Laboratories with no one to manage them: why public health workers are fleeing the field

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There were days, nights and weekends in the first few months of the pandemic when Denise Von Bargen was the only person performing covid testing at the Ventura County Public Health Laboratory. She used to have eight or nine employees to help her, but one by one they were all retired or gone to other jobs.

Like other California public health laboratories responsible for large-scale disease testing and surveillance, the Ventura Lab has received federal and state funding for new equipment and short-term hires to bolster its response to covid-19. But the funding was temporary, and Von Bargen, the manager, could not use it to increase the salaries of her employees, who could earn more money by working less in the private sector.

Operations deteriorated further last month, after the lab lost its license to perform routine tests that check the county’s seawater for deadly bacteria. It appears to be a clerical error: the license documents have changed and the staff usually responsible for submitting the application have resigned.

“The greatest threat to [public health labs] right now it’s not the next emerging pathogen, “said Donna Ferguson, director of the Monterey County public health laboratory,” but the labs are closing due to understaffing. “

Across California, public health departments are losing experienced workers to retirement, burnout, partisan politics, and higher paying jobs. Even before the coronavirus pandemic stifled departments, staff numbers had shrunk along with county budgets. But the decline has accelerated over the past year and a half, even as millions of dollars in federal funds have poured in. Public health nurses, microbiologists, epidemiologists, health workers and other staff fighting infectious diseases like TB and HIV, restaurants and working to keep communities healthy are abandoning the field. This is a problem that temporary funding increases cannot solve.

Brain drain undermines community health surveillance in ways big and small. People who work in public health laboratories, for example, perform complex tests for fatal diseases that require specialized training that most commercial laboratories lack. Although their work is largely invisible to the public, it touches almost every aspect of society. Public health laboratories take samples of shellfish to make sure they are safe for consumption. They are monitoring drinking water and developing tests for emerging health threats such as antibiotic resistant viruses. They also test for serious illnesses, such as measles and covid. And they usually do it at a fraction of the cost of commercial labs – and faster.

Directors of public laboratories are generally required to hold a doctorate and must have the appropriate credentials for their laboratories to be certified.

Ferguson said he felt like there was a revolving door in his lab as recent college graduates join for a few months to gain experience, with a starting salary of $ 19l hour, then move on to higher paying jobs in hospitals. It is virtually impossible to hire qualified staff for part-time positions, such as those created with temporary funding bursts, due to the training required. In California, many laboratory positions require a public health microbiologist certificate from the Department of Public Health.

California has 29 public health laboratories, up from nearly 40 before the 2008 recession. A laboratory in Merced has been without a director for months and may close soon. Although there is no official tally for the reduction of the field, almost all laboratories are short of key staff members, said Godfred Masinde, president of the California Association of Public Health Laboratory Directors, laboratory director for San Francisco and replacing as laboratory director. in Fresno County. Dozens of public health microbiologist positions are vacant statewide.

“We have funding now; we have material, ”Masinde said. “But we don’t have the staff to operate the equipment.

His San Francisco lab typically performs 100,000 tests for gonorrhea and chlamydia each year, and 150 to 200 tests for syphilis each day, Masinde said. While California also has state-run labs, he noted, they just don’t have the capacity to take over for closed county labs.

Counties are also struggling to recruit and retain staff for other positions. An informal survey by California directors of public health nursing found that at least 84 public health nurses have left their jobs since March 2020. Many have retired, part of an aging workforce who struggles to recruit nurses in an obscure field requiring 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 births, work on early childhood development, and help respond to infectious disease outbreaks. “So providing a more holistic approach and also addressing the social determinants of health,” said Michelle Curioso, director of public health nursing for Kern County and chair of the California directors of public health nursing. Like laboratory staff, public health nurses must be specially certified to work in public health services.

In California, the average annual salary for a registered nurse is over $ 120,000, according to the Bureau of Labor and Statistics, while public health nurse job postings in several counties offer salaries starting around. of $ 65,000.

Nursing shortages have been particularly severe in rural California. In Butte County, several public health nurses retired earlier than expected, said Monica Soderstrom, director of public health care for Butte, and two young nurses who went on maternity leave decided not to. come back after finding better paying jobs. “It has been difficult to fill our vacancies,” said Soderstrom, “as we compete with hospitals and clinics that pay enrollment premiums due to covid staffing needs.”

The loss of the county’s top health officials – the department directors and health workers responsible for leading the pandemic response in local communities – has been particularly striking, reflecting a sobering national trend. Seventeen of California’s 58 counties have lost their health worker since March 2020, and at least 27 have lost a director or deputy director. The director and deputy director of the State Department of Public Health also resigned.

The collective expertise lost with these departures is difficult to overestimate.

Take, for example, Dr. Robert Bernstein, who moved to California in 2018 to become a health worker for rural Tuolumne County after more than two decades of public health work for the Centers for Disease Control and Prevention, The Organization. World Health and Florida. Ministry of Health, among other organizations. In California, health workers must be physicians and are responsible for enforcing state and local laws and protecting the public from health risks.

In March 2020, as the pandemic made its first wave across the state, Bernstein was asked to resign by the county’s supervisory board. According to Bernstein, supervisors were unhappy that he ordered rabies vaccines for two children bitten by bats – including one bat that tested positive for rabies – against their parents’ wishes. The county declined to comment on the matter, saying it is legally prohibited to discuss personnel matters.

Bernstein moved to Butte County and became a health worker after his predecessor resigned in May 2020. Bernstein saw his colleagues in neighboring counties facing threatening public threats because of covid-related health orders, start to resign, apparently one after another. In some communities, public health workers have also faced rude and mocking pushbacks from elected officials, even as law enforcement officials openly refused to implement their health guidelines.

“You might, as a public health worker, have the authority and responsibility to recommend or even impose certain public health actions,” Bernstein said, “but you need a partnership with those who have the authority to carry out [them] outside.”

In September of that year, Bernstein was disillusioned with the dynamics and the idea that his family could get drawn into covid resentment. “I just decided that as a 16-year-old father of triplets, I don’t need me or the children to be threatened in any way, and I can do a good job of public health at the level of state or federal or even international level, ”Bernstein said.

Michelle Gibbons, executive director of the County Health Executives Association of California, said local departments are seeing the cascading effects of these high-level defections, with middle managers reluctant to take leadership positions, although senior officials may demand salaries over $ 200,000. .

The state budget this year included $ 3 million for an assessment of California’s public health infrastructure, and public health leaders believe this will show staffing and training to be major issues. . Yet the budget did not include additional long-term funding for health services. Amid negative headlines and a lobbying blitz, Gov. Gavin Newsom has finally agreed to add $ 300 million a year for public health, with a handshake deal not set to begin until July.

Advocates warn the timing is important: many public health workers are hanging on to watch their communities go through the pandemic and will leave once it subsides. “We’re going to see a huge wave of retirements when this is over,” said Kat DeBurgh, executive director of the Health Officers Association of California.

In Ventura County, Von Bargen, exhausted by the pandemic, has been trying to retire for a year. She didn’t want to give up the lab she had fought so hard to keep open for, and it took her that long to find a replacement. His successor will start early next year, when Von Bargen will also join the ranks of former public health workers.

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

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