ATROPHY AND ADJUNCTIFICATION
CHANGES IN PUBLIC HEALTH EMPLOYMENT OPPORTUNITIES
The public health workforce is not okay. In this series of articles, I will share what it has been like to work on the public health frontline during the COVID-19 pandemic and how these experiences have changed me forever. I will share the lessons I have learned and what I want the people around me to know, both inside and outside of the public health sector.
This post was originally published at JPHMP Direct.
If you find this post valuable, please subscribe and share.
“But it must be really easy to get a public health job during a pandemic!” I have lost count of how many times I have heard this refrain. This infectious disease epidemiologist is here to say that it’s NOT easy, and to offer validation and solidarity to other frustrated public health professionals. There are many of us out here. You are not alone.
In my previous column, I called out some examples of out-of-date career advice in public health. In this column, I shall explore some of the contextual dynamics of the job market in public health, based on my personal experiences of applying for public health jobs since long before the latest emergency response and the experiences of my students, colleagues, friends, and people in my network who have reached out to me for advice. In forthcoming entries, I plan to explore the recruitment process for jobs in public health, and to seek constructive advice for building a career in public health that genuinely reflects the current and rapidly changing environment.
Entering public health
As described in last week’s column, the #publichealthjobs scene has experienced many changes since the start of the COVID-19 pandemic now over 2.5 years ago. Increased attention to public health as a professional route has led to many new recruits joining our field, including new candidates for MPH degrees and professionals entering public health from other areas and bringing with them years of experience and skills from other fields. However, this rapid increase in the volume of candidates entering into public health has not been met with equivalent changes on the employment market presenting opportunities for these individuals. Forget employment: these individuals can barely find internships. Are we generating new public health professionals at a greater rate than we can employ them?
Entry-level and early career professionals
Let’s start off by defining our terms:
Entry-level professionals are entering the workforce right out of their latest qualification, which for public health professionals is most often an MPH.
Early career professionals include those all the way from entry-level up to around 5 years of employment experience. Don’t ask me whether internships are included because I have no idea what the official line is, but personally I would not overlook any experience in which the candidate clearly demonstrated independence and responsibility.
The most notable change I have witnessed in our employment market was the rapid growth early in the COVID-19 pandemic in early career opportunities geared mainly towards the recent MPH grads and career-switchers described above, including contact tracers and community health workers. Which was a great start, but evidently not enough; especially as these were invariably fixed-term appointments funded through grants or other time-limited opportunities. What happens now as those early career professionals are reaching their next stage — what’s their path for growth and development?
I am also hearing about another change in the jobs market for early career professionals, who tell me that jobs advertised as “entry-level” now frequently specify a requirement of at least 1-2 years’ work experience, or require advanced use of specialized skills that could only have been acquired in a work environment (because they are not taught in MPH courses). Let’s be clear about the use of the terminology: if a job is advertised as “entry-level” it should not have any requirement of previous work experience. I have repeatedly heard complaints from entry-level candidates who are unable to get a toehold into a public health career because they cannot find any advertised opportunities for that very first job.
Experienced professionals
What about those of us who already have specialist training and experience, who have been working thanklessly in this field for years, constantly reinventing ourselves in order to avoid stagnation and frustration? Since the start of the COVID-19 emergency response, I have adapted to the changing environment and worked as a public health professional under multiple frameworks: I have variously been an employee, a volunteer, a contractor, a consultant for a multinational corporation, a freelance writer, and an independent entrepreneur and sole practitioner running my own business. I have worked full-time and part-time, in-person and remotely, across the public and nonprofit sectors (including academia) and the private sector. My preference remains to search for a position offering stable full-time employment in the public or nonprofit sectors, at a respectable salary that reflects my experience and qualifications, with a decent benefit package and opportunities for training and career development. However, it has become increasingly clear to me that I am chasing a unicorn. Decent, secure, well-paid opportunities in public health are evidently the exception, not the norm.
The public health needs remain great but staffing and funding have suffered from historic underfunding and remain excruciatingly low. If a global pandemic hasn’t been sufficient to shake things up a bit, then what will make the difference that we need? How can governmental health departments staff up in a high-quality and sustainable manner that will allow us to continue to address ongoing needs for COVID-19 surveillance and mitigation, to investigate newly emerging infections including monkeypox & polio, to improve emergency preparedness, and to implement a long sought-after data modernization process — if not by creating long-term, secure, sustainable job opportunities for skilled public health professionals with scientific, technical, and management expertise? With insufficient permanent staff on their roster, how will jurisdictions maintain and improve existing programs addressing this nation’s other public health burdens, including the epidemics of opioid addiction, chronic diseases, mental health, and gun violence? Where is the funding from the American Rescue Act going? It’s been 2.5 years and we’re still waiting for the creation of budget lines for permanent hires, along with the associated budget lines for their benefits and professional development. How do we make sure that the hotly anticipated new CDC grant funding will go to creating jobs at health departments not management consultancies?
Contractual employment mechanisms: the adjunctification of public health
Instead of permanent hires, these days job opportunities in public health are increasingly being advertised as short- or medium-term contracts, or as RFPs (requests for proposals) ready for consultants to bid on fixed-term assignments (from global management consulting firms to solo entrepreneurs such as myself). I’ve mentioned before some of my gripes with contract hiring: in particular, the way in which it is robbing an entire cohort of public health professionals of opportunities to develop skills and relationships. Contract hires may be advertised by employment agencies or by nonprofit groups funded through grants. Either way, they are hiring on behalf of government agencies whose direct recruitment procedures are widely acknowledged to be too clunky to be responsive to immediate needs, due to the restrictions of legal requirements or union regulations.
I view the use of contract and consulting mechanisms as understandable temporary responses to the external pressures from the historic lack of funding in our field, forcing employers to find the most efficient and economic way of getting a task done. The US public health system is still woefully underfunded and understaffed, creating pressures throughout. So assignments are staffed in the most short-term economical way, with no regard for long-term workforce development. However, the use of contractual mechanisms should be a transitional strategy, as we move towards funding and developing long-term stable opportunities in which public health professionals and their employers alike can mutually benefit from their career growth and skills-building. I argue that the myopic focus on getting the present task done through contracts is depleting the public health workforce of the future.
I have been witness (and unwilling participant) to the same pattern of “adjunctification” now sadly well-established in academia: the move towards hiring more short-term adjunct teaching positions and cutting tenure track budget lines fixes an immediate need but ultimately undermines academic resources and threatens the system supporting future students and research. Working recently both as a contracted public health professional and as an adjunct professor, I have experienced employers treating my peer group with a lack of respect and communication, as distinct from the rest of their tenured or permanent workforce. In both public health and teaching higher education, I have encountered barriers to developing professional networks disguised as opportunities for advancement. Accepting a contracted public health position or an adjunct teaching appointment may provide a brief opportunity to gain new skills and exposures but is rarely a stepping stone on the way to anything else within the same institution — and has become a fast track to being sidelined and silenced. Public health professionals and professors alike still need respectable compensation and benefits, opportunities for training and professional development, and job security in order to continue to provide their services and grow in their careers.
Advertising an assignment as a contract typically allows the employer to wriggle out of responsibilities for employee benefits and staff development. Opportunities opened up as an RFP ready for consultants to bid further allow the employer to select the lowest-cost bidder, and require the public health professional to invest huge amounts of downtime in developing their bid, often for low chances of return on their investment. These RFPs often represent insurmountable barriers to entry for early-career public health professionals. Even at a more mature stage of my own career, I often feel discouraged from bidding or experience insecurities in charging a full daily rate that reflects my need to cover business development and benefits, including health insurance. Worse still, I recently applied to a job advertised as a secure, long-term position in a public health organization. At the end of an arduous interview process, the conversation resulted in an attempted bait-and-switch as the interviewer told me that they had selected a different candidate for the full-time position and asked me whether I would be interested in a consulting contract instead. Within a couple of hours, I saw the same interviewer again advertising the same full-time position under the same misleading description.
I am disappointed to see public health organizations using their funds and their power to engage in these short-sighted employment practices, which ultimately deplete and detract from the long-term development of the public health workforce. Public health professionals deserve better. We seek increased funding and visibility for our work, to leverage for better employment prospects and career advancement. What will it take to use that federal funding for the creation of permanent jobs and ongoing training opportunities within health departments at the state and local level and within nonprofit public health agencies? Where is the lobbying and advocacy to make sure that new federal funding recognizes the need for public health job creation and professional development, and does not go straight into the pockets of the global management consulting firms?
So, the next time somebody tells me that they have heard that there’s a shortage of epidemiologists at this time, perhaps I’ll try asking them whether they have actually seen fully funded professional job opportunities advertised. Do they realize that there’s a shortage of jobs, not a shortage of work to be done? The next time you hear, “But I thought it would be really easy to get a job in public health at this time,” how will you answer? Let me know in the comments or on LinkedIn.