Public Health Recruitment and Retention: Findings from a Recent Qualitative Study

Public health workforce challenges have been well-documented, including the lack of public health workers, high turnover within public health, and too few public health students going into governmental public health. The National Association of County and City Health Officials (NACCHO) identified three domains for the Center for Public Health Systems (CPHS) to explore further and develop recommendations: 1) Student perceptions of public health, 2) Public health student internships and fellowships, and 3) Local health department onboarding. These domains are part of the employee life cycle and are areas public health agencies could focus on to improve workforce challenges.

In Spring 2024, CPHS conducted interviews with local health department employees and focus groups with newly hired local health department employees, current students, and current career counselors. Please see the table below for a breakdown of the interviews and focus groups.

In the sections below we highlight key findings and recommendations that were developed from the interviews and focus groups. Please see our forthcoming manuscript in JPHMP that discusses these three topics in greater detail and how they are intertwined.

Key Student Perceptions of Public Health Findings

• Most students and career counselors had overall neutral perceptions of public health. However, both participant groups were more likely to describe healthcare or governmental public health adjacent entities than governmental public health when asked about organizations involved in public health. Both groups greatly desired more connection between schools and local health departments to enhance education and employment opportunities for alumni.
• Some student participants described being dissuaded to pursue careers in governmental public health due to low wages.
• Students’ first impressions of a particular career often came from instructors or career counselors; however, many student participants shared having a weak or no relationship with their career counselors. Some students shared that they had not interacted or even heard from their career counselors. This broken linkage can create additional challenges for health departments wanting to recruit soon-to-graduate students into their agencies.

Recommendations:

• Career counselors should enhance connection with local health departments and students and be a link between the two.
• Public health agencies should partner with colleges/universities to connect alumni and soon-to-graduate students with current agency employees to showcase careers and employment opportunities.
• Public health agencies should collaborate with colleges/universities to assist with and “demystify” the hiring process.

Please see our Student Perceptions Infographic for additional findings.

Key Public Health Student Internships and Fellowships Findings

• Many local health departments described having constraints (e.g., funding; capacity to review applications, place students, supervise interns) that limited their internship and fellowship programs.
  • Internship and fellowship programs were inconsistent across health departments. This included recruitment, application process, projects/tasks, supervision, and hours.
• Health departments with robust internship or fellowship programs provided students with real-world, hands-on experiences that increased students’ likelihood of going into governmental public health and enhanced their job applications.
• Rather than directly “converting” interns or fellows to a full-time position, health departments were often required to have open application processes that interns or fellows are eligible to apply for.
  • Some programs assisted interns and fellows in highlighting their internship/fellowship experience on the application and preparing for the interview, which gave them an edge in the application/hiring process.

Recommendations:

• Create standardized processes and templates (e.g., recruitment, applications, project workplans) for internship and fellowship programs.
• Develop mentorship and networking opportunities for students throughout internship or fellowship.
• Ensure that internship students experience many (or all) aspects of the health department.
• Establish clear expectations and objectives for interns and fellows.
• If possible, establish formal internship/fellowship to full-time employee pathways to increase the number of public health students in governmental public health.

Please see our Internships and Fellowships Infographic for additional findings.

Key Local Health Department Onboarding Findings

• Health departments described successful onboarding as strategically integrates newly hired employees, creates a growth-oriented environment, and facilitates seamless communication to achieve organizational objectives. Effective practices included:
  • Structured process: Ensuring each new hire knew what tasks and training need to be completed in what timeframe.
  • Fostering a supportive workplace culture: As soon as someone accepts a position, they immediately had a support system as they navigate their new role and department. This system can include purposeful connection of the new hire to team members, regular check-ins, mentorship, and ensuring the workplace has an inclusive and welcoming environment.
  • Promoting cross-departmental communication and collaboration: Promote engagement and connection across the agency such as social events and team building.
• Agencies discussed needing additional resources to improve workforce development such as restructuring onboarding, developing mentorship programs, and improving employee training.

Recommendations:

• Standardize onboarding across agencies and improve communications, coordination, and processes/management within onboarding.
  • Standardized onboarding may include checklists and timelines that new employees can easily understand and follow.
• Invest in onboarding and ongoing employee training and support.
• Conduct stay and exit interviews for onboarding and agency quality improvement.
• Ensure employee onboarding includes purposeful connection for new employees and creates an environment where all feel welcomed and included.

Please see our Onboarding Infographic for additional findings.

Nikki Weiss, PhD is a biocultural anthropologist specializing in mixed methods research. She completed her undergraduate education in biology at the University of Wisconsin-Eau Claire, and she earned her master’s and doctorate in anthropology from Ohio State University. Before arriving at CPHS, Nikki worked for the Johns Hopkins Center for Indigenous Health – Great Lakes Hub, as well as for the CDC Foundation. Her research interests include health equity and making health care accessible and attainable for all.