The early months of the pandemic were days, nights, and weekends when Denise von Bargen was the only person doing covid tests at a public health laboratory in Ventura County. She once had eight or nine employees helping her, but one by one, they all retired or left for another job.
Like other public health laboratories in California tasked with large-scale testing and disease surveillance, Ventura has received federal and state money for new equipment and short-term hiring to support its response to covid-19. But the funding was temporary, and Von Bargen, the director, could not use it to raise the salaries of her employees, who could earn more money by doing less work in the private sector.
Operations deteriorated further last month after the lab lost its license to conduct routine tests that test the county’s ocean waters for deadly bacteria. It looks like it was a technical mistake: the licensing documents changed and the staff normally responsible for filing the application quit.
“The biggest threat [public health labs] “This is not the next emerging pathogen right now,” said Donna Ferguson, director of the Monterey County Public Health Laboratory, “and laboratories are closing for lack of staff.”
Across California, health departments are losing experienced employees to retirement, attrition, party politics, and high-paying jobs. Even before the coronavirus pandemic strangled departments, headcounts were dwindling along with county budgets. But the recession has accelerated over the past year and a half, despite receiving millions of dollars in federal money. Public health nurses, microbiologists, epidemiologists, health workers and others who fight infectious diseases such as tuberculosis and HIV, conduct restaurant inspections, and work to maintain public health are leaving the field. This is a problem that a temporary increase in funding cannot solve.
The brain drain undermines public health surveillance on a large and small scale. For example, people who work in public health laboratories conduct sophisticated tests for fatal diseases that require specialized training that most commercial laboratories lack. Although their work is largely invisible to the public, they affect almost every aspect of society. Public health laboratories take samples of shellfish to ensure they are safe to eat. They monitor drinking water and develop tests to detect new health threats such as antibiotic-resistant viruses. They also check for serious illnesses such as measles and covid. And they usually do it for a fraction of the cost of a commercial lab — and faster.
Public laboratory directors are usually required to hold a doctorate and must have the appropriate credentials to certify their laboratories.
Ferguson said her lab seems to have a revolving door as recent college graduates join her for months to gain experience, starting at $ 19 an hour, and then moving on to higher-paying hospital jobs. It is almost impossible to hire qualified staff for part-time positions, such as those created with temporary funding increases due to the training required. In California, many laboratories require a Public Health Microbiologist certification from the Department of Health.
California has 29 public health laboratories, up from 40 before the 2008 recession. The laboratory in Mercedes has been without a director for several months and may soon be closed. While there is no official estimate of how much the field has shrunk, nearly every laboratory is missing key staff, said Godfred Masinde, president of the California Association of Public Health Laboratory Directors, director of the San Francisco laboratory and alternate director of the laboratory. in County Fresno. Dozens of public health microbiologists are vacant across the state.
“We have funding now; we have the equipment, ”Masinde said. “But we don’t have the staff to work with the equipment.”
His San Francisco lab routinely performs 100,000 tests for gonorrhea and chlamydia every year and 150 to 200 tests for syphilis every day, Masinde said. He noted that while California also has government labs, there is simply no way for them to fill the gaps in shuttered county labs.
It is also difficult for counties to recruit and retain staff in other positions. An informal survey by California public health directors found that at least 84 public health nurses have quit their jobs since March 2020. Many have retired, part of the graying workforce, faced with the challenge of hiring nurses in an obscure field that requires special accreditation.
Public health nurses receive training in nursing and public health and often work with families or communities, not just individual clients. They visit the home after childbirth, work on early childhood development, and help respond to outbreaks of infectious diseases. “This provides a more holistic approach and addresses the social determinants of health,” said Michelle Curioso, director of nursing for Kern County and president of the California Director of Nursing. Like laboratory staff, public health nurses must be specifically certified to work in public health departments.
According to the Bureau of Labor and Statistics, California has a registered nurse’s average annual salary of over $ 120,000, while public health nurse job advertisements in several counties offer salaries starting at $ 65,000.
The nursing shortage was particularly acute in rural California. In Butte County, several nurses retired earlier than expected, said Monica Soderstrom, Butte’s director of nursing, and two young nurses who took maternity leave decided not to return after finding higher-wage jobs. “It was difficult to fill our vacant positions,” Soderstrom said, “as we compete with hospitals and clinics that pay login bonuses due to staffing requirements.”
The loss of top district health leaders – department directors and health officials tasked with leading the pandemic response in local communities – was particularly dramatic, reflecting a sobering national trend. Since March 2020, seventeen of California’s 58 counties have lost their healthcare workers, and at least 27 have lost a director or assistant director. The director and deputy director of the State Department of Health also resigned.
It is difficult to overestimate the collective experience lost as a result of these departures.
Take, for example, Dr. Robert Bernstein, who moved to California in 2018 to become a health care provider in rural Tuolumn County after more than two decades of public health work at the federal Centers for Disease Control and Prevention, the World Health Organization and Florida. Department of Health, among other organizations. In California, healthcare professionals must be physicians and are responsible for complying with state and local laws and protecting the public from health hazards.
In March 2020, as the pandemic was making its first spike in the state, the county supervisory board asked Bernstein to step down. Bernstein said executives were upset that he ordered rabies vaccines for two children bitten by bats, including a bat that tested positive for rabies, against their parents’ wishes. The district declined to comment on this issue, saying that the discussion of personnel issues is prohibited by law.
Bernstein moved to Butte County and became a health care provider after his predecessor retired in May 2020. Bernstein watched as colleagues in neighboring counties, faced with public threat from covid-related health orders, began to resign, seemingly one by one. In some communities, public health officials have also faced harsh and derisive opposition from local elected officials, even as law enforcement leaders openly refused to comply with their health prescriptions.
“You, as a public health officer, might have the authority and responsibility to recommend or even prescribe certain public health actions,” Bernstein said. [them] from.”
By September of this year, Bernstein had become disenchanted with the dynamics and the notion that his family could be drawn into malice. “I just decided that as a dad of sixteen-year-old triplets, I didn’t need to be threatened in any way or the children, and I could do well in public health at the state, federal, or even international levels. level, “Bernstein said.
Michelle Gibbons, executive director of the California County Health Executives Association, said local departments see the cascading consequences of high-level defections, with middle managers hesitating to move into leadership positions, even though senior officials can earn more than $ 200,000 in salaries. …
The state budget this year included $ 3 million to assess California’s public health infrastructure, and public health officials believe this will show staffing and training are major challenges. However, the budget did not include additional long-term funding for health departments. Amid negative headlines and a wave of lobbying, Gov. Gavin Newsom eventually agreed to add $ 300 million a year in health care, and the handshake agreement should not begin until July.
Advocates warn that timing matters: many public health workers look to see their communities during the pandemic and leave when it dies down. “When this is over, we will have a huge wave of retirement benefits,” said Kat DeBourg, executive director of the California Association of Medical Professionals.
In Ventura County, von Bargen, plagued by the pandemic, has been trying to retire for a year. She didn’t want to leave the lab she had fought so hard for to stay open, and it took so long to find a replacement. Her successor will begin work early next year, at which time von Bargen will also join the ranks of the former health officials.
This story was produced by KHN, publisher of California Healthline, an independent editorial service for the California Health Foundation.