Public Health Workers Are Fleeing

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There were days, nights and weekends in the pandemic’s early months when Dennis von Bargen was the only person to run coronavirus tests at the Ventura County Public Health Laboratory. She had eight or nine employees to help her, but one by one, they all retired or left other jobs.

Like other public health laboratories in California tasked with extensive disease testing and monitoring, the Ventura lab has received state and federal funds for new equipment and short-term designations to bolster its response to covid-19. But the funding was temporary, and Von Bargen, the manager, couldn’t use it to raise the salaries of her employees, who could make more money doing less work in the private sector.

Operations deteriorated further in the past month, after the lab lost its license to conduct routine tests to check the county’s ocean waters for the deadly bacteria. Apparently it was a clerical error: the license papers were changed, and the staff normally responsible for submitting the application resigned.

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“The biggest threat to [public health labs] “Right now it’s not the next emerging pathogen, but labs are closing due to staff shortages,” said Donna Ferguson, director of the Monterey County Public Health Laboratory.

Across California, public health departments are losing experienced employees to retirement, burnout, party politics and higher-paying jobs. Even before the coronavirus pandemic choked departments, staffing shrank with district budgets. But the decline has accelerated over the past year and a half, even as millions of dollars in federal money have poured in. Public health nurses, microbiologists, epidemiologists, health workers and other personnel fighting infectious diseases such as tuberculosis and HIV screen restaurants and work to keep communities healthy as they abandon the field. It is a problem that temporary boosts in funding cannot solve.

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The brain drain impairs stewardship of community health in ways both large and small. People who work in 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 invisible to the public, they touch nearly every aspect of society. Public health laboratories take samples of shellfish to ensure they are safe to eat. They monitor drinking water and develop tests for emerging health threats such as antibiotic-resistant viruses. They also test for serious diseases, such as measles and the virus. They usually do this at a fraction of the cost of a commercial lab — and faster.

General laboratory managers are usually required to hold doctoral degrees, and they must have appropriate credentials for their laboratories in order to be accredited.

Ferguson said there appears to be a revolving door in her lab, where recent college graduates join for a few months to gain experience, starting at $19 an hour, then move on to higher-paying jobs in hospitals. It is nearly impossible to hire qualified employees for part-time roles, such as those created with temporary funding payments, due to the required training. In California, many laboratory positions require a public health microbiologist certification from the Department of Public Health.

California has 29 public health laboratories, down from about 40 before the 2008 recession. One lab in Merced has been without a director for months and could close soon. Although there’s no official tally of how much the field has shrunk, nearly every lab is missing key staffing, said Godfried Masindi, president of the California Association of Public Health Laboratory Managers and lab director in San Francisco, who serves as the lab’s director. in Fresno County. Dozens of public health microbiologist positions are open across the state.

“We have funding now and we have equipment,” Masindi said. “But we don’t have the staff to operate the equipment.”

Masindi said his lab in San Francisco typically runs 100,000 tests for gonorrhea and chlamydia each year, and 150 to 200 tests for syphilis each day. He noted that while California also has state-run labs, it simply doesn’t have the capacity to withstand the slump of closed county labs.

Provinces are struggling to recruit and retain employees in other positions, too. An informal survey of public health nursing directors in California found that at least 84 public health nurses have left their jobs since March 2020. Many retirees, part of an aging workforce, have faced the challenge of hiring nurses in an obscure field 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 birth, work on early childhood development and help respond to outbreaks of infectious diseases. “Providing a more comprehensive approach, as well as addressing the social determinants of health,” said Michelle Curioso, director of public health nursing for Kern County and chief of California’s directors of public health nursing. Like laboratory workers, public health nurses must be specifically 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 public health nurse jobs in many counties offer salaries starting at about $65,000.

The nursing shortage was particularly severe in rural California. In Butte County, many public health nurses retired earlier than expected, said Monica Soedström, director of public health nursing in Butte, 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, because we compete with hospitals and clinics that pay check-in bonuses due to staffing needs,” Soedström said.

The loss of the county’s top health leaders — department managers and health staff tasked with leading the pandemic response in local communities — has been particularly stark, reflecting a sobering national trend. 17 of California’s 58 counties have lost health workers since March 2020, and at least 27 counties have lost a director or assistant director. The director and deputy director of the state’s public health department also resigned.

It is hard to overstate the collective experience lost with those departed.

Take, for example, Dr. Robert Bernstein, who moved to California in 2018 to become the health officer for rural 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 state of Florida. Ministry of Health, among other organizations. In California, health officials must be physicians, and they are tasked with enforcing state and local laws and protecting the public from health risks.

In March 2020, just as the pandemic was making its first wave across the state, Bernstein was asked to resign by the county board of supervisors. According to Bernstein, supervisors were upset that he had ordered rabies vaccinations for two children who had been stung by bats—including bats that tested positive for rabies—against their parents’ wishes. The county declined to comment on the matter, saying it is legally prohibited from discussing personnel matters.

Bernstein moved to Butte County and became a health official after his predecessor resigned in May 2020. Bernstein watched his colleagues in nearby counties, facing public threats due to coronavirus-related health orders, begin to resign, seemingly one by one. In some communities, public health officials have also faced blunt and cynical opposition from local elected officials, even when law enforcement leaders have publicly refused to implement their health directives.

“As a public health officer you may have the authority and responsibility to recommend or even delegate certain public health actions, but you need to partner with those in authority to implement them,” Bernstein said. [them] Outside.”

By September of this year, Bernstein was disillusioned with the dynamism and the idea that his family could indulge in the rancor of hunger. “I have just decided, as a father of 16-year-old triplets, that I don’t need to endanger myself or the children in any way, and I can do a good job in public health at the state, federal, or even international level,” he said. Bernstein.

Local administrations are seeing the ripple effects of those high-level defections, said Michelle Gibbons, executive director of the California County Health Executives Association, with mid-level managers reluctant to move into senior positions, even though senior officials can command salaries in excess of $200,000. .

This year’s state budget included $3 million to assess California’s public health infrastructure, and public health leaders believe it will show staffing and training are key issues. However, the budget did not include additional long-term funding for health departments. Amid negative news headlines and misinformation, Governor Gavin Newsom eventually agreed to add $300 million annually to Public Health, a handshake deal that wasn’t due to begin until July.

Advocates warn that timing matters: Many public health workers are clinging to seeing their communities through the pandemic and will leave once it subsides. “We’re going to see a huge wave of retirements when that’s over,” said Kat de Burgh, executive director of the California Health Officers Association.

In Ventura County, Von Bargen, exhausted by the epidemic, is trying to retire for a year. She didn’t want to leave the lab that she struggled so hard to keep open, and took so long to find a replacement. Her successor will begin early next year, at which point von Bargen will also join the ranks of former public health staff.

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

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