Counting and Characterizing the Public Health Workforce: Enumeration 2012

1. Counting and Characterizing the Public Health Workforce: Enumeration 2012 Matthew L. Boulton, MD, MPH University of Michigan School of Public Health

2. Initial effort to count public health workers Approximately 450,000 paid public health workers in U.S. in 2000 34% local 33% state 19% federal 14% other U.S. Public Health Workforce

3. 80% public health workforce inadequately trained 40% of workforce will retire within 10 years Recommended certification or credentialing of all public health workers Eight core training areas: Informatics Genomics Communication Cultural competence CBPR Global health Policy & Law Ethics 2003 Institute of Medicine Report

4. Why is the Public Health Workforce so Difficult? • Workers have extremely diverse training and educational backgrounds • Public health activities occur in a wide array of settings • Represented by many professional groups • No commonly used workforce job classification • No repeatable, affordable, standardized, and highly acceptable workforce monitoring system in place

5. CDC/HRSA Public Health WorkforceEnumeration Report Numerous data sources for public health workforce enumeration extending over years Data largely from periodic surveys issued at varying intervals using different methodologies No standardized job classifications across surveys; occupational classifications may not accurately reflect job function Few surveys collect individual level information Little data on worker demographics, training & educational background, licensure & certification http://www.phf.org/resourcestools/Pages/Enumeration_of_the_Public_Health_Workforce.aspx

6. Data Sources

7. Workers by Case Definition Occupation *Weighted Estimates

8. National Laboratory Capacity Assessment, 2011 • Public Health, Environmental & Agricultural Lab Workforce • Organizational data from 80 laboratories & individual level data on approximately 2000 laboratorians • Over 50% of labs report little or no capacity to provide education and training to their workers • Laboratorians self-evaluate low competence in many core areas • Lack of training opportunities was barrier to worker recruitment for 26% of labs and to retention for 38% of labs

9. CSTE National Epidemiology Assessment, 2009 The number of epidemiologists in state health departments decreased by 10% between 2006 and 2009 assessments Approximately 14% of epidemiologists have had no formal training in epidemiology More than 1/3rd of states indicated a need for additional staff training in 23 of the 27 applied epidemiology competencies 17% of the epidemiology workforce anticipates retirement, resignation or release from workforce within next 5 years

10. Public Health Nurse Workforce Survey • Organizational survey launched July 23rd; data collection taking place through mid-September (50 state health departments and 328 local health departments in sample) • Individual survey being piloted (~7500 nurses in sample) • Preliminary study findings will be presented at APHA (October 30; 2:30-4:00 pm)

11. Bureau of Labor Statistics Data • Occupational Employment Statistics (OES) program produces employment and wage estimates for over 800 occupations • Data collection methods • Semi-annual mail survey of establishments: 200,000 establishment surveyed every 6 months; 1.2M surveyed over 3 years • BLS draws sample and produces survey materials; State Workforce Agencies collect the data • National estimates produced based on responses

12. Sample Public Health Occupational Classifications • 21-1094: Community health workers • 17-3025: Environmental engineering technicians • 17-2081: Environmental engineers • 19-4091: Environmental science and protection technicians • 19-2041: Environmental scientists and specialists • 19-1041: Epidemiologists • 21-1091: Health Educators • 21-1022: Medical and public health social workers • 19-1042: Medical scientists, except epidemiologists • 21-1014: Mental health counselors • 21-1011: Substance abuse and behavioral disorder counselors

13. National Profile of Epidemiologists Research Epidemiologists Applied Epidemiologists ASPH, other University data NACCHO BLS Local Government Epidemiologists Federal Government Epidemiologists CSTE Self-employed, Consultant Epidemiologists Epidemiology Faculty Hospital and Industry data ASTHO Hospital/ Pharmaceutical Epidemiologists State Government Epidemiologists

14. Other Enumeration Challenges and Limitations • State governance structure (e.g. centralized/decentralized) may impact whether duplicate data are reported to ASTHO and NACCHO • National data sources (e.g., BLS, ACS) lack the specificity required to disaggregate public health workers from the publicly available data • Enumeration is only addressing number of workers; workforce characteristics are also important but often not collected • No consensus for minimum data elements to collect • Depending on the data source, many workers uncategorized

15. Where Do We Go? • CDC working to refine federal workforce estimates • Enumeration Work Group assisting with: • Refining national enumeration estimate for 2012 • Discussing methods for addressing duplicate counts between surveys • Classifying uncategorized workers • Establishing minimum data elements to collect • Recommending BLS SOC modifications • Developing a workforce classification schema

16. New Classification Schema • Multi-axial listing to create a common language for workforce classifications which organizations can map to • 10 Axes under development • Program area • Specialization area/expertise • Funding source • Condition of employment • Demographics • Job title • Job setting/venue • Education • Licensure/certification • Job Tasks

18. Contact Information Center of Excellence in Public Health Workforce Studies University of Michigan School of Public HealthDepartment of Epidemiology1415 Washington HeightsAnn Arbor, MI 48109(734) 615-6041phworkforce@umich.edu

19. Job Classifications • Administrative or Clerical Personnel • Behavioral Health Professional • Emergency Preparedness Staff • Environmental Health Worker • Epidemiologist • Health Educator • Laboratory Worker • Nutritionist • Public Health Dentist • Public Health Manager • Public Health Nurse • Public Health Physician • Public Health Informatics Specialist • Public Information Specialist • Other Public Health Professional or Uncategorized Workers

20. Project Case Definition • Individuals providing Essential Public Health Services employed in: • Traditional state, territorial and local governmental public health agencies/departments • Federal agencies with a clear mandate to provide public health services • Non-public health state, local, or federal governmental agencies providing environmental health services • Non-public health state, local or federal governmental agencies providing public health laboratory services • Used 15 occupational classifications from the ASTHO and NACCHO Profile Surveys • Based on data availability

21. Learning Management Systems • May be a source of individual-level worker data in the future • Significant challenges with using LMS for enumeration: • Duplication of workers across LMS • Data may not be updated • Most systems not built for research purposes- extracting comparable data from a variety of systems is difficult

22. Challenges and Limitations • Varied data collection methods makes comparison of survey data difficult • Lack of definitions/descriptions of job functions for some job titles made grouping difficult • Federal occupational classifications did not group well within ASTHO/NACCHO Profile Survey occupations • Occupational classifications may not accurately reflect job function