Abstract
We examined factors that influence the decision to join the public health workforce. In this cross-sectional study, we used 2010 secondary data representing 6939 public health workers. Factors influencing the decision to take jobs in public health were significantly associated with specific previous employment settings. Respondents generally rated organizational factors as more influential than personal factors in terms of their decision to work in governmental public health. Leaders should consider tailoring recruitment efforts to maximize job uptake and enhance the potential for long-term retention.
US public health agencies are experiencing ongoing workforce shortages. This situation is expected to worsen with 26% of state public health workers being eligible to retire by 2016.1–5 Strategies for mitigating these shortages require understanding the factors that influence professionals to join the workforce and using this information to guide recruitment and human resources policies.6,7
A 2008 qualitative study of state and local public health employees in 6 communities found that limited opportunities for advancement or additional training or education are unappealing to young workers.8 In an effort to fill the gap in knowledge about public health workforce recruitment, numerous recent calls for more research into the public health workforce have been made.9–11 More systematic information about what matters to individuals considering jobs in governmental public health is an essential step to addressing workforce shortages.10 We used 2010 data from public health workers to contribute to filling these gaps. Study findings may inform changes to workforce recruitment strategies and contribute new insight toward resolving workforce shortages.
METHODS
Secondary data came from the Council on Linkages Between Academia and Public Health Practice’s 2010 survey of public health workers. A full report on the survey methodology is available elsewhere.12 We used data on 6939 persons working in public health organizations at the time of the survey.
We examined factors motivating respondents to take their first jobs with their current governmental public health employers according to respondents’ previous work settings (i.e., health care services, private industry, and public health degree programs). Respondents rated the degree to which they were influenced in their decisions to work in governmental public health by 19 recruitment factors, including 12 organizational and 7 personal factors. We rated each factor individually with an 11-point Likert scale (0 = no influence; 10 = a lot of influence). We used multivariable regression to compare differences between each group and all other respondents, with controls for age, gender, educational level, and jurisdiction. We conducted analyses with Stata version 13.1 (StataCorp LP, College Station, TX).
RESULTS
Multivariable analyses indicated that respondents previously working in health care services were significantly more positively influenced by 6 organizational factors (i.e., specific duties and responsibilities, identifying with the mission of the organization, opportunities for training or continuing education, ability to innovate, flexibility of work schedule, and autonomy or employee empowerment; Table 1). Employees coming from private industry were significantly more positively influenced by competitive benefits and job security. Respondents coming directly from degree programs were significantly more positively influenced by opportunities for training or continuing education, ability to innovate, and future opportunities for promotion. Several factors were also significantly negatively associated with decisions to take jobs, which differed by previous work setting.
TABLE 1—
Multivariable Regression of Organizational Factors Influencing Recruitment to Governmental Public Health: Council on Linkages Between Academia and Public Health Practice’s 2010 Survey of Public Health Workers
| Variables | Specific Duties and Responsibilities, b (95% CI) | Competitive Benefits, b (95% CI) | Job Security, b (95% CI) | Identifying With Mission of Organization, b (95% CI) | Opportunities for Training or Continuing Education, b (95% CI) | Ability to Innovate, b (95% CI) | Flexibility of Work Schedule, b (95% CI) | Immediate Opportunity for Advancement or Promotion, b (95% CI) | Competitive Salary, b (95% CI) | Autonomy or Employee Empowerment, b (95% CI) | Future Opportunities for Promotion, b (95% CI) | Ability to Work From Home, b (95% CI) |
| Previous setting | ||||||||||||
| Health care services | 0.35** (0.9, 0.23) | 0.07 (–0.09, 0.23) | –0.16 (–0.33, 0.01) | 0.33** (0.17, 0.49) | 0.32* (0.07, 0.56) | 0.48** (0.29, 0.66) | 0.84** (0.69, 1.00) | −0.26** (–0.42, –0.09) | −0.61** (–0.87, –0.35) | 0.78** (0.48, 1.08) | −0.28* (–0.50, –0.05) | −0.14 (–0.29, 0.01) |
| Private Industry | −0.29* (–0.50, –0.09) | 0.29** (0.17, 0.40) | 0.36** (0.12, 0.59) | −0.31* (–0.52, –0.09) | −0.12 (–0.32, 0.09) | −0.37** (–0.55, –0.20) | −0.01 (–0.17, 0.16) | −0.12 (–0.30, 0.06) | −0.26** (–0.42, –0.09) | −0.33** (–0.49, –0.17) | 0.09 (–0.10, 0.28) | 0.02 (–0.09, 0.12) |
| Public health degree program | 0.22 (–0.03, 0.47) | −0.05 (–0.39, 0.30) | –0.02 (–0.27, 0.23) | 0.37 (–0.09, 0.83) | 0.66** (0.30, 1.01) | 0.44* (0.08, 0.80) | −0.11 (–0.54, 0.31) | 0.17 (–0.17, 0.51) | 0.07 (–0.26, 0.40) | 0.21 (–0.03, 0.44) | 0.45* (0.07, 0.83) | 0.23 (–0.03, 0.50) |
| Jurisdiction | ||||||||||||
| Local (Ref) | ||||||||||||
| State | 0.15 (–0.14, 0.39) | 0.44** (0.24, 0.65) | 0.58** (0.36, 0.79) | 0.05 (–0.19, 0.28) | −0.06 (–0.23, 0.10) | −0.26 (–0.53, 0.02) | 0.08 (–0.11, 0.28) | 0.19 (–0.14, 0.51) | −0.10 (–0.46, 0.26) | −0.26 (–0.54, 0.02) | 0.22 (–0.29, 0.73) | 0.14 (–0.01, 0.29) |
| National | −0.14 (–0.42, 0.15) | 0.43** (0.23, 0.63) | 0.80** (0.57, 1.04) | −0.30 (–0.60, 0.00) | −0.21 (–0.48, 0.07) | −0.47*(–0.82, –0.12) | −0.48** (–0.73, –0.22) | 0.42** (0.15, 0.70) | 0.02 (–0.48, 0.52) | −0.66** (–0.93, –0.40) | 0.64** (0.29, 0.98) | 0.29* (0.03, 0.55) |
| Education level | ||||||||||||
| High school (Ref) | ||||||||||||
| Associate’s degree | 0.37* (0.03, 0.71) | −0.18 (–0.44, 0.08) | −0.30** ( –0.51, –0.13) | 0.39* (0.09, 0.69) | 0.17 (–0.14, 0.49) | 0.16 (–0.11, 0.43) | 0.66** (0.28, 1.03) | −0.10 (–0.48, 0.27) | −0.60* (–1.01, –0.18) | 0.75** (0.40, 1.10) | −0.35* (–0.62, –0.78) | 0.55** (0.33, 0.76) |
| Bachelor’s degree | 0.94** (0.65, 1.23) | −0.41* (–0.72, –0.11) | –0.65** (–0.88, –0.42) | 0.68** (0.44, 0.91) | 0.11 (–0.12, 0.35) | 0.58** (0.32, 0.84) | 0.46 (–0.04, 0.96) | −0.28 (–0.72, 0.16) | −0.33 (–0.68, 0.03) | 1.48** (1.09, 1.87) | −0.55** (–0.87, –0.23) | 0.55** (0.45, 0.65) |
| Master’s degree | 1.26** (0.87, 1.66) | −0.50** (–0.81, 0.20) | −1.0** (–1.36, –0.76) | 1.09** (0.83, 1.35) | −0.06 (–0.34, 0.22) | 0.96** (0.63, 1.30) | −0.28 (–0.72, 0.16) | 0.01 (–0.45, 0.46) | −0.22 (–0.59, 0.15) | 1.54** (1.11, 1.96) | −0.35* (–0.65, –0.04) | 0.56** (0.36, 0.76) |
| Terminal degree | 1.27** (0.88, 1.66) | −0.95** (–1.27, –0.63) | –1.44** (–1.79, –1.08) | 1.35** (0.94, 1.76) | −0.42* (–0.78, –0.06) | 0.96** (0.49, 1.42) | −0.12 (–0.61, 0.36) | −0.37 (–0.95, 0.21) | −0.50* (–0.92, –0.08) | 1.25** (0.82, 1.68) | −0.78** (–1.14, –0.42) | 0.57** (0.38, 0.76) |
| Gender | ||||||||||||
| Male (Ref) | ||||||||||||
| Female | 0.28** (0.16, 0.39) | 0.19 (–0.12, 0.49) | 0.15 (–0.08, 0.37) | 0.34** (0.14, 0.55) | 0.11 (–0.12, 0.34) | −0.04 (–0.23, 0.14) | 0.58** (0.38, 0.78) | −0.13 (–0.95, 0.21) | −0.07 (–0.27, .013) | 0.16 (–0.10, 0.42) | 0.01 (–0.32, 0.35) | −0.08 (–0.20, 0.04) |
| Age group, y | ||||||||||||
| 18–24 (Ref) | ||||||||||||
| 25–34 | −0.27 (0.99, 0.45) | 0.33 (–0.33, 1.00) | 0.72* (0.18, 1.26) | −0.35 (–0.98, 0.29) | −0.24 (–0.85, 0.38) | −0.43 (–0.98, 0.12) | 0.67 (–0.33, 1.67) | −0.11 (–0.90, 0.69) | 0.07 (–0.59, 0.74) | 0.00 (–0.79, 0.78) | −0.50* (–0.97, –0.03) | −0.11 (–0.51, 0.29) |
| 35–44 | −0.36 (–1.07, 0.35) | 0.06 (–0.68, 0.79) | 0.68* (0.13, 1.23) | −0.39 (–1.01, 0.22) | −0.59 (–1.25, 0.08) | −0.60* (–1.14, –0.07) | 0.24 (–0.78, 1.27) | −0.22 (–0.75, 0.31) | −0.14 (–0.82, 0.54) | −0.22 (–1.01, 0.57) | −0.82** (–1.22, –0.43) | −0.32 (–0.79, 0.15) |
| 45–54 | −0.35 (–1.12, 0.41) | 0.01 (–0.66, 0.67) | 0.51 (–0.05, 1.08) | −0.19 (–0.95, 0.56) | −0.83* (–1.42, –0.23) | −0.77* (–1.33, –0.21) | −0.18 (–1.16, 0.79) | −0.54* (–1.05, –0.02) | −0.60 (–1.27, 0.06) | −0.46 (–1.22, 0.30) | −1.32** (–1.71, –0.9*4) | −0.45 (–0.93, 0.03) |
| 55–64 | −0.37 (–1.15, 0.39) | −0.27 (–0.93, 0.40) | 0.32 (–0.24, 0.87) | −0.06 (–0.74, 0.62) | −0.91** (–1.47, –0.35) | −0.63 (–1.26, –0.00) | −0.38 (–1.42, 0.66) | −0.73* (–1.29, –0.17) | −0.77* (–1.51, –0.02) | −0.41 (–1.14, 0.32) | −1.67** (–2.13, –1.21) | −0.54* (–1.02, –0.06) |
| ≥ 65 | −0.25 (–0.97, 0.47) | −0.47 (–1.52, 0.58) | –0.20 (–1.01, 0.60) | 0.26 (–0.54, 1.06) | −1.01** (–1.62, –0.40) | −0.37 (–0.93, 0.19) | −0.45 (–1.60, 0.70) | −1.51** (–2.13, –0.90) | −1.46* (–2.48, –0.45) | −1.06* (–1.78, –0.34) | −2.15** (–2.84, –1.46) | −0.96** (–1.47, –0.46) |
Note. CI = confidence interval. Public health degree program comprises all respondents who indicated coming directly from a bachelor’s or master’s public health degree program into governmental public health. Local jurisdiction comprises local, tribal, district, and regional jurisdictions. National jurisdiction comprises national and multistate jurisdictions. Terminal degree comprises MD, JD, and doctoral degrees.
*P < .05; **P < .01.
With regard to personal factors, respondents originating in health care services rated “personal commitment to public service” and “wanted a job in the public health field” as significantly more influential (Table 2). Respondents coming from public health degree programs were significantly more likely than all other respondents to cite “personal commitment to public service,” “wanted a job in the public health field,” and “wanted to work with specific individuals” as factors influencing their decisions.
TABLE 2—
Multivariable Regression of Personal Factors Influencing Recruitment to Governmental Public Health: Council on Linkages Between Academia and Public Health Practice’s 2010 Survey of Public Health Workers
| Variables | Personal Commitment to Public Service, b (95% CI) | Enjoy Living in the Area, b (95% CI) | Wanted a Job in the Public Health Field, b (95% CI) | Wanted to Live Close to Family and Friends, b (95% CI) | Needed a Job, Did Not Matter Whether It Was in Public Health, b (95% CI) | Wanted to Work With Specific Individuals, b (95% CI) | Family Member or Role Model Was or Is Working in Public Health, b (95% CI) |
| Previous setting | |||||||
| Health care services | 0.23* (0.01, 0.45) | −0.19 (–0.40, 0.02) | 1.07** (0.81, 1.33) | −0.11 (–0.35, 0.13) | −1.45** (–1.74, –1.16) | 0.12 (–0.08, 0.31) | 0.02 (–0.18, 0.21) |
| Private industry | −0.60** (–0.81, –0.39) | −0.05 (–0.29, 0.19) | −0.43** (–0.63, –0.23) | −0.15 (–0.36, 0.06) | −0.01 (–0.26, 0.24) | −0.51** (–0.67, –0.36) | −0.08 (–0.32, 0.16) |
| Public health degree programs | 0.56** (0.19, 0.93) | 0.19 (–0.16, 0.53) | 2.44** (2.02, 2.85) | 0.18 (–0.18, 0.54) | −1.38** (–1.85, –0.91) | 0.44* (0.12, 0.76) | −0.03 (–0.29, 0.23) |
| Jurisdiction | |||||||
| Local (Ref) | |||||||
| State | −0.14 (–0.43, 0.14) | 0.24 (–0.24, 0.73) | −0.32 (–0.73, 0.10) | 0.33 (–0.08, 0.74) | 0.21 (–0.23, 0.66) | 0.15 (–0.15, 0.46) | 0.09 (–0.16, 0.34) |
| National | −0.32* (–0.57, –0.07) | −0.40 (–0.91, 0.12) | −0.55** (–0.91, –0.20) | −0.46** (–0.74, –0.18) | 0.49* (0.11, 0.87) | −0.21* (–0.39, –0.03) | 0.24* (0.04, 0.44) |
| Education level | |||||||
| High school (Ref) | |||||||
| Associate’s degree | 0.21 (–0.10, 0.53) | 0.33* (0.10, 0.56) | 0.36 (–0.02, 0.75) | 0.27* (0.02, 0.51) | −1.05** (–1.50, –0.60) | 0.21 (–0.08, 0.51) | −0.46* (–0.83, –0.09) |
| Bachelor’s degree | 0.54** (0.19, 0.90) | 0.23 (–0.05, 0.51) | 0.68** (0.28, 1.07) | 0.14 (–0.15, 0.44) | −0.80** (–1.09, –0.50) | 0.00 (–0.26, 0.25) | −0.58** (–0.89, –0.27) |
| Master’s degree | 1.25** (0.95, 1.55) | 0.04 (–0.28, 0.36) | 1.24** (0.79, 1.68) | −0.31 (–0.67, 0.06) | −1.13** (–1.51, –0.75) | 0.07 (–0.25, 0.39) | −0.80** (–1.22, –0.39) |
| Terminal degree | 1.13** (0.63, 1.63) | 0.40 (–0.20, 1.00) | 1.25** (0.67, 1.84) | −0.05 (–0.56, 0.47) | −1.53** (–2.12, –0.94) | −0.11 (–0.49, 0.27) | −0.95** (–1.40, –0.50) |
| Gender | |||||||
| Male (Ref) | |||||||
| Female | 0.14 (–0.26, 0.54) | −0.21 (–0.50, 0.07) | 0.49** (0.34, 0.65) | 0.38* (0.09, 0.66) | −0.16 (–0.54, 0.22) | 0.37** (0.18, 0.56) | −0.23 (–0.48, 0.01) |
| Age group, y | |||||||
| 18–24 (Ref) | |||||||
| 25–34 | −0.68* (–1.18, –0.19) | 0.43 (–0.33, 1.20) | −0.85* (–1.62, –0.09) | 0.05 (–0.91, 1.01) | −0.53 (–1.14, 0.09) | −0.53 (–1.14, 0.09) | −0.99* (–1.81, –0.16) |
| 35–44 | −0.69* (–1.20, –0.18) | 0.48 (–0.34, 1.30) | −1.11** (–1.80, –0.43) | 0.12 (–0.78, 1.03) | −0.55 (–1.23, 0.13) | −0.39 (–1.13, 0.35) | −1.12* (–1.91, –0.32) |
| 45–54 | −0.55* (–1.02, –0.09) | 0.47 (–03.4, 1.28) | −1.10** (–1.84, –0.37) | −0.14 (–1.05, 0.77) | −0.74 (–1.54, 0.07) | −0.55 (–1.33, 0.22) | −1.15* (–1.98, –0.32) |
| 55–64 | −0.59* (–1.04, –0.14) | 0.52 (0.18, 1.22) | −0.87* (–1.59, –0.15) | −0.23 (–1.10, 0.63) | −0.87* (–1.71, –0.04) | −0.67 (–1.41, 0.08) | −1.32** (–1.99, –0.66) |
| ≥ 65 | −0.67 (–1.39, 0.04) | 0.70 (–0.15, 0.73) | −1.28** (–2.1, –0.45) | −0.39 (–0.56, 0.47) | −0.80 (–1.76, 0.16) | −0.60 (–1.60, 0.40) | −1.00 (–1.99, –0.12) |
Notes. CI = confidence interval. Public health degree programs comprises all respondents who indicated coming directly from a bachelor’s or master’s public health degree program into governmental public health. Local jurisdiction comprises local, tribal, district, and regional jurisdictions. National jurisdiction comprises national and multistate jurisdictions. Terminal degree comprises MD, JD, and doctoral degrees.
*P < .05; **P < .01.
DISCUSSION
Key findings indicate that the settings from which governmental public health employees came were significantly associated with ratings of organizational and personal factors in terms of decisions to join governmental public health. The most influential factors were specific duties and responsibilities, competitive benefits, job security, and identifying with the mission of the organization—factors within organizations’ control and for which leaders can develop strategies. Therefore, whenever possible, agencies should maintain or enhance benefits, make their recruitment value known to decision-makers, and highlight benefits in job postings.
Respondents coming from health care services, the majority of whom were nurses, tended to highly rate those factors that were associated with daily work (e.g., flexible schedules and employee autonomy). To attract these employees, agencies might emphasize these job characteristics and facilitate flexible scheduling. Respondents coming from private industry, who mainly serve as managers or administrators, administrative support professionals, environmentalists, and nurses, were more motivated by job security and competitive benefits. Public health agencies seeking to recruit high-quality employees in these positions should be prepared to compete with private industry on these factors.
This study reinforces the importance of opportunities for advancement and access to continuing training or education to individuals coming from degree programs. These respondents, many of whom work as managers, administrators, epidemiologists, statisticians, and data analysts, have already made substantial investments toward their public health careers by obtaining degrees in the field. When considering employment, they may seek opportunities for a return on that investment through promotion and advancement. Agencies should establish potential career paths for entry-level positions and create learning environments supportive of gaining new skills and experience on the job.4 With the increasing supply of public health–trained graduates (69% increase in the past decade), public health agencies could explore ways to more successfully recruit these individuals.3,5–7 A limitation of this study is that it surveyed current workers and does not include perspectives of those who had not yet entered the public health workforce. Future research should seek to fill this gap and address other issues also pertinent to retention.
Acknowledgments
The authors would like to thank the Council on Linkages Between Academia and Public Health Practice for the use of their data.
Human Participant Protection
Institutional review board approval was received for this study from Tulane University.
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