Why public health workers are fleeing the field

There were days, nights and weekends in the early months of the pandemic where Denise Von Bargen was the only person to run covid tests at the public health lab in Ventura County. She once had eight or nine employees to help her, but one by one they had all retired or traveled to other jobs.

Like other California public health labs accused of extensive disease testing and monitoring, the Ventura Laboratory received federal and state funding for new equipment and short-term employment to bolster its response to covid-19. But the funding was temporary, and Von Bargen, the director, could not use it to increase the salaries of his employees, who could make more money working less in the private sector.

Operations deteriorated further last month after the lab lost its license to run routine tests that check the county’s seawater for deadly bacteria. It appears to have been a typo: The license papers changed and the staff typically responsible for submitting the application had stopped.

“The biggest threat to [public health labs] right now is not the next new pathogen, “said Donna Ferguson, director of the Monterey County Public Health Laboratory,” but laboratories are closing due to staff shortages. “

Across California, public health departments are losing experienced employees due to retirement, exhaustion, party politics, and higher-paying jobs. Even before the coronavirus pandemic throttled wards, staff numbers had shrunk with county budgets. But the decline has accelerated over the past year and a half, even though millions of dollars in federal money have flowed in. Public health nurses, microbiologists, epidemiologists, health officers and other staff who ward off infectious diseases such as tuberculosis and HIV inspect restaurants and work to keep communities healthy leaving the area. This is a problem that temporary increases in funding cannot solve.

The brain drain destroys society’s health care in both large and small ways. The people who staff public health laboratories, for example, perform complex tests for deadly diseases that require specialized training that most commercial laboratories lack. While their work is largely unseen by the public, they touch on almost every aspect of society. Public health labs test seafood to make sure it is safe to eat. They monitor drinking water and develop tests for new health threats such as antibiotic-resistant viruses. They also test for serious diseases, such as measles and covid. And they typically do so at a fraction of the cost of commercial labs – and faster.

Public laboratory directors are typically required to have doctoral degrees, and they must have appropriate credentials in order for their laboratories to be certified.

Ferguson said it feels like there’s a revolving door in her lab as freshmen from the university join in a few months to gain experience, to a starting salary of $ 19 an hour, and then move on to higher-paying jobs in hospitals. . It is almost impossible to hire qualified staff for part-time roles, such as those created with temporary outages in funding, due to the necessary training. In California, many laboratory positions require a public health microbiologist certificate from the Department of Public Health.

California has 29 public health labs, down from nearly 40 before the recession in 2008. A lab in Merced has been without a director for several months and may soon close. Although there is no official count of how much the field has shrunk, almost all laboratories lack key employees, said Godfred Masinde, president of the California Association of Public Health Laboratory Directors, San Francisco Laboratory Director and fills in as Fresno County Laboratory Director. Dozens of public health microbiologist positions are vacant around the state.

“We have financing now; we have equipment,” Masinde said. “But we do not have the staff to operate the equipment.”

His San Francisco lab typically runs 100,000 tests for gonorrhea and chlamydia each year and 150 to 200 tests for syphilis each day, Masinde said. While California also has state-run laboratories, he noted, they simply do not have the capacity to address closed-county laboratories.

The counties are also struggling to recruit and retain staff for other positions. An informal survey conducted by California Directors of Public Health Nursing showed that at least 84 public health nurses have left their jobs since March 2020. Many retired, part of a graying workforce challenged to recruit nurses to an obscure area that requires special accreditation.

Public health nurses are trained in nursing and community health and often work with families or community groups, not just individual clients. They make home visits after births, work on the development of early childhood and help respond to outbreaks of infectious diseases. “So provide a more holistic approach, and also address the social determinants of health,” said Michelle Curioso, director of public health care for Kern County and president of California Directors of Public Health Nursing. Like laboratory staff, public health nurses must be specially certified to work in public health departments.

In California, the average annual salary for a registered nurse is more than $ 120,000, according to the Bureau of Labor and Statistics, while job postings for public health nurses in several counties offer salaries starting at about $ 65,000.

Lack of nurses has been particularly severe in rural California. In Butte County, more public health nurses retired earlier than expected, said Monica Soderstrom, Butte’s director of public health care, and two young nurses who went on maternity leave decided not to return after finding higher-paying jobs. “It has been difficult to fill our vacancies,” Soderstrom said, “as we compete with hospitals and clinics that pay enrollment bonuses due to covid staffing needs.”

The loss of top county health leaders – department heads and health officers tasked with leading the pandemic in local communities – has been particularly marked, reflecting a sober national trend. Seventeen of California’s 58 counties have lost their health care workers since March 2020, and at least 27 have lost a director or assistant director. The director and deputy director of the state Department of Public Health also resigned.

The collective expertise lost with these departures is hard to overestimate.

Take, for example, Dr. Robert Bernstein, who moved to California in 2018 to become a health officer in Tuolumne County after more than two decades working in public health for the Federal Centers for Disease Control and Prevention, the World Health Organization and the Florida Department of Health, among other organizations. In California, health officers must be doctors and are accused of enforcing state and local statutes and protecting the public from health hazards.

In March 2020, just as the pandemic was making its first rise in the state, Bernstein was asked to resign by the county supervisory board. According to Bernstein, the supervisor was upset that he had ordered rabies vaccines for two children who were bitten by bats – including a bat that tested positive for rabies – against their parents’ wishes. The county declined to comment on the matter, saying it is legally forbidden to discuss personnel matters.

Bernstein moved to Butte County and became a health officer after his predecessor resigned in May 2020. Bernstein watched as colleagues in neighboring countries facing threatening public threats over covid-related health orders began to stop, apparently one after the other. other. In some communities, health professionals also met with rude and scornful setbacks from local elected officials, even though law enforcement leaders openly refused to enforce their health directives.

“You can, as a public health worker, have the authority and responsibility to recommend or even mandate certain public health measures,” Bernstein said, “but you need a partnership with those who have the authority to carry out [them] out.”

In September this year, Bernstein was disillusioned with the dynamics and notion that his family could be captured by the covid attack. “I have just decided that as the father of 16-year-old triplets, I do not need me or the children to be threatened in any way, and I can do good public health work at the state or federal level or even the international level,” Bernstein said. .

Michelle Gibbons, executive director of the County Health Executives Association of California, said local departments see the overlapping effects of these top-level dropouts, with middle-level executives reluctant to move into senior positions even though top officials may order salaries of more than $ 200,000 .

The state budget this year included $ 3 million for an assessment of California’s public health infrastructure, and public health executives believe it will show staff and education are important issues. Yet the budget did not include additional long-term funding for health departments. Amid negative headlines and a lobbying blitz, Govin Newsom eventually agreed to add $ 300 million a year to public health, a handshake agreement not scheduled to begin until July.

Proponents warn that timing matters: Many public health workers hang on to see their community through the pandemic and will leave when it ebbs. “We’re going to see a huge wave of retirements once this is over,” said Kat DeBurgh, executive director of the Health Officers Association of California.

In Ventura County, Von Bargen, exhausted by the pandemic, has been trying to retire for a year. She did not want to leave the laboratory, she struggled so hard to stay open and it took so long to find a replacement. Her successor will start at the beginning of next year, where Von Bargen will also join the ranks of former public health employees.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, an impartial health policy research organization unrelated to Kaiser Permanente.

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