New research from the Fairbanks School details the changes needed to bolster the public health workforce

The public health workforce is central to the public health infrastructure but has been underfunded and experienced a shortage of employees for decades, according to a new article from the Fairbanks School of Public Health at Indiana University Indianapolis and Columbia University.

Barriers to having a fully staffed and trained workforce include:

• Insufficient and time-restricted funding.
• A lack of visibility for public careers.
• Complex and lengthy hiring processes.

A recent study estimated that US health departments need another 80,000 workers to ensure the provision of foundational public health services.

“It is essential that agencies identify ways to make the process easier for hiring managers and more successful in terms of recruiting appropriately skilled new staff,” said Valerie Yeager, lead author of the study and professor of health policy and management. “Leaders with the authority and political will to support hiring process changes will be crucial.”

Yeager continued, “The current hiring system functions in environments where staff have high workloads and high rates of burnout. Successful recruitment of new staff is crucial to easing the burden of vacancies and ensuring that the time invested in recruitment is not wasted. For example, when hiring managers spend months recruiting to fill a position only to find that they cannot get a salary approval that aligns with candidate expectations or that top candidates have already taken another job, frustration grows.” 

The civil service and merit system can inadvertently create obstacles for people who may be interested in these roles. On average, it takes the government 204 days to complete merit-based hiring. In comparison, the hiring process in the private sector is much quicker, averaging 12–49 days. Job candidates are often also required to take a civil service exam or another written or oral exam, which may be infrequently offered.

Even with increased funding from the American Rescue Plan, some health departments could not recruit new staff because of the low salaries they could offer. Lower salaries and student loan debt are a deterrent for potential applicants, even with generous retirement benefits offered by government agencies.

“Significant issues remain to be addressed if meaningful change is to happen,” said Heather Krasna, coauthor of the study and associate dean of career services at the Columbia Mailman School of Public Health.

The report included next steps to close the gaps in the governmental public health workforce:

• Review hiring processes from start to finish and establish standard performance metrics
• Consider workarounds to decentralize some control of the hiring process
• Facilitate the conversion of contractors, fellows, and interns to permanent hires
• Modernize recruitment technology and marketing to improve candidate experience
• Conduct routine market comparisons to ensure competitive salaries and offer incentives including tuition remission and student loan repayment programs

“When Money Is Not Enough: Reimagining Public Health Requires Systematic Solutions To Hiring Barriers,” was published in Health Affairs on June 3, 2024.