Road to Nowhere?

Career development pathways in Public Health - Part I

In prior installments, I have described the changing market for public health employment and derived lessons for job seekers and employers based on my experiences and reports throughout my network. Over the next 3 episodes, I will bring these conversations together and turn my attention to a feature currently missing from the public health landscape to the detriment of all stakeholders: career development paths. I’ll start off by identifying the challenge, and move towards discussing actionable interventions.

Photo courtesy of Secta.AI: The theme developing here seems to be getting me off the road and into the forest.

Implications of a changing job market: instability and inequity

I have previously described how changes in the public health employment market are leading to a growing reliance on temporary contracts, consultancies, and outsourcing. Increasingly, I see positions that used to be considered jobs now advertised as contracts or consulting opportunities, which allow the employer to default on health insurance and other benefits. While bringing increased flexibility to employers in the short term, over the longer term this trend reduces job security for public health professionals, cuts opportunities for individuals to consolidate skills, curbs the ability of the public health workforce to develop new talent, and undermines institutional capacities. 

Lately I’ve met a growing number of public health professionals like myself who are lurching from contract to contract, without any guarantee of security or stability (far less health insurance coverage), and with no idea what will happen next. I’ve been shocked to learn how many of us are reliant upon the steady income and health insurance coverage of a spouse’s job. I’ve highlighted several times before the irony of our wellness-oriented sector neglecting the health insurance of its own workforce. This highly inequitable reality is not why we got our education and training in public health, and prevents the evolution of a diverse workforce. Follow your epi training and look for the selection bias here: who’s left in the public health workforce when so many of our former colleagues have moved on? Working in public health ought to be a career path not a privilege.

If we’ve learned any lessons from the events of the last few years, we've seen that without consistent, reliable funding to create consistent, reliable jobs, the public health workforce will remain wholly unprepared for the next crisis. How do we communicate this urgency to political leaders and voters?

Retention and career development

We’ve all had a lot to say about hiring practices in public health, especially the processes of recruiting. Meanwhile, retention and development of the existing workforce remain under-appreciated priorities. In the long term, it’s a lot healthier for organizations to keep good staff on board and support them to maintain, develop, and extend their skills, than to hire somebody new. Staff retention requires the creation and support of a healthy work environment, including opportunities for growth, flexibility for remote work, and strong policies on disability and caregiving accommodations. Proactively developing supportive retention strategies must also include attention to the removal of stressors in the workplace, e.g. toxic management that has been allowed to fester. And look, I haven’t even mentioned salaries yet.

“Train people well enough so they can leave, treat them well enough so they don’t want to.”

Richard Branson

One overriding feature of our field that has become increasingly apparent is the lack of long term career development pathways for public health professionals. Our physician colleagues progress from their studies into a series of well-defined and recognizable steps through internships, residencies, fellowships, and other forms of clinical practice. Within public health, we can assume no such continuity of career progression, nor can we readily recognise the credentials and staging of a fellow public health practitioner, particularly when operating outside of our own very narrow silo. Perhaps there are learning opportunities to be found in our variety and professional diversity, but only if we recognize each others’ strengths - without which career progression will remain precarious and haphazard.

Where are all the jobs?

As I have continued to analyze the public health job market through this column and my LinkedIn posts, I have been overwhelmed by messages from frustrated readers languishing at various stages of their public health careers. In particular, I have received many reports from recent grads frustrated that they are unable to find employment opportunities straight out of school, because all the ads they see require prior work experience (even for so-called “entry-level” positions). Meanwhile, I can tell you that there is certainly a lack of opportunities at the mid-senior level, because those are the ones that I am seeking, alongside a not insignificant number of my under-employed peers from grad school. So where are all the jobs?

As far as I can tell, there seems to be a sweet spot where employers are recruiting for candidates with about 3-5 years of experience - that's when they are still cheap but don't require a huge investment of resources for training and supervision, and have not yet reached a level of knowledge or experience where they are seen as threatening to management and the comfortable status quo. My worry is what will happen next for those early career professionals when they complete their fixed-term contracts and are seeking the next opportunity? This is why we need actual career development paths for public health professionals. We must cherish public health professionals at each and every career stage, and enable them to move on to the next.

We know from survey data that public health professionals have been leaving the workforce in droves, leaving gaping deficits in the public health workforce. But we also know that there are many unemployed public health professionals out there at all stages of their careers who have been unable to find suitable employment. Make it make sense. Why is there such a mismatch? If it is a mismatch in terms of geographic availability, then let’s get cracking with remote hiring. If it is a mismatch in terms of the skills availability, then let’s explore expectations for hiring and training. Temporary mechanisms employed during the COVID-19 emergency response successfully overcame both of these barriers, albeit temporarily.

Here’s another data point to consider: remember back in 2020, when universities gleefully reported an uptick in enrolment numbers in their public health programs and launched new programs in public health, associated with increased awareness of public health due to the COVID-19 pandemic? Well, a few years later, what do you think is happening to the record number of public health graduates now emerging from those programs to find that funding for public health has been cut and job opportunities no longer exist? Kudos to schools like Yale School of Public Health who have noticed this mismatch and are developing pipeline programs in partnership with State Health Departments. We need more innovative and joined-up thinking like this.

Just wait, the jobs are (still) coming… (or are they?)

Ever since the early days of the COVID-19 pandemic, we have been hearing the repeated refrain: “Just wait, the jobs are coming.” We heard this at repeated intervals through the acute phase of the COVID-19 pandemic every time a new bill was passed to fund COVID-related activities - from early efforts funding respirators and PPE, to vaccines and therapeutics later. We heard it again with the CDC public health infrastructure funding that emphasized the urgent need for a data modernization initiative. 

Sometimes we saw the creation of new jobs accompanying the funding: mostly entry level, fixed-term contracts, e.g. contract tracers, community health workers, vaccinators. But I’m still waiting to see the jobs for which an experienced well-qualified public health professional seeking stable employment building public health infrastructure can qualify (ahem, it’s me, hi, I'm the problem). And now latest reports have come full circle in their speculation about how imminent funding cuts to public health will inevitably cut employment opportunities and lead to layoffs. Have we missed the boat? 

A holistic and sustainable approach to public health demands that we pay attention to the human components of the system as well as the technical commodities. Where are the career development opportunities associated with each and every single one of these funding initiatives? 

In next week’s installment, I will continue this train of thought to lay the groundwork for developing interventions that support retention through career development paths in public health.

Join me to continue the conversation in Notes or Chat or Comments or Threads.

• What have been your experiences of developing your career path in public health? Where have you found opportunities for growth?

• What do you think a career development path in public health should look like? What kinds of interventions would you like to see?