U.S. Health Departments Experience Workforce Shortages and Struggle to Reach Adequate Staffing Levels in Public Health

Gaps persist in hiring sufficient U.S. public health workers, and health departments continue to face challenges in recruiting new employees, according to a new study by researchers at Columbia University Mailman School of Public Health and Indiana University. Insufficient funding, a shortage of people with public health training, and a lack of visibility for public careers, in addition to lengthy hiring processes, are cited as barriers contributing to an absence of progress in achieving a satisfactory level of workers. The results are published online and in print in the June issue of the journal Health Affairs.

“Public health systems are currently experiencing a mismatch between the number of graduates in the field and hiring needs and will need to reconceptualize their procedures and approaches to sufficiently staff their departments to meet the nation’s changing public health,” said study author Heather Krasna, PhD, associate dean, Career Services at Columbia Mailman School and adjunct assistant professor of Health Policy and Management.

Krasna continues, “Hiring managers report challenges in overcoming civil service– and merit system– related barriers, including delays in establishing positions for advertisement, vague and confusing civil service exam requirements, and comparatively low salaries.” This is despite the American Rescue Plan Act of 2021. which provided funding to support workforce needs during the COVID-19 pandemic. Even with increased funding from the American Rescue Plan Act, some health departments could not recruit new staff because of the low salaries they could offer. “Significant issues remain to be addressed if meaningful change is to happen.”

For example, it takes government agencies 204 days, on average, 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 tend to be infrequently offered.

In addition, lower salaries are compounded by student loan debt, and even the generous retirement benefits that historically have been offered by government agencies are less motivational for younger hires.

“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. Leaders with the authority and political will to support hiring process changes will be crucial,” said Valerie A. Yeager, professor and interim director of the Center for Health Policy at Indiana University Richard M. Fairbanks School of Public Health.

Krasna and Yeager are proposing the following next steps if governmental public health is to close the workforce gaps:

• Review hiring processes from start to finish and establish standard metrics.
• Consider workarounds to decentralize some control of the hiring process.
• Convert contractors, fellows, and interns to permanent hires.
• Modernize recruitment technology and marketing to improve candidate experience.
• Offer competitive salaries and incentives, including the possibility of repaying student loans.
• Improve permanent funding for public health departments.