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New Report Identifies Shortage Of Epidemiologists In Big City Health
Departments
A new report by the
Big Cities Health Coalition (BCHC) has found that 28% of their
jurisdictions do not have a lead epidemiologist to oversee
epidemiology activities. Altogether, the cities in the Coalition
represent 62 million persons or about 1 in 5 Americans. A total of 26
of the 30 Coalition Health Departments responded to the survey of
epidemiology capacity carried out from January to May 2021.
Shortfall
To reach full
epidemiology capacity, the big city health departments would need to
increase staff by 602 (47%) over the number of 1,284 epidemiologists
now serving. Since the time of the last report in 2017, the number of
epidemiologists has increased 18%, much less than the increase needed
to reach full capacity as measured now.
According to
Chrissie Juliano, executive director of the BCHC, “The headline
really is that big city health departments are in dire need of
additional epidemiologist staffing,”. Speaking with Infectious
Disease Special Edition she added “The shortfall puts the nation’s
efforts to combat future and current pandemics at risk.”
Specific Programs
The health departments
have multiple specific program areas and epidemiologists are scattered
throughout these topic areas. As might be expected, 100% of the health
departments have program areas in preparedness, infectious disease,
and also COVID-19 response. Of the sixteen program areas asked about,
the infectious disease and the COVID-19 areas were the most likely to
have a formal lead epidemiologist (88% and 96% respectively). Maternal
and child health is a frequent program area, however, only about
two-thirds of these programs have a lead epidemiologist. Other common
program areas are chronic disease, environmental health, vital
statistics, and informatics, and proportionally fewer of these have an
epidemiology lead. There are relatively few mental health,
occupational health, and genomics programs in these big city health
departments.
As an indication of
the impact of the COVID-19 pandemic, there are almost as many
epidemiologists now engaged in that program area (614) as there are in
the other 15 program areas (670). Despite this increase, the report
identifies COVID-19 response and infectious disease as the two areas
in greatest need of more epidemiologists (127 and 174 respectively).
Other strongest needs are in the areas of informatics, chronic
disease, and general epidemiology.
Epi Capacity
When queried about
their capacity to conduct key epidemiologic activities of different
kinds, 92% of the 26 jurisdictions reported capacity as substantial
to full for monitoring health status, 76% as substantial to full for
diagnosing and investigating problems, and 40% as substantial to full
for research and evaluation.
Vacancies
The big city health
departments reported having 176 vacant positions overall with the
intent to fill 142 of these as civil service positions or with
contractors. But these numbers reflect only about a quarter of the 602
positions needed for the departments to operate at full epidemiologic
capacity.
The health departments
were asked open-ended questions to identify the most critical issues
they face. Among the themes which emerged are: human resources and
hiring issues including staff burnout, data modernization challenges,
funding problems, and training priorities.
Recommendations
The Big Cities Health
Coalition report makes the following recommendations:
1. Provide
cross-training that enables epidemiologists to shift across program
areas as needed, particularly during public health emergencies.
2. Enhance skills in data analytics to support data modernization
efforts.
3. Streamline onboarding training to assist with surge and/or
temporary staffing and alleviate the burden on existing staff while
preparing new staff to qualify for FTE positions if interested.
4. Update salary
scales to be competitive with other industries.
5. Collaborate with Human Resources staff and health department
leadership to be able to hire temporary and permanent staff in a
timely manner.
6. Recruit additional epidemiologists, especially for emerging program
areas (i.e., genomics) and with advanced knowledge and skills for
research and evaluation.
7. Develop a plan to build epidemiology capacity and staffing
internally to reduce reliance on contractors and reduce costs in
procurement, decrease project delays and increase institutional
knowledge.
8. Foster relationships with universities and schools of public health
to harness the pipeline of incoming epidemiologists.
9. Facilitate opportunities for students to be exposed to public
health practice at a health department.
10. Explore opportunities for academic institutions to support health
departments for special projects or subject matter expertise,
particularly during an emergency response.
11. Ensure reliable access to the peer reviewed literature
To access the full
report, visit:
https://bit.ly/3Ird5vn
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