The loss of public health workers is a problem seen nationwide, according to a study by the de Beaumont Foundation, a public health-focused philanthropy based in Bethesda, Maryland. The study should sound alarm bells about funding and staffing needs nationwide, said Foundation CEO Brian Castrucci.
The study found that 46% of state and local public health employees left their jobs between 2017 and 2021.
“Imagine going into a war with China,” with nearly half of the military quitting, Castrucci said. “There would be congressional hearings. There would be a draft. But there has never been a foreign nation that has taken more American lives… than COVID.
Missing health workers leaves Georgia and other states ill-prepared to deal with another pandemic or public health emergency. More immediately, basic preventive health services provided by public health workers – such as regular vaccinations, maternal care and drug abuse prevention – must be restored to pre-pandemic levels, or even increased, according to the experts.
Public health encompasses programs that guarantee access to health care. Of Georgia’s 159 counties, at least 66 do not have a pediatrician, which means local health departments are key to ensuring children are immunized, according to the state Department of Public Health. Public health workers also inspect restaurants and swimming pools, examine babies for conditions that may affect their growth and development, and record vital statistics such as births and deaths.
The Beaumont study authors say the condition of public health workers is worse than following previous health emergencies such as HIV and Ebola. Yet simultaneously, they say, the need to regroup and prepare for the next emergency is much greater.
“We are more vulnerable to infectious disease today than we were at the start of this COVID pandemic,” Castrucci said.
Some of the biggest losses of public health workers in Georgia have been in key roles: 625 nurses, 36 lab workers and nine doctors have left their jobs throughout the pandemic. Another 462 workers categorized as healthcare workers, including nutritionists, medical assistants and pharmacists, have also left in the past three years.
Some of these positions have been filled in the past three years, but not all. Funding for some vacancies has been exhausted.
As bad as it is, it was even worse in 2021 when the turnover rate reached 38% – which may have been an all-time high of employee loss for health districts. The year before the pandemic, the turnover rate was 21%
In an interview with The Atlanta Journal-Constitution about the loss of staff, Dr. Kathleen Toomey, chief of the Georgia Department of Public Health, spoke about the demands of public health work during the pandemic.
“Public health workers are literally working day and night to protect communities, whether through epidemiology and monitoring disease trends, or raising awareness for various health issues, not just COVID, but for d other health problems. And they always did, but it never got that kind of exposure,” Toomey said.
The cumulative effect of working wave after wave of coronavirus outbreaks has been profound. By fall 2021, vaccines were widely available and hopes were high for bringing the pandemic under control. But then a more dangerous coronavirus variant – delta – arrived and deaths increased.
“We are more vulnerable to infectious disease today than we were at the start of this COVID pandemic.”
– Brian Castrucci, CEO of the Beaumont Foundation
“I remember visiting districts to see the team collectively to see how the team was doing and I could tell just by looking at their faces how exhausted they were,” Toomey said.
But nothing was as overwhelming as what a health district told Toomey in August 2021 during a mobile vaccination event in northern Georgia. DPH nurses were doing vaccinations when a group of people showed up to protest the shooting. They shouted at the workers, even throwing stones at them. Other districts reported similar harassment at other vaccination sites.
“And that was just for me, so awful,” Toomey said. “That these (people) are our team working night and day in the cold, in the heat, and that’s how they have been welcomed by some communities.”
The challenges faced by public health workers across the country are well documented. According to a CDC analysis published in July 2022, 44% of public health workers said they plan to leave their jobs in the next five years.
O’Sullivan, the district nurse director and acting clinical director for the Dekalb County Board of Health, said that with full staff, her office could easily serve 2,000 more patients than they do.
In addition to burnout, she cites pay — county officials have reported a starting salary for a registered nurse of $56,000 — well below what hospitals pay and less than half of what some nurses could earn working with temp agencies during coronavirus surges. But even with higher salaries in hospitals, they too are suffering from nursing shortages caused by burnout.
Toomey told the AJC she believes salary increases approved by Gov. Brian Kemp and the Legislature, which went into effect last year, have helped slow and reverse the trend line of worker departures.
All state employees, including DPH workers, got an annual salary increase of $5,000. The state has also earmarked $16.3 million for additional pay raises for frontline workers, including epidemiologists, environmental health specialists and public health nurses, to make them more competitive. with salaries from hospitals and the Centers for Disease Control and Prevention.
For his office O’Sullivan is doing what the wealthiest hospital chains have done: partnering with nursing schools to train students and hopefully attract them. “I say, ‘Imagine a life where we can keep people from going to the emergency room. Just imagine a life where your community is healthy and people walk, run and ride their bikes when they come to visit.
When the students hear this, she says, “You can see the light bulb go on.