Source: http://www.sltrib.com/news/ci_8599898

Public health work force shrinking in Utah, across nation
By Lisa Rosetta
The Salt Lake Tribune
Article Last Updated: 03/17/2008 06:33:56 AM MDT

When disease or disaster strikes, public health officials will respond.
But in Utah and other states with a public health work-force shortage, they may do it at the expense of their "regular" jobs - such as restaurant and septic tank inspections - putting the public at risk for other problems.
A report released last week by The Association of State and Territorial Health Officials (ASTHO) said public health department staffs across the country are shrinking, making it tougher for them to respond to health threats.
"There is, in my mind, a crumbling of the public health infrastructure," agrees Gary House, director of the Weber-Morgan Health Department. "We're finding we don't have the resources and staff . . . we need to address many of the public health emergencies we see on a continuing basis."
Over the past two decades, the report said, the ratio of public health workers per 100,000 Americans decreased by 10 percent. Between 2003 and 2004, the number of state and local public health workers decreased by more than 6,000 full-time employees.

Reckoning with retirement
The problem in large part stems from a graying work force.
The 2007 survey findings indicate that although state health agencies have not yet experienced a large departure by retirees, an exodus of older, highly skilled workers is inevitable. In Utah, between 20.1 percent and 30 percent of public health nurses, epidemiologists, environmental scientists and laboratory professionals will be eligible for retirement within the next five years.
It's a troubling situation for the state, which in 2007 had a vacancy rate close to 9 percent - about 7 percent higher than in 2003, the report said.
The trend is playing out nationwide. By 2012, ASTHO found, some state health departments will have more than 50 percent of their work force eligible to retire.
David Sundwall, director of the Utah Department of Health and president of ASTHO, said his staff was tested last year when it responded to a bus rollover in San Juan County, the Crandall Canyon coal mine disaster in Emery County and the cryptosporidium outbreak, which occurred chiefly along the Wasatch Front.
Though such events stretch his staff thin, Sundwall said, he sees it as the health department's job to be "elastic." Hiring enough people to comfortably handle large-scale public health events means he would be overstaffed during the down times.
"What we need to do is figure out how we can collaborate with our friends in the private sector," such as hospitals and other providers, he said.

Local help wanted
While the ASTHO report focuses on state health departments, some local health departments are bracing for similar challenges.
Lloyd Berentzen, director of the Bear River Health Department and president of the Utah Association of Local Health Officers, said budget constraints have made it difficult to create needed positions.
This year, each of the state's 12 local health departments asked the Legislature for two new employees - one nurse and one environmental scientist - at a total price tag of $2 million. Instead, they got $250,000, which will pay just a portion of the salary for one new full-time employee in each district.
Further compounding the problem, Berentzen said, is fewer people are pursuing public health careers. Registered nurses and environmental scientists, for example, are being lured to the private sector, where they can make more money.
"We're competing with hospitals and everyone else to get them," he said.
As a result, local health departments are hiring some people who aren't immediately qualified for their jobs, House said.
"We have significant turnover in environmental health," he said. "I would say over the last two years I've hired five to 10 employees, with maybe 70 to 80 percent [of them] being trainees," he said. "That simply means they do not possess licensure so they have to go through at least a year training."

Losing leaders
About a third of the local health departments' directors will be eligible to retire in the next five years. When they go, Berentzen said, Utah will lose their leadership and institutional knowledge.
"You're going to see a lot of that expertise drop off," he said.
House, who is faced with losing most of his senior level employees to retirement within the next five to 10 years, is concerned they'll be difficult to replace.
"I'm not necessarily convinced I have people in lesser positions that are ideal candidates to take their place," he said. "I'm also not convinced we're going to have success recruiting their replacements."
Smaller - and less experienced - staffs mean incidents or outbreaks can bring day-to-day operations to a halt. This year, Berentzen's environmental scientists conducted about half as many restaurant inspections as they should have - because of their high workload.
"My fear is down the road some major things are going to happen that we could have prevented had we paid attention to it beforehand," he said.
lrosetta@sltrib.com
By the numbers
* 10 percent: The decrease in the ratio of public health workers per 100,000 Americans over the past two decades.
* 47: The average age of a public health worker in state government nationwide.
* 40: The average age of new hires in state health agencies nationwide.
* Between 20.1 percent and 30 percent of public health nurses, epidemiologists, environmental scientists and laboratory professionals in Utah will be eligible for retirement within the next five years.
Source: Association of State and Territorial Health Officials
My fear is down the road some major things are going to happen that we could have prevented had we paid attention to it beforehand.
-Lloyd Berentzen, director of the Bear River Health Department and president of the Utah Association of Local Health Officers.