With pandemic, government public health workforce faces a retention crisis

The nation’s public health workforce is staring down a serious retention crisis. Faced with death threats, bullying and constant harassment, nearly one in three government public health employees included in a recently published report say they’re considering leaving their job within the next year. 

Driven by burnout and poor mental health, health care workers across all sectors are migrating or exiting the profession at an alarming rate, and the majority cite poor mental health as the reason. 

“More than half of America’s public health workers report at least one symptom of post-traumatic stress disorder (PTSD) as a result of the COVID-19 pandemic,” reads a statement about the report, “Public Health Workforce Interests and Needs Survey,” which fielded responses from 40,000 government health care workers. The findings were released last month by the de Beaumont Foundation, a Maryland-based charitable organization, in collaboration with the Association of State and Territorial Health Officials.  

Those symptoms include nightmares, avoidance, uneasiness, anxiety, numbness and detachment. One in four respondents reported having three-to-four symptoms. The survey notes that government public health workers serve as “the backbone of community health, providing critical services such as health education, disease monitoring and prevention, data analysis, disaster response, and maintenance of the safety of water and food supplies, including restaurants.”

Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation noted that “Public health has been underfunded for decades, but the pandemic has pushed the workforce to their limit. … This is an underreported story that affects the health of communities across the country. These data show that the public health workforce is fast approaching a breaking point.”

Confronting the pandemic head-on in homeless shelters, community clinics, ICUs, emergency rooms and through vaccination efforts over the last two years have “been extremely challenging for state and local public health workers on the frontlines of protecting community health amid a deadly and highly politicized public health crisis,” the statement continues. 

This crisis is impacting those in different positions in different ways. For example, expected PTSD was found to be “more prevalent among those working in big-city departments (28 percent) than among those working in state health agencies (24 percent) or other local health departments (24 percent).” And health care executives, especially, reported bullying, threats and harassment from constituents as well as “national and local advocates who opposed their guidance and decisions about the pandemic (including masking, social distancing, and vaccination.” With that, nearly 60 percent of executives said they felt their health care expertise has been undermined or challenged in the last few years. 

Amid the immediate difficulties, there’s concern about the long-term implications. Today’s stress could leave to chronic retention problems among government health care workers in the years and decades to come. That, in turn, could “threatening the health and well-being of communities for years to come,” the statement says. 

From a administrative standpoint, the survey notes that “understanding employees’ reasons for leaving is critical for improving recruitment and retention.” The top five reasons for leaving noted by respondents include pay (49 percent), burnout (41 percent), lack of opportunities for advancement (40 percent), stress (37 percent), organizational climate/culture (37 percent).

Of all the challenges state, territorial and county health agencies have faced amid COVID-19 over the last few years, “most critically has been the mental health and exhaustion of the public health workforce. Public health professionals and their agencies have sustained a level of effort that is unprecedented in prior public health emergencies. We must focus on helping our public health workforce recover from the COVID-19 response while building more resilient systems for the future that can surge and scale for these kinds of emergencies,” said Michael Fraser, CEO of the Association of State and Territorial Health Officials.