Five minutes with former CDC head Rochelle Walensky on school debt forgiveness, hazard pay and the importance of data analysis in medicine.
(Bloomberg) — Talent wars and worker shortages have been hallmarks of the labor market in the past few years and that’s been especially true in health care. For public health workers, the Covid-19 pandemic exacerbated an already acute shortage. Almost half of all employees working at state and local public health agencies left their jobs between 2017 and 2021, according to an analysis published earlier this year. And a hefty portion of staff still report wanting to quit. If the trend continues, the US could lose 129,000 workers over the next two years.
To stop the exodus, former Centers for Disease Control and Prevention chief Rochelle Walensky said that the US public health system needs to step it up in the fight for talent. She knows the field has a tough sell to make — particularly to young doctors, public health school graduates and other skilled workers who face a mountain of school debt and are being courted by more lucrative jobs in science and medicine. Now’s the time to build political will behind recruitment and retention tactics such as debt relief, hazard pay, and work-from-home benefits, she says.
Walensky, who stepped down as director of the CDC on June 30, says addressing the deficit is urgent. Underfunded and under-resourced public health agencies are already ill-equipped to help those who are already underserved, particularly people of color, low-income families and rural communities. And time is of the essence since it’s not a matter of if another pandemic will happen, but when.
Work Shift spoke with Walensky in Atlanta at the CDC’s headquarters the day before she stepped down from its top role. She outlined the challenges facing the US public health workforce in the wake of the end of the Covid-19 public health emergency. (Responses have been edited and condensed.)
The US public health workforce is 80,000 workers short of what’s needed to deliver the bare minimum of services, according to a 2021 study by the de Beaumont Foundation that you often cite. How does the US address that gap?
Now it’s probably even more. When you think about the average doctor coming out of medical school with at least $200,000 to $250,000 of debt, tax-free loan repayment would go a far way to say, “I don’t need to go into a higher-paid job, because in public health my loans are going to be forgiven.”
We train some of the best of the best. We recruit some of the best fellows and then we can’t even retain them. There’s a lot we could do to start bolstering this infrastructure: We could offer danger pay or over-time pay. If you are on the front lines in a health-care center that is treating Ebola, you should probably get danger pay.
What about remote work? Is that really viable given public health work often demands boots-on-the-ground coordination and response at the community level?
All of America — all of the world — is tackling that question. How do we strike the right balance when people have felt quite productive being able to work from home? The real question is: From where does one work? I was doing our daily calls during the Sudan Ebola outbreak, and my team was on the ground, calling from literally a treatment tent. They were not here [at CDC’s headquarters], but they were working. Much of what we do is deployment, whether it’s to Laredo, Texas or Equatorial Guinea.
There’s no question that people have not wanted to deploy, especially to disease-stricken places. So, when they do, should there be an expectation that the next day they have to come into the office? Absolutely not. We’ve hired some extraordinary talent that we otherwise might not have been able to if not for the capacity to do some remote work. We get diversity of talent that way. We get geographic diversity, too, of people who might not want to relocate to Atlanta. It really does open up a pool of incredible expertise.
What we don’t want, frankly, is to have people who earn less because they’re working for the government and in these [public health] jobs to pursue other positions because they want to work-from-home two days a week.
You’ve faced scrutiny from Republican lawmakers who suggest you were working from home rather than out of CDC headquarters in Atlanta. How have you responded to them?
Yes, there’s been scrutiny. But I don’t think everyone really knows that I moved to Atlanta. I do maintain two homes. There’s no question I try to spend my weekends in Boston. But I paid rent and I moved. I know because last week moving out was painful! This is just partisan intent to make a difficult situation — to take shots.
Building morale among CDC staff has been particularly difficult during the pandemic. How have you thought about workforce retention during such a challenging time?
We have to do more to upskill, mentor and cross train. I didn’t realize having trained as an infectious disease and HIV doctor that it’s very hard to cross disciplines in academia. If I wanted to suddenly become a smoking cessation expert, it would be hard. But at the CDC there’s a lot of opportunity to cross pollinate. That gives renewed energy.
As CDC director, you oversaw an agency of 12,500 staffers. What lessons have you taken away in terms of managing a workforce that large?
You have to surround yourself with your dream team that understands what makes you drive, understands tough love and how to deliver it, and can complete your sentences and are all singing from the same song book. That then leads to the next layer of leaders that can do the same thing.
And then I really try to talk to the people. I’ve had these “unsung hero” calls, where early on [in the job], I started calling people who were doing amazing things. “Oh, this person rapelled out of a helicopter.” “Or this person stayed up all night to book flights to deploy people.” I have tried to reach deeply [across the agency] to let people know that I see them.
In what ways do you think the public health workforce has to modernize after the Covid emergency?
Data. Do we have data analysts? Are our schools of public health even teaching data analysis? It’s not just about data entry anymore. The data sets have to be cleaned. They have to be managed. They have to be crossed and linked. Who is doing that? This is where upskilling comes into play.
Read More: CDC Director Walensky Leaves Deep Divides, Weary Staff for Successor to Heal
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