What Matters in Recruiting Public Health Employees: Considerations for Filling Workforce Gaps

Salary Disparities in Public Health Occupations: Analysis of Federal Data, 2021‒2022

Objectives. To assess salary differences between workers within key public health occupations in local or state government and workers in the same occupations in the private sector. Methods. We used the US Department of Labor's Occupational Employment and Wage Survey (OEWS). Referencing previous studies matching Standard Occupational Classification (SOC) codes with health department occupations, we selected 44 SOC codes. We contrasted median salaries in OEWS for workers in each occupation within state or local government with workers in the same occupations outside government. Results. Thirty of 44 occupations paid at least 5% less in government than the private sector, with 10 occupations, primarily in management, computer, and scientific or research occupations paying between 20% and 46.9% less in government. Inspection and compliance roles, technicians, and certain clinicians had disparities of 10% to 19%. Six occupations, primarily in social work or counseling, paid 24% to 38.7% more in government. Conclusions. To develop a sustainable public health workforce, health departments must consider adjusting their salaries if possible, market their strong benefits or public service mission, or use creative recruitment incentives such as student loan repayment programs for hard-to-fill roles. (Am J Public Health. 2024;114(3):329-339. https://doi.org/10.2105/AJPH.2023.307512).

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.

Understanding Low Utilization of Employee Assistance Programs and Time Off by US Public Health Workers During the COVID-19 Pandemic

OBJECTIVE

Despite high rates of reported mental health symptoms among public health workers (PHWs) during the COVID-19 pandemic, utilization of employer-offered resources was low. Our objective was to understand what barriers and deterrents exist for PHWs accessing employer-offered resources.

METHODS

Four national public health organizations disseminated a national online survey of public health department employees during March-April 2021; 26 174 PHWs completed the survey. We examined 5164 write-in survey responses using thematic analysis to identify key reasons why PHWs were not accessing time off and employee assistance programs (EAPs) and to understand what resources PHWs would like to see their employers offer.

RESULTS

The top reasons that PHWs reported for not taking time off during the COVID-19 pandemic were financial concerns (24.4%), fear of judgment or retaliation (20.8%), and limitations in the amount of time off offered or available (11.0%). The top reasons that PHWs reported for not using EAPs during the COVID-19 pandemic were difficulty accessing EAPs (53.1%), use of external services (21.5%), and a lack of awareness about EAPs or motivation to initiate their use (11.3%). While desired employer-offered resources varied widely, PHWs most frequently listed financial incentives, paid time off, flexible scheduling, and organizational change.

CONCLUSION

Organizations can best help their employees by organizing the workforce in a way that allows PHWs to take time off, creating a positive and supportive organizational climate, regularly assessing the needs of PHWs, clearly communicating the availability of employer-offered benefits, and emphasizing the acceptability of using those benefits.

Making a Living in Governmental Public Health: Variation in Earnings by Employee Characteristics and Work Setting

CONTEXT

This article examines factors related to earnings in the context of the governmental public health system's urgent need to recruit and retain trained public health workers as many in the existing workforce move toward retirement.

METHODS

This article characterizes annualized earnings from state and local public health practitioners in 2017, using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), which was fielded in fall/winter 2017 to more than 100 000 state and local public health practitioners in the United States. The response consisted of 47 604 public health workers for a response rate of 48%.We performed descriptive statistics, bivariate analyses, and interval-based regression techniques to explore relationships between annualized earnings, supervisory status, gender, years of experience, highest degree (and whether it was a public health degree), job classification, race/ethnicity, union/bargaining unit, paid as salary or hourly wage, setting, and region.

RESULTS

Higher supervisory status, higher educational attainment, white non-Hispanic race/ethnicity, male gender, salaried employment, bargaining unit (labor union) position, certain geographic regions, having a clinical/laboratory/other scientific position, and working in either a state health agency (SHA) or a large local health department (LHD) setting are all associated with higher salary. Having a public health degree versus a degree in another area did not appear to increase earnings. Being a person of color was associated with earning $4000 less annually than white peers (P < .001), all else being equal. The overall regression model showed a gender wage gap of about $3000 for women (P = .018). Supervisors, clinical and laboratory staff, public health sciences staff, and union staff also earned more than their counterparts.

DISCUSSION

As multiple factors continue to shape the public health workforce, including increasing racial/ethnic diversity, continued retirements of baby boomers, and the growth of bachelor's-level public health education, researchers should continue to monitor the gender and racial/ethnic pay gaps. This information should help the field of governmental public health as it endeavors to rebuild its capacity while current workers, many at the highest level of leadership, move on to retirement or other jobs. Public health leaders must prioritize equitable pay across gender and race/ethnicity within their own departments as they build their organizations' capacity to achieve health equity.

Changes in the State Governmental Public Health Workforce: Demographics and Perceptions, 2014-2017

Context:

Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents.

Objective:

Using data from agencies that participated in 2014 and 2017, we conducted multi–cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data.

Design:

The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017.

Setting:

Thirty-three state health agency central offices that participated in both 2014 and 2017.

Participants:

Permanently employed governmental public health staff.

Main Outcome Measures:

We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott–adjusted χ² analyses were used to compare changes between 2014 and 2017.

Results:

The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001).

Conclusions:

Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.

Public Health Workforce Development Needs: A National Assessment of Executives' Perspectives

INTRODUCTION

Workforce development is one of the ten essential public health services. Recent studies have better characterized individual worker perceptions regarding workforce interests and needs, but gaps remain around workforce needs from program managers' perspectives. This study characterized management perspectives regarding subordinate's abilities and training needs and perceived challenges to recruitment and retention.

METHODS

In 2017, the Directors Assessment of Workforce Needs Survey was sent to 574 managers at state health agencies across the U.S. Respondents were invited based on the positions they held (i.e., to be included, respondents had to be employed as managers and oversee specific program areas). In 2018, descriptive statistics were calculated, including Fisher's exact for inferential comparisons and Tukey's test for multiple comparisons, as appropriate.

RESULTS

Response rate was 49% after accounting for undeliverable e-mails; 226 respondents met the inclusion criteria. The largest perceived barriers to staff recruitment were wages or salaries (74%) and private sector competition (56%). Similarly, wages or salaries were identified as the main cause of turnover by 70% of respondents, followed by lack of opportunities for advancement (68%), and opportunities outside the agency (67%).

CONCLUSIONS

The Directors Assessment of Workforce Needs Survey fills important knowledge gaps and complements previously identified evidence to guide refinement of workforce development efforts. Although competition from the private sector remains challenging, these findings indicate that recruitment and retention must be top priorities in state health agencies nationwide. Prioritizing individual state health agency workforce gaps and committing to provide specific local-level interventions to those priorities is crucial for individual health agencies.