elements and more. You’re looking at all these different aspects and I think if you are in a more senior leadership role you probably move a little bit away from the daily tasks of answering a hotline call. You may have staff that does that sort of thing but you’re looking at a more strategic perspective so you’re looking at the culture of the organization, you’re working with leaders on strategic initiatives to move the needle so to speak on compliance culture for the organization, and how do you do that? After you’ve gotten the nuts and bolts down on the compliance program you’re working on strategy, culture, and those sorts of things.

Brian: Absolutely. If we could pose another question:

Question: What would you consider the largest or the most significant pro, and maybe the most significant con, of being a compliance professional?

CJ: I think the biggest pro for me is the constant learning and changing of things and meeting people. That was my biggest pro. I didn’t really enjoy sitting in the office. Maybe this was more personality, I think each person may find it different, but for me it was the opportunity to be engaged with the entire organization, learn what they do, learn how these rules intersect with what they do and learning myself. The pro for me was it was rarely the same thing every day, so a constant learning environment, and I really enjoy that.

I think the con for me would probably be the inherent perception that a lot of people have that compliance is out to get you. Their police, they are this or that and I just don’t believe that fundamentally as a compliance philosophy that I police. I manage activities that the organization has decided are important for the organization but compliance belongs to everybody. Especially with some stronger personality types, I don’t mean to paint to broad brush here, but some doctors that I worked with thought I stayed up over the weekend to come up with new rules and laws to ruin their lives. No, I have things to do in my free time, I’m not trying to ruin your life. These rules and laws come from higher powers, and there are ways to be involved in that process if you don’t like those rules and laws. A lot of times you have to let people vent and then you can get through the rest of the meeting. If they want to vent about this new rule, I ask that, I don’t like all these either but they are what they are and we are trying to keep your organization safe. I’m not here to police you; I am trying to be proactive.

Brian: Yeah, I couldn’t agree more and to circle back I think you and I share several pros and cons. From my perspective, a slightly different pro is in the last twelve years or so as a compliance professional what I noticed and found my passion in is that ability to watch a compliance program build in its work and watch how it translates to the culture and how employees and members of our workforce positively respond to that culture. For me that’s very motivating. I really love watching that transition and it’s one of the most amazing things here at Healthicity now I get to do that with tons of different types of organizations from all kinds of spectrums. From a con perspective, I would reiterate a lot of those experiences that you described and I’ve had myself. If I had to think of a particular con is finding a way to not to be overwhelmed. Compliance can be so overbearing and the pressure of maintaining compliance in an organization regardless of it is a huge enterprise, nationwide health system or a small physician practice with less than two or three providers. The pressure to make sure your organization is complaint is real and so finding good positive coping mechanisms and finding a mentor, I think you mentioned having a mentor in a previous podcast. Finding that person, finding other resources in your network, that you can help share that burden with because I think once you enter this profession and then you find other likeminded professionals in compliance and you start having those conversations, we all have a shared experience and so relying on each other to help keep us motivated and not become overwhelmed. It’s a con but it’s also an achievement at the same time because if you stay in this profession for ten plus years, you are going to have highs and lows, it’s going to be like riding a roller coaster sometimes and you’re going to have to go into the CFO’s office and talk about how the organization owes a lot of money back to the government. You’re going to have a difficult conversation with a provider that’s going to be challenging for you both professionally and personally, sometimes, so just finding ways to measure those and finding strength in the successes that you have.

CJ: Yes, to that point about those conversations, you’re often the messenger and you’re often bringing some sort of news that the recipients not going to love but that’s part of our job, to be those individuals in the organization who are going to speak the truth and hopefully you have a supportive enough environment that you can speak the truth safely. Without that I think you are going to struggle in an organization, very interesting conversation there.

Brian, one of the other questions that we often get, especially from people who are trying to transition to a career in compliance, has to do with salary and salary for an entry level person versus salary for a more senior position, benefits, those sorts of things, and this of course is going to vary.

Question: What are your experiences or thoughts when people ask you that kind of question about average wage and benefits for different levels?

Brian: This is going to sound so routine but it really depends on your experience, your background, what you bring to the organization, and what profession you were in before.  Are you entering the compliance profession as a graduate of an undergraduate degree or an advanced degree? Where are you in education and experience wise? And, without getting into too much detail and explaining explicit salaries, I really believe HCCA does a fantastic job of putting together their annual salary report. If you are really considering a transition to this profession that is a tremendous resource to go look at, compare those data elements to your career and where you are and, see where you might fit but it does vary wildly. It just does and the economics of the organization will usually dictate the salary that’s available.

CJ: That’s so true and I agree with you, the HCCA salary is really good. So, those who are just listening in, the HCCA is the Healthcare Compliance Association. They have tens of thousands of members and they do these annual salary surveys. I was looking at that recently for a client and you may need to be a member to use this feature but they have an interactive salary survey where you can pick out all sorts of criteria. So, to your point Brian, about how much experience you have, you can list out twenty different fields you can say has this much experience, this region of the country, this level of education, and this size of organization. Sometimes they’ll list what the total revenues are for that organization because, as you mentioned, the economics of the organization often drive salary. I threw in some of those basic entry level characteristics, less than 3 years of experience and again it’s going to depend on the geographic area of the country but we’re looking at probably 60 to 70,000 depending on what experience you have in other fields and then on the senior level we’re talking six figures, people get bonuses and that sort of thing upwards to 2 to 300,000 and even greater depending on the amount that the organization has available. It’s just so broad and so wide but I agree with you. Look at that salary survey and you can drill down given your specific circumstances and experience and education.

Brian: And for me, CJ, I think the last point on this subject is the job market is not just specific to compliance but really all industries. The job market today is very dynamic. The US economy has thrived, it’s currently steering down today as we speak but you see the unemployment levels and the market availability, I have known fellow compliance professionals who have transitioned for sweet heart deals. They are getting great job offers in this market so I think the overall job market also dictates a little bit from entry level to senior level compliance professionals. It’s really difficult to gauge because there are a ton of variables, and I’ll close with, it’s a very rewarding career if it’s something you are passionate about.

CJ: That’s right; it’s got to be a good fit for you, liking the types of things we talked about today, and in other podcasts. Well, with that, we are often asked:

Question: If you could go back in time as a private individual what advice would you give?

What advice would you give to your early compliance professional self if you could go back in time, knowing what you know now?

Brian: Yeah. Read more, be more patient, and be more compassionate.

CJ: That’s great advice.

Question: Anything specific on what you would read more?

Brian: It depends on your current path and on your current field. For me, a good portion of my career I stayed focused on HIPAA compliance. I’m really familiar with StarConnect, I think back as well. Be as broad as you can. CJ, you may remember, I described compliance as being 5 miles wide and 5 miles deep and none of us can cover 25 square miles. But go half a mile to a mile deep on all 7 elements of compliance, plus HIPAA, plus the other regulatory requirements that might impact your organization. Then choose a specialty, choose an area of compliance where it’s passionate for you, and then go 5 miles deep and learn it forwards and backwards. Become a trusted resource for that particular subject in compliance.

CJ: Yeah, I agree with that.

Brian: How about you?

CJ: I think, there’s so much that I tell myself and I don’t have any regrets but if you literally could go back one thing I would say, because part of this question is getting at the advice to others early in their career, I would tell myself, and others, make sure you are getting a good fit in the organization. That you like the culture, be bold when you’re interviewing, and ask questions that probe a little bit. Of course, they’re not going to be able to tell you details that are maybe confidential but it shows what place you are in. You could ask questions like, “I’m doing an audit and I find out that we are going to potentially have to repay 5 million dollars, how do you see this organization reacting?” You could use a hypothetical like that but part of the reason I say that is if they say, “We’ve never had to do anything like that” just gauging their reaction because switching jobs and going into another career it’s a big investment in time and effort, sometimes you move or relocate, and it’s a lot of investment for the entity hiring you too so wouldn’t it be better if everyone knew up front where they stood and where you stood? I know that’s easier said for me now because I’ve established a career and when you’re trying to get into it you’re just trying to get into that first job so I get that you have to balance those but I think it’s really important to make sure you’re fitting into a compliance culture that you’re comfortable with. Unfortunately, there are compliance programs out there that are just window dressing, they are just trying to check a box and they’re not serious about it. Some people are okay with that but some people would be, like, look I am in this to make the organization better. Is this organization really committed to making it better?

Brian: CJ I think that’s wonderful, just beautiful advice for individuals considering entering compliance as a profession.

CJ: Yeah, easier said than done [laughs] but that’s the hypothetical if we could go back in time. Brian another question that we got is:

Question: What are the different types of compliance jobs?

If you are starting in compliance, maybe for a hospital for example, or any other entity that you are comfortable addressing.

What specific jobs are out there? What types and roles?

Brian: I think that’s really interesting. It could be anything from HIM professionals, who are working in the HIM department, who are just starting to collect the health record and, manage the health record. It could be individuals who are in patient accounting or patient financial services that are just starting the process of processing claims data or bills for payment. It could be an IT person who’s tasked with the responsibility of implementing the HIPAA security rule. There are so many different avenues. There are professional educators who enter the profession as a professional educator. I think that’s the beauty of compliance is it really takes a village; it takes many of us with different skills and backgrounds to manage a really healthy and effective compliance program.

Question: What do you think?

CJ: Yeah, I think it will also depend on the organization, as we’ve been saying. So, if you’re in a smaller organization you might be considered a compliance generalist where you’re asked to do all sorts of these things; policy writing, developing education, doing audits, doing interviews, and investigations. In larger organizations there may be more specialization. So, I was in a very large organization with a compliance department where we had a data analyst that was really a technical expert, not necessarily a compliance expert, but we had so much compliance data in the organization and other sorts of data that we needed somebody with expertise to analyze that data. So, he learned the compliance spin over time but his core skill was the data analytics, that was a very specialized thing. Like you mentioned, we had people who were educators, I come from an education background as well, and so I have some experience and kind of a passion for developing training. So, there are skills that are unique there so that might be a role. Some people that are coming from a healthcare background, maybe nursing or some other clinical background, might get involved in patient safety if that’s a piece of it. You also get things like medical coding and billing where you’re looking at medical records and you’re trying to use your clinical knowledge to help comply with certain things, like was this procedure medically necessary? Is it documented appropriately? Those sorts of things start to utilize people’s clinical knowledge. Auditing, there’s auditors that thought they might not be content experts in everything, like you said you can’t know the 5 miles wide and 5 miles deep, but auditing skills are a unique skillset where you follow a certain procedure so the audit is not biased. You are presenting results to management and your following these accepted auditing practices regardless of what the subject is. Writing is a skill and that’s a role, people who are helpful in writing policies. We’ve had investigators before, this was a different organization but it was also a large compliance department. We had one person who had some expertise in investigations from a prior career so she did all of our sensitive investigations where interviewing skills were essential, so when you’re interviewing somebody and they could potentially be lying and those sorts of things. That’s where that skillset came in and then you have managers, people who are running the program, managing teams and those management skills, so if you have management skills that is a real art and skill unto itself so, you could probably get involved in compliance and learn some of the content but being able to manage a team into success and those sorts of things so I think there’s a lot of opportunities but it’s going to depend on the size of the organization.

Brian: I could not agree more with everything you said. Going back to what I said earlier in today’s podcast, is that what makes compliance fun for me is because we can do so many different things, you get to build trust and relationships with those team members, and your internal stakeholders to really manage and effective compliance program.

CJ: Absolutely. We’re getting close to the end so I’m going to ask for some final thoughts from you. Let me give you a final thought that came into my mind. You were talking earlier about mentors. One prior podcast we drilled home the point of finding a mentor and to reach out to some of us. Brian, I want to report to you someone reached out to me and we had some really good conversations and this individual was looking at a job switch and they were moving from kind of a standard, academic medical center type of system and the job opportunity was more in industry. It was with a medical device company. With compliance, there’s a lot of overlap but it’s definitely a shift in culture from a nonprofit to a for profit so we had some really good conversations. She asked what kind of questions I might ask in the interview, how she could get a feel for the organization and that sort of thing. That was really energizing to me so we were talking about the importance of mentoring and I really enjoy doing that. I just want to re-emphasize the importance of that and I’m glad you brought it up in one of your prior comments.

Question: What last minute thoughts or comments do you have Brian?

Brian: Just that one, I value these conversations we have, they seem so natural and I’m grateful for our friendship and the working relationship we have. I also want to pass on to you; I had a similar experience form our previous podcast in this series. I had an individual reach out and thank you and I both for this series and how it helped them navigate the early stages of their career. And, to your point, encourage any of the listeners today to find that mentor or reach out to us here through the Healthicity channels. Find someone else in your local community, attend a regional or HCCA conference, become a member of HCCA, start finding those resources and make connections. I think most of our listeners will find compliance professionals are whole heartedly and genuinely interested in helping and mentoring new compliance professionals.

CJ: Yeah and I would encourage people to also get involved and give back, even at the early stages. Maybe volunteer to write an article. You might not feel like you have the subject matter expertise but maybe you write an article for HCCA magazine or something that is about your journey into compliance and the biggest questions that you have. You can be authentic and honest in where you are currently and I think that could be helpful to other people. I know they’re always looking for authors in their monthly publication or submit to speak. Find somebody else and you could speak to something that you do have experience in and co-present with somebody else. Get involved, give back, and I think the earlier you do that in your career you’ll see that doors open and you make relationships.

Brian: That’s fantastic advice. CJ, thank you so much for today, I really appreciate it. It’s always a pleasure to spend some time with CJ.

CJ: Absolutely, Brian. Thanks for all your expertise and experience that you bring to the table and share. We’re going to explore other opportunities, maybe bring on guests to continue this conversation of careers in compliance and see we can find others who might want to talk with us on air. If you might be interested or know somebody, we’d love to see who might be interested in talking about these things. Thanks everybody for listening to another episode of Compliance Conversations. Have a great day.