Legislation from Smith et al and Murray & Burr are so important because it recognizes that public health should be treated like other in-demand health professions like nursing and incent recruitment into education and workforce appropriately.

I have a brother who is a generation younger than I am. In 2013, as a youngin’, he visited my partner and me in DC, and we took him to all the usual sights. To his chagrin (now), we also recorded a video of him singing, “I’m Just a Bill” on the steps of the Capitol for a class project. Because it was his birthday yesterday, I am not linking to the video in this post, but it is devastatingly adorable (and very embarrassing I’m sure).

This past week, that song has been going through my head quite a bit – between Tina Smith’s (MN) S.3506 – Strengthening the Public Health Workforce Act and the new PREVENT Pandemics Act discussion draft put out by Murray and Burr, there is a lot of potential good news in store for the public health workforce. So long as the bills don’t die in committee like previous efforts.

There are a number of pressing workforce issues public health must contend with, recruitment and retention foremost among them. As we’ve talked about before in this series, public health has a tough time recruiting new graduates. It’s not merely a matter of pay and competing with health care (though this is an enormous issue), but how long it takes to go through the hiring process. In a time known as, alternately, the Great Resignation / Reshuffling / Renegotiation, taking several months to navigate a bureaucratic process to get paid not as much money during a pandemic might be reasonably said to lack some appeal.

In Yeager et al’s analysis, job security, competitive benefits, personal commitment to public service, and wanting a job in the public health field were all significant as correlates of staying on the job. This is consonant with research on intrinsic motivation in the public sector more broadly. This is also an area that I myself have looked at over the years. As I reflect on a study done in 2015 on the role of intrinsic vs. extrinsic motivation for staying in or leaving public health, it’s hard to overstate how unreasonable the field’s reliance on intrinsic motivation seems to me now. We have expected that internal motivations to serve our communities would outweigh the basic fundamentals of competitive pay, job satisfaction, and a clear career trajectory, all of which may be viewed as more attainable in the private sector. Student loans, y’all.

COVID-19 has made clear these assumptions are fundamentally untenable. This is highlighted in one of the favorite charts I’ve ever made, this one to do with turnover (obviously yes, I have favorite charts).

Projected Probability of Staff Leaving Between 2017 and 2020 by Age and Setting

Abbreviations: BCHC, Big Cities Health Coalition; LHD, local health department; Other LHD, other local health department; SHA-CO, state health agency central office. Source: Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States, Journal of Public Health Management and Practice

To me, what this chart shows clearly that we must attack recruitment and retention problems from multiple angles. Pre-COVID, we had decently high turnover across all age ranges, but most especially in the <35 and 65+ groups. In some respects, I view the 65+ issue as more of a succession planning and knowledge transfer issue than a retention issue (how long can people reasonably delay retirement?). But for those under 35, clearly there is competition for this group of highly educated staff who came of age in a culture of changing jobs or even organizations every couple years. That reality is one of the reasons the legislation from Smith et al and Murray & Burr are so important – it recognizes that public health should be treated like other in-demand health professions like nursing and incent recruitment into education and workforce appropriately. Given staff cuts and losses since the Great Recession, the still-TBD impact of COVID-19 on the workforce, and our need for 80,000 more staff, at minimum, to deliver core public health services post-COVID, I hope we see many more good ideas for how to bring the next generation into the governmental public health workforce, and to keep them there.

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