Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States

Enhancing Workforce Pathways: Insights From a Paid Internship Pilot Program Linking Public Health Students and Local Health Departments

The persistent understaffing of the governmental public health workforce has led to program cutbacks, staff burnout at local health departments (LHDs), and an urgent need to replenish staffing. To build recruitment pathways into LHDs and build their workforce capacity, we introduced a paid internship initiative connecting Master's in Public Health students from a Midwestern university with LHDs in the state. This article presents the pilot program developed and the insights gained from it. Program participants included nine LHDs that hosted 10 students for 12-week internships. Internship projects were developed by LHDs with support from the state's association of county and city health officials. All students completed their internship projects satisfactorily. The experience highlighted that while students contributed to LHDs through short-term projects, with sustained backing and minor adjustments, this model can serve to reinforce the governmental public health sector's existing and future capacity in the long term.

Accredited Public Health Department Characteristics Associated With Workforce Gaps Identified in Workforce Development Plans

OBJECTIVE

When pursuing accreditation by the Public Health Accreditation Board, local health departments (LHDs) must submit a workforce development plan (WDP). The purpose of this study was to examine LHD characteristics associated with workforce gaps identified and strategies implemented by LHDs.

DESIGN

We conducted a qualitative content analysis of all WDPs submitted to the Public Health Accreditation Board between March 2016 and November 2021.

SETTING

We examined WDPs from all accredited LHDs (n = 183) at the time of data collection in January 2022. A majority of LHDs had more than 50 staff members (n = 106, 57.9%), had a decentralized governance structure (n = 164, 89.6%), had county-level jurisdictions (n = 99, 54.1%), and served rural populations (n = 146, 79.8%).

MAIN OUTCOME MEASURES

For each overarching theme, we constructed 2 binary variables indicating whether the LHD identified a workforce gap or strategy among any subthemes within each overarching theme. Logistic regressions were used to examine relationships between LHD characteristics and identification of a workforce gap or strategy for each theme.

RESULTS

Few LHD characteristics were significantly associated with gaps identified or strategies implemented by LHDs. LHDs applying for reaccreditation had higher odds (adjusted odds ratio [AOR], 2.44; confidence interval [CI], 1.04-5.83) of identifying a leadership gap and of identifying a recruitment gap (AOR, 2.94; CI, 1.11-7.52) compared to LHDs applying for accreditation for the first time. LHDs serving urban populations had higher odds (AOR, 2.83; CI, 1.32-6.25) of identifying a recruitment strategy compared to LHDs that only served suburban/rural populations.

CONCLUSIONS

Overall, many workforce gaps reported by LHDs were universally observed irrespective of LHD characteristics. While most LHDs identified strategies to address gaps, our findings also reveal workforce areas where LHDs reported gaps without an accompanying strategy, indicating areas where LHDs could use more technical assistance and support.

Minnesota Public Health Corps: A Qualitative Assessment of AmeriCorps' Members Experiences

CONTEXT

Long-standing gaps in public health capacity exist due to extensive workforce shortages, particularly in governmental public health (GPH); these gaps were worsened during and after the COVID-19 pandemic. In response, the federal government established Public Health AmeriCorps (PHA), which supported the integration of AmeriCorps members in public health systems. Minnesota Public Health Corps (MNPHC) prioritized placing members in GPH agencies to increase GPH capacity. Initial evaluation results (2022-2023) suggest that program members were well-integrated into agencies. This article reports on the contextual information offered by MNPHC members throughout their service, including the specific programs and activities members implemented, to better explain how members were successful at extending agencies' capacity.

OBJECTIVES

Activities, challenges, and successes of members during their service are described to better explain how members were successful at extending their sites' capacity.

DESIGN

Descriptive qualitative methods using data reported each month by 60 members.

SETTING

GPH agencies with at least one AmeriCorps member.

PARTICIPANTS

MNPHC members and GPH agencies.

INTERVENTION

MNPHC members at GPH agencies across Minnesota who implemented service plans.

MAIN OUTCOME MEASURE

Outcomes of interest included salient themes within MNPHC members' (1) activities, (2) encountered challenges and barriers, (3) successes.

RESULTS

MNPHC members implemented public health activities that helped bolster the capacity at host sites. The most common activities were related to public health communications, community engagement, and data analysis. Reported successes were largely concerned with progress made on the different activities being implemented by members. Members also reported few challenges; however, most reported challenges related to common issues encountered in public health, such as difficulty working with community partners or finding available data.

CONCLUSIONS

MNPHC offers a compelling model that provides support to the GPH workforce while also offering those considering a career in GPH an opportunity to experience a range of public health activities.

Factors influencing the turnover intention for disease control and prevention workers in Northeast China: an empirical analysis based on logistic-ISM model

PURPOSE

This study aimed to determine the current turnover intention among workers at Centers for Disease Control and Prevention (CDCs) in Northeast China and to investigate the factors contributing to this phenomenon.

MATERIALS AND METHODS

The cross-sectional study was conducted in May 2023 across four northeastern provinces of China. The study included a total of 11,912 valid participants who were CDC workers selected using a stratified cluster sampling method. The study assessed demographics, turnover intention, work resources, work perceptions, and psychological support through online questionnaires. The binary logistic regression analysis identified the factors associated with turnover intention for CDC workers, while the Interpretative Structural Modelling (ISM) revealed the hierarchical relationship between the influencing factors.

RESULTS

The study found that 28.8% of the respondents reported high turnover intention. The binary logistic regression suggested that the risk factors of turnover intention among employees included gender, age, education, and several work-related, organizational, and psychological factors. The work-related factors were daily working hours, job burnout, and role overload. The organizational factor was unit support for training, unit's infrastructure conditions, leadership style, remuneration package and performance appraisal and promotion system. The psychological support factors were family support, professional identity, and organizational commitment. The ISM analysis results showed that the primary factors influencing CDC workers' intention to leave were internally connected and grouped into four categories according to their level of impact: surface, transition, deep, and essential factors. Notably, the essential factors were professional identity and organizational commitment.

CONCLUSION

Nearly one-third of the respondents expressed a strong desire to resign from their employment. Turnover intention among CDC workers was subject to diverse influences. Early identification, detection, and targeted multidisciplinary interventions should be introduced to address the array of factors that affect staff, with particular emphasis on boosting the professional identity and organizational commitment of CDC workers.

Minnesota Public Health Corps: A New Model For Building The Governmental Public Health Workforce

Governmental public health agencies in the US are understaffed, and ongoing shortages will have a detrimental effect on their ability to provide basic public health services and protections. Public Health AmeriCorps was established in 2022 to support efforts to create a stronger and more diverse public health workforce nationwide. The Minnesota Public Health Corps, one of the largest Public Health AmeriCorps models, is a capacity-building program that places AmeriCorps members directly into governmental public health settings across the state. We used data from the first year of the Minnesota Public Health Corps (2022-23) to describe the experiences of thirty-five sites participating in the program. We also examined preliminary findings about how it shaped AmeriCorps members' skills and prospects related to career development in public health. Corps members were younger and more diverse than the current public health workforce in Minnesota, and the majority said that they intended to pursue a public health career. Host sites reported improved capacity to deliver public health services and indicated that corps members helped them reach new populations. Our evaluation demonstrates that this statewide program may be a scalable model to address parts of the acute capacity gaps at public health agencies, as well as long-term efforts to revitalize the workforce.

Public health workforce survey data (2016-2021) related to employee turnover: proposed methods for harmonization and triangulation

Introduction

Public health workforce numbers are unsustainable at best and dire at worst: based on 2017 and 2019 data, 80,000 FTEs needed to be hired by health departments to provide basic public health foundational services before COVID-19 hit, suggesting that the situation is worse after the mass exodus of public health officials due to the pandemic. As such, a better understanding of public health workforce turnover is critical to improving recruitment and retention in the discipline.

Methods

This methods report details how the authors harmonized four public health workforce surveys-the Public Health Workforce Interests and Needs Survey (PH WINS), the National Association of County and City Health Officials (NACCHO) Profile, the NACCHO Forces of Change survey, and the Association of State and Territorial Health Officials (ASTHO) Profile-in order to examine employee turnover.

Results

We found that 31% of the public health workforce reported considering leaving their positions at some time in the future. Furthermore, the majority of agencies reported that zero vacancies had been filled in both 2018 and 2019.

Discussion

These findings suggest that retention, recruitment, and onboarding may be areas upon which to focus evaluation and quality improvement endeavors, allowing public health organizations to better attract and retain the most qualified candidates.

What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments

OBJECTIVE

Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans).

DESIGN

This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021.

MAIN OUTCOME MEASURES

Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme.

RESULTS

The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18).

CONCLUSION

While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health

BACKGROUND AND OBJECTIVES

Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay.

DESIGN

Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models.

RESULTS

In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor.

CONCLUSIONS

Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover.

IMPLICATIONS

Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.

Seven Years, 3 Surveys, a Changed World: The State Public Health Workforce 2014-2021

CONTEXT

The COVID-19 pandemic and other public health challenges have increased the need for longitudinal data quantifying the changes in the state public health workforce.

OBJECTIVE

To characterize the state of governmental public health workforce among state health agency (SHA) staff across the United States and provide longitudinal comparisons to 2 prior fieldings of the survey.

DESIGN

State health agency leaders were invited to have their workforce to participate in PH WINS 2021. As in prior fieldings, participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey.

SETTING AND PARTICIPANTS

State health agency staff.

MAIN OUTCOME MEASURES

PH WINS 2021 maintains the 4 primary domains from 2014 and 2017 (ie, workplace engagement, training needs assessment, emerging public health concepts, and demographics) and includes new questions related to the mental and emotional well-being; the impact of the COVID-19 pandemic on staff retention; and the workforce's awareness of and confidence in emerging public health concepts.

RESULTS

The percentage of SHA staff who self-identify as Black, Indigenous, and people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as poor/fair.

CONCLUSION

The 2021 PH WINS results represent unique and current perspectives on the SHA workforce and can inform future public health infrastructure investments, research, and field practice to ensure a strong public health system.

Determinants of workplace perceptions among federal, state, and local public health staff in the US, 2014 to 2017

Background

The governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce.

Methods

Workforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response.

Results

In 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p < .0001); and 62% vs 52% in HHS (p < .0001). Among state staff, intent to leave increased from 22 to 31% (p < .0001), but fell in 2017 from 33 to 28% for HHS (p < .0001). Correlates of intent to leave included low job satisfaction, pay satisfaction, and agency type. Federal entities saw the highest proportion respondents that indicated they would recommend their organization as a good place to work.

Conclusions

While intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11703-x.