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Nearly half of all public health workers in state and local agencies left their positions over the last half-decade, a new study found.

Comparing public health agency staff lists from 2017 with those of 2021, researchers led by Jonathon P. Leider, PhD, of the University of Minnesota in Minneapolis, discovered that 46% of workers were no longer present in 2021.

Importantly, more than 100,000 workers -- which amounts to half of the total governmental public health workforce -- could leave by 2025 if current trends continue, the group detailed in .

Their study tracked intent to leave as well as actual separations of 150,000 workers at close to 100 agencies participating in the (PH WINS) in 2017 and 2021.

"Even though we've had so many people already leave, we still have 40% plus of the workforce saying, 'I'm thinking about leaving,'" Leider told 番茄社区app. "These are the people that are more educated in public health science than ever before, in pandemic crisis management than ever before. How do you replace people like that?"

As for the characteristics of those who left, Leider said the researchers observed a "first-in, first-out-the-door" scenario, with roughly three-quarters of workers 35 and younger and of those with 5 years or less tenure no longer at a public health agency by 2021.

Workers that had been with an agency 10 years or more, meanwhile, were much less likely to leave, he said.

Intentions vs Actions

What caught Leider and his colleagues' attention was the inverse relationship they found between workers' intent to leave and actual separations, both by age and by tenure -- information they gleaned from the survey data.

Of the public health workers with 5 years of experience or less in 2017, about half said they planned to leave, but in actuality 77% left their organization by 2021. Similarly, among those 35 and younger, only 43% considered leaving in 2017 but 74% ultimately left.

Conversely, among those who had been at their agency 21 years or more, 83% said they were thinking about leaving within the next 5 years, but only 41% had by 2021.

While that "flip" in intentions versus actions wasn't entirely surprising, "the scale of it was very surprising," said Leider.

Among state, big-city, and other local public health employees, those who had been with their agencies for 5 years or less were 10 to 17 times more likely to actually leave compared with employees with more than 5 years of tenure:

• State: adjusted odds ratio (aOR) 17.4 (95% CI 15.00-20.18, P<0.0001)
• Big-city: aOR 10.83 (95% CI 8.87-13.23, P<0.0001)
• Other local: aOR 14.43 (95% CI 12.48-16.69, P<0.0001)

Choosing to Stay, Choosing to Go

Among workers 65 and older, the primary reasons for staying with their organization were benefits (50%), job satisfaction (50%), and "pride" in their organization (44%), the study found.

For those 35 and younger who reported an intention to leave, the strongest contributing factors were pay (63%), lack of opportunity to advance (51%), work overload and burnout (44%), job satisfaction (41%), and stress (39%).

Asked why a larger share of young people may have left than were even considering leaving, Leider said one possible reason is the "" -- a term used to characterize the "different relationship" the workforce appeared to have with their employers during the pandemic -- which found younger employees leaving their jobs at greater rates across both the private and public sectors.

Another reason could be the stressors of the pandemic itself. Like clinicians, public health workers put their lives at risk running COVID-19 clinics, on top of "getting harassed and harangued" for decisions they made around closing schools and other public spaces, he said.

Close to half of non-federal public health workers surveyed in 2022 reported symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), or some combination of those conditions.

A third possible reason could be that a majority of those working in public health are women, a segment of the population that experienced significant difficulty finding childcare while working from home during the pandemic, Leider noted.

Regarding projections of nearly half of the public health workforce leaving, Leider emphasized that those figures were based on trends continuing as they did during the pandemic. On one hand, the projection is "conservative," because it would mean that older workers who already delayed their retirement would continue to do so, which seems unrealistic, he said. While on the other hand, projections aren't so conservative because two probable drivers of young people leaving -- the pandemic and the Great Renegotiation -- likely will have less influence on workers' decisions in subsequent years.

As for ways to keep people in public health, Leider said staff need better pay and better benefits and to know that they have a "clear path forward" to advance in their careers, "otherwise, young people will see public health as a training ground to go and get a better paying job in the private industry later on. And that's no good for anybody."

Methodology, Limitations

Of the 150,352 staff included from 96 state and local public health agencies, 41,121 were at these agencies in 2017 only, 61,844 were there in 2021 only, and 47,387 were present during both years. This included 79,622 de-duplicated staff from state agencies, 20,056 from big-city health departments, and 5,235 from other local health departments across both years.

Among the study's limitations were that jurisdictions serving fewer than 25,000 people and local health departments with fewer than 25 staff in 2017 were excluded.

Additionally, the method of determining "actual separations" does not provide clear information on why a worker left. Also, Leider added, "we don't know in the data we have if people leave the field versus just their organization."

PH WINS data from 2021 indicate than only 28% of those surveyed suggested they were considering leaving their position for another public health position within government. The caveat there is that many workers left who did not report an intention to leave, and "we have no insight into them," Leider said.

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