A Workforce in Transition
by JP Leider, PhD
It’s clear that the governmental public health workforce is changing.
We’re on the precipice of generational change, with 22% percent of staff planning to retire in the coming years. Separately, we also have many that are interested in leaving for reasons other than retirement, about 25% overall. Among those under age 35, 32% are considering leaving. I have written and continue to write in JPHMP about the determinants of this turnover, and what public health departments might do about it. But I want to step away from that for a minute and talk about what schools and programs of public health might do about it, too.
In a recent blog in Health Affairs, Emory professor Ronald Valdiserri, former Deputy Assistant Secretary for Health (Infectious Diseases), makes a coherent and cogent argument for better establishing links between academia and practice. Valdiserri notes that academia must increase the value and decrease the burden of these partnerships to the practice community. I take this argument to be right — and perhaps a hard one to pull off well. What I do want to note and talk about in this post are the various and varied factors swirling in this space that demands deeper context as we consider how we might structure, and restructure, these partnerships.
First are the strained financial realities of practice. The idea of academic health departments, partnerships on research of importance to practice, and joint appointments between health departments and universities are well-trod and tough-to-finance operations. Money is tight in government, and generally at universities, too. Even if the money exists for such projects and appointments, the very mechanisms to allow this type of collaboration may themselves not exist. An example I like to give is my own history: when I was finishing up my doctorate, I was also working for the Maryland Department of Health. At the time, the easiest way for this arrangement to work was to pay with a purchase order, so they “bought” my time using the same mechanism that you would, for instance, purchase a copier or reams of paper for that copier from a vendor. What a way to make a boy feel special.
In the years since, I understand that new channels exist to facilitate this at my alma mater and former place of employment, but my point is more that every relationship is and will be unique to the entities in it — and the minutiae of financial transactions can materially hinder, or help, these relationships get off the ground.
It is somewhat difficult to find sources of funds for these type of partnerships, and Valdiserri talks about putting these positions within the broader conversation of the Foundational Capabilities and funding those. That seems pretty reasonable to me. We would have to make sure that these partnerships are valuable to the locals and that incentives for promotion and tenure would be aligned with practice and service at the appointees’ institutions. McCullough found that about one-quarter of state health agency staff had worked in partnership with academia, and half found it successful. Often, policy and practice are not sufficiently incentivized for those on a tenure track. This can make it tough for young faculty, or midcareer faculty, to find the time and space to work on practice projects, even if the money is there.
As we think about maximizing value to local health departments from the perspective of academia, it’s pretty important to keep in mind that most of our students do not go into governmental public health, and most probably wouldn’t even if the positions were available. Similarly, most positions in government public health are not held by people who have public health degrees. One interesting exception is the small slice of public health workers who work in the Public Health Sciences (as opposed to say, clerical) and are under 35 (Figure). These folks are highly educated, much more likely to have an MPH or other public health master’s degree, and they’re also the ones who most often say that they are considering leaving for reasons other than retirement. I know, I know, I said I wouldn’t talk too much about turnover — but it’s important to keep in mind the potential misalignment in student interest with what practice has to offer. When CEPH made it a requirement that all public health students had to have applied practice experiences, I admit to wondering how health departments in the country would respond, and whether there would be enough internships and the like to go around. I’m not sure that concern has really come to fruition. While there are not a ton of data on this point, it’s fair to say many of these practica are happening outside of government. There’s nothing wrong with that — we need to meet students where their interests are. But to Valdiserri’s point, we need to make sure that we are setting up academic-practice partnerships, and internship pipelines, that are of value BOTH to the practice community and to our students.
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Jonathon P. (JP) Leider, PhD, is an independent consultant in the public health and health policy space, as well as a Senior Lecturer at the University of Minnesota and Associate Faculty at the Johns Hopkins Bloomberg School of Public Health. He has active projects and collaborations with foundations, national public health organizations, public health researchers and academics, and public health practitioners. His current projects focus on public health systems, the public health workforce, and public health finance. He holds a PhD in Health Policy and Management from the Johns Hopkins Bloomberg School of Public Health. [Full bio]