Building Bridges to Public Health: Harnessing Career Potential

A Q&A with Dr. JP Leider

This week, we continue to feature content from the Public Health Review podcast produced by our colleagues at the Association of State and Territorial Health Officials (ASTHO).

Today, I’m presenting the perspectives of Dr. JP Leider, Associate Professor at the University of Minnesota School of Public Health, where he is also Director of the Center for Public Health Systems. JP shared approaches that can help connect graduates to work within the field of public health. I will share highlights from his interview with Public Health Review, and you can  access the full version here.

Photo: Dr. JP Leider

Q. Public health was under attack during the pandemic. But… people are still interested in this field, they want to get a degree and they want to get involved.

A. “Well, there's a little bit of a disconnect there. Because whether at the bachelor's or master's level, people that get degrees in public health don't really go into governmental public health. It's maybe the fourth or fifth thing that folks go into, after health care, or health insurance, or research. You know, it's it's pretty far down that list. So, I think that's part of what's very different now versus 30 years ago.”

Q. Fair enough. How do we fix that?

A. “One of the really beneficial things about the time we live in now, is there's a lot more recognition about the need to build pathway programs, between schools and health departments—which I think there's always been this idea of, "Oh, yeah, you need to have internships." But, now we recognize you need to have paid internships that are systemic and structural, and are not just based on "Oh, yeah, I know, this person over here, I know that person over there.

You need to create something that exists between institutions, that's easy for students, that pays them for their time. But after, there's a summer internship, that makes it easy for them to later get a job. That after school, makes it so that they want to stay there. I think that's what's a little bit different now that kind of makes that barrier to entry, lower than it's ever been. I think that's what's really different now.”

“Every year, we… come together and try and figure out what is most pressing. And recruitment is almost always at the top of that list.

Q. How does the work you're doing for the Consortium for Workforce Research in Public Health attempt to resolve some of these questions?

A. “What's really exciting about what the consortium is doing and this new public health workforce research center, is that it's the first time such a center has ever really existed for public health. There are nine of these health workforce research centers in the country. You know, there's one for behavioral health, one for the emerging health workforce, but public health hasn't had its day in the sun before. And I think there's recognition now by HRSA, and the CDC, that public health has long needed this.

And every year, we do at least eight research projects that are selected and pitched by the public health community. So, not just by us at a university or with our partners at universities, but by the entire community. We kind of come together and try and figure out what is most pressing. And recruitment is almost always at the top of that list.”

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Q. What can you tell us you're learning from all of this work?

A. “… So, one of the interesting challenges that we're finding for some of these regions is that you would think with so many bachelor's and master's degrees being conferred, there'd be a pretty decent labor supply to choose from. But in certain parts of the country, there's actually quite a dearth. And so, we might consider really strong pathways or incentive programs in particular regions, like in Wyoming and Idaho, parts of New Mexico and so on, where it appears like there might not be that much to choose from. So, we've been able to kind of identify particular geographies where this is an issue.”

Q. We're talking a lot about workforce-related tools on this podcast, but one we haven't mentioned yet, is the Staffing Up calculator. What is it? And how does it play into the solution?

A. “The Staffing Up calculator is a project that was funded by the de Beaumont Foundation and CDC, in partnership with the Public Health Accreditation Board, and a whole mess of us worked on it. I'm pleased to say that it's this kind of multi-year project culminating in this workforce calculator.

Originally, Staffing Up was created to answer a kind of straightforward question, how many people do we need in public health to deliver the foundational public health services? The foundational public health services being this framework around, what do you need to deliver everywhere, for public health to work, anywhere? It's not just what you need in a community, for that whole community to work, right? There are these community-specific services you need, that are kind of particular to your community, but there's this core that everywhere needs. That's the foundational public health services.

And Staffing Up was conceived during the pandemic with the idea that one day the pandemic would be over, or we would be recovering from it. And we would need to know, you know, what do we need next? What did we need before it? And so Staffing Up kind of 1.0 came out a few years ago now, and it found that prior to the pandemic, we needed at least 80,000 FTEs more across kind of a whole array of state, local. And it wasn't evenly distributed between say, chronic disease and communicable and so on. Like the foundational capabilities, like administrative and organizational competencies, and so I needed a lot more folks. And so did environmental health and so on.

But, what came in Staffing Up kind of 2.0, was this idea that we could create a tool that individual agencies could kind of use as the beginning of a conversation, to figure out what might I need in my organization to do this work? And so that's what the calculator can help work toward. To look at this number and say, "does this seem right to deliver the foundational public health services?" Not to deliver every single activity that I might need in my organization, but to deliver that kind of core. And that's what the calculator, that's what we built it to do.”

Q. There are all kinds of jobs in public health, but you must have a sense for which positions need to be filled the most. What is the biggest need in public health right now?

A. “When we do research about kind of the most in need staff, the most in need occupation types, you know, you kind of hear pretty clearly that yes, you need a lot of organizational admin staff around the financial areas to support the running of your orgs. But, in terms of like public health and clinical care, you always hear that you need more public health nurses. But these days, I would say even more than that, it's data scientists types and Epi types, and then community health workers. That's very clearly the types that you're hearing, have a tough time keeping, getting, finding at all.”

Q. Are you hoping that all of this research will somehow accelerate the process, get more people interested, fill the pipeline faster, lead to more hiring sooner?

A. “Yeah, I think that there's very little that a given agency can do to raise all of its salaries. But, one thing that most agencies can do is target specific pay bands. So if they know they're not being competitive, even for, say, public health nurses, maybe what they can do is target the support staff, right? So, maybe they can split that occupation and think, "hey, maybe I don't need a public health nurse to do all of the things I have my public health nurse doing. Maybe I can reserve their expertise more to the clinical perspective, like the top tier of the clinical perspective and have other kinds of clinical support staff or other support staff do those roles." That kind of medical division of labor, clinical division of labor happened in the 90s. But you've you've also seen it start to happen with other kinds of functions and logistical and data support too, in the public sector more broadly. And I think public health could benefit from that as well.”

Q. The pay band idea is an interesting approach. But I assume there are others. Can you talk about some of those?

A. “I would say that when it comes to finances, people these days are competing a little bit on pay, and a little bit on benefit and feel like a lot of that's out of their control. And so where I see people being successful is a lot in the job environment space. So, they're doing more with flex work and full-time remote work, which I think is very smart. People don't want to come to the office four days a week anymore, or maybe even three.

But, they're also doing things that I think are very, very smart around making it clear about internal promotion and career tracks. So we know that people who are millennials and younger, don't stay in their jobs for a career, right? They're there for a few years and maybe longer if you're lucky, but probably not. How can you make it clear what their trajectory is? And how can you make the job environment beneficial and enticing, but not expect them to stay for 10 or 15 years? And settle for that? Like how can you as a manager find that acceptable? Being realistic, I think is a very smart idea.”

Q. You're an expert in this field, so we'd like to get some words of wisdom or advice from you. Anything that agencies looking to fill, a lot of positions ought to be focused on right now?

A. So in my work with HR folks and administrative folks, around recruiting and retention, the biggest issue that I have run into these days, is that our recruitment systems are beyond antiquated. It's not just that we're behind the times, we're so behind the times that like the private sector isn't even competing with us anymore.

And so my advice would be, do all of the things that you can to speed up the time from your job post to onboarding. You know, get yourself updates to your HR systems and your HR models, by any means necessary.

Whatever you have to do, because it's the talent pipeline and the modernization of it, that will pay enormous dividends, almost more than anything else. And the ongoing vacancy rates that will hurt you more than anything else, those have multiplying effects in your organization. So, if you have a 25 to 35% vacancy rate, it's not just a statistic that looks bad. It hurts every part of the organization.”

Q. As we wrap up, can you give them something to look forward to?

A. “People that are applying that are younger, are more educated and interested in the work as a group, than they have ever been before. And so, to be able to capture that interest and excitement, even if it's only for three to five years, compared to you know, 12 to 15 years before, is something that is hugely beneficial. It's just a matter of how do you harness that potential for the time that you have them?”

To hear this interview in full, please listen to the Public Health Review podcast on Apple Podcasts, Google Podcasts, or Spotify.  Find out more at https://www.astho.org/communications/podcast/ where you can subscribe, download this episode in full, and check out all their prior episodes too. Many thanks to ASTHO, Public Health Review, and interviewer Robert Johnson for permitting us to share highlights from their podcast interview.

Dr. JP Leider is an Associate Professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, and founding director of the School's Center for Public Health Systems. He is the Principal Investigator of the HRSA-funded Public Health Workforce Research Center and a member of the Consortium for Workforce Research in Public Health. His current projects focus on public health systems, the public health workforce, and public health finance. Dr. Leider is also the Director of Evaluation for the Region V Public Health Training Center. Previously, Dr. Leider has worked in public health philanthropy and public health practice. He holds a Ph.D. in Health Policy and Management from the Johns Hopkins Bloomberg School of Public Health, as well as a bachelors from the University of Minnesota.

Join us to continue the conversation in Notes or Chat or Comments or Threads:

• Dr. Leider describes “antiquated” recruitment systems in public health. What have been your experiences with recruitment in public health and how could these systems be improved?

• Both Dr. Leider and Dr. Krasna (last week) have talked about the disconnect between the bumper crop of public health graduates looking for jobs and restrictions on the employment options available to them. What needs to change? Who is responsible?