Karen Seifert has watched year after year as colleagues in the California Department of Public Health (CDPH) have left for higher-paying careers in the private sector.
Later this month, she’ll join them.
Seifert’s new job at a private Bay Area hospital pays close to $200,000 — double what she earned as a state nurse tasked with auditing medical facilities to ensure patients were receiving adequate care.
“I’m sad to leave my job,” Seifert said. “I wouldn’t be leaving if I could make it. But I can’t financially.”
After the COVID-19 pandemic shined a light on the often invisible, but essential, work of those in the public health sector, California made it a priority to reverse decades of underinvestment. It set aside hundreds of millions of dollars to increase staffing.
But retaining professionals like Seifert, who worked tirelessly on the pandemic’s frontlines, while trying to recruit thousands of skilled workers to fill new roles in state and local public health agencies will be a daunting task.
“You have a lot of people with (public health) degrees, but the competition for them is really fierce,” said Heather Krasna, an associate dean at Columbia University’s School of Public Health. “If you don’t pay people enough, you won’t be able to recruit them or they won’t stay.”
About 24% of the jobs across CDPH were vacant in June — nearly 10% higher than six years earlier, according to the State Controller’s Office.
Over those same six years, the department added more than 1,200 positions, including more than 750 in just the past two years. Its budget jumped from $3.2 billion to $5.5 billion.
Most of the vacancies are for Associate Governmental Program Analysts, a broad role in state government that varies from department to department.
At CDPH, for example, someone in this role might oversee and approve spending plans for local health departments who’ve received state and federal grants for infectious disease research. Another analyst might oversee asset management and inventory for the department’s financial branch.
CDPH also needs more Health Facilities Evaluator Nurses, such as Seifert, and Health Program Specialists, described by the state as “critical to the department’s basic mission.”
Should the thousands of positions at the state and county level remain unfilled, the system’s ability to perform its basic missions — let alone combat the next pandemic — could be at risk.
Public health workers are principal players in curbing the fentanyl crisis. They convince reluctant residents to get vaccinated. They inspect restaurants and educate the public about the risks of mosquito-borne diseases, including recently reported cases of Malaria. And that’s just part of their portfolio.
“Public health is about preventing people from getting sick in the first place,” said Brad Pollock, chair of the UC Davis Department of Public Health Sciences. “If you don’t have enough people working in the agencies, then these issues are going to get ignored, which means more people get hurt and compromise their health.”
COVID pandemic spurs investment in public health
In the wake of COVID-19, federal and state officials vowed to strengthen the country’s public health system.
President Joe Biden’s 2021 American Rescue Plan earmarked $7.4 billion for state and local public health workers, including a new $3 billion grant program to directly support state and local public health agencies. The funds will assist with recruiting, hiring and training epidemiologists, nurses, contact tracers and other health workers, according to a report from the Legislative Analyst’s Office.
That same year, California launched a major study of its public health system. Based on the recommendations of The “Future of Public Health” working group, the state committed an additional $300 million to local public health agencies, and $100 million for 404 new positions in the CDPH.
The agency declined repeated requests for an interview with The Sacramento Bee about this story.
An emailed statement, sent from the communications office on behalf of spokesperson Ali Bay, said the department’s high vacancy rate is “inflated” due to the influx of positions created with the new funds. The email also said the state’s months-long hiring process, which includes multiple rounds of exams and interviews, keeps the agency from filling positions in a timely manner.
According to an analysis of federal data by the Rockefeller Institute of Government, 2021 marked the highest rate of job openings in state and local public agencies, including public health, over the past 20 years.
“When you get a huge influx all at once in the number of authorized positions, that can sometimes take years to fully fill,” said William Owens, an analyst for the Legislative Analyst’s Office. “… Looking year over year, we would expect vacancy rates to generally decline as positions get filled.”
Still, openings have been hard to fill and public health officials worry that elected officials are already beginning to undervalue the sector’s workforce, as they say was the case prior to the pandemic.
Gov. Gavin Newsom, for instance, proposed paring back $49.8 million from public health workforce training and development programs in January as a way to bridge the state’s budget gap. Although he eventually withdrew the item in the state’s final version of the 2023-24 budget, public health funding still took a hit at the federal level.
The debt ceiling deal reached between President Joe Biden and House Speaker Kevin McCarthy in late May clawed back $400 million in workforce grants for local public health workers who fight infectious diseases, including sexually transmitted infections.
“It’s a critical alarm for us,” said Megan McClaire, chief deputy director of the Los Angeles Public Health Department, which was slated to receive $6.6 million in grants annually over the next two years. “We’re hoping that this is the worst of it.”
Expanding California’s public health workforce will take time
Even with the post-pandemic surge in funding and expanded public health programs at universities, such investments are not going deliver immediate, “microwave results,” said Sara Bosse, director of the Madera County Department of Public Health.
“They’re going to be slow-cooked, pull-apart tri-tip results,” she said. “It’s going to be worth the wait.”
Many health professionals took early retirement or left the field, burned out by the pandemic-era’s long hours and low pay, as well as trauma from intimidation and harassment.
More than half of U.S. public health workers reported at least one symptom of post-traumatic stress disorder as a consequence of the COVID-19 pandemic, according to a 2022 survey of nearly 45,000 state and local employees. They said they were contemplating leaving because of high levels of stress.
Meanwhile, the majority of graduates with public health degrees are going into the private sector, where funding tends to be more stable and salaries are higher. Only about a fifth of those with public health degrees are pursuing a career in government, according to the Association of Schools and Programs of Public Health.
Awais Khan, 29, of Sacramento, recently found himself making that decision. Khan graduated from UC Davis with a Masters in Public Health in 2021 and now works as a clinical educator for Dignity Health, the California-based non-profit hospital system.
As his time at UC Davis wound down, Khan considered a range of career opportunities, including public health, healthcare and academia. He was offered two positions – one at UC Davis and another at Dignity Health. The position at Dignity paid almost double what he was offered at the university and what he saw listed on public agency job boards.
“I loved both of them honestly but I couldn’t continue with Davis knowing that I could do that much better somewhere else,” Khan said, adding that he’s “never looked back.”
A history of underfunding for public health
State and local public health agencies were thrust into the pandemic after years of chronic underfunding. Federal and state support had been flat for a decade, according to the study by CDPH’s Future of Public Health Workgroup. Across the country, funding dropped 16% over the past decade and agencies lost a quarter of their workforce, the report also found.
The leader of Sacramento County’s public health department said a history of under-investment left the agency unprepared.
Most of the responsibility for infection control fell to a handful of people on the core public health team, who ended up working long hours and through the weekends. The department also relied heavily on volunteer medical professionals to staff test sites and vaccination clinics, as well as answer phones and emails.
“There were just a few of us that had the expertise and experience to be able to do the work that was required,” said Dr. Olivia Kasirye, public health officer for Sacramento County. “I think that contributed to a lot of exhaustion and burnout that we were seeing.”
Felicia Barbato, who has worked as a health facilities evaluator nurse for CDPH for 12 years, said the stress of the COVID-19 pandemic exacerbated the “revolving door” of people leaving her division.
“I really worry about what’s going to happen during the next pandemic,” said Barbato, who serves on the bargaining committee for SEIU Local 1000, which is currently negotiating a new contract with hopes of securing unprecedented raises.
The base salary range for state evaluator nurses is a little under $78,000 to just over $102,000, according to CalHR records. By contrast, the mean wage for a private registered nurse in the San Francisco and East Bay area was just under $165,000 in 2022, according to the Bureau of Labor Statistics. In the Sacramento area, it is about $145,000.
When colleagues leave, as Seifert plans to, Barbato said she ends up shouldering their unfinished work. And now that her workload is higher, Barbato has less time to dedicate to each audit or complaint before having to move on to the next one. The time crunch forces her to sometimes “cut corners” and not make as many follow-up calls or review additional documents.
“There’s no end. You never get to a point where you go, ‘Oh, I got all my work done,’” Barbato said. “It’s incredibly demoralizing.”
Seifert understands the additional weight her colleagues will have to carry in her absence. But as a recently divorced single mother, she said the career move is necessary to plan for her and her children’s future.
“I don’t really have a choice,” she said. “Financially, I have to go.”