'Public health cannot be everything:' department struggles to fill dozens of vacancies

One department of city government is feeling the strain of a record-high number of job openings, according to officials from the Louisville Metro Public Health and Wellness Department.

The health department has dozens of vacancies it's struggling to fill, and applicants to those jobs who turned down offers say it's because compensation packages aren't competitive enough, said Dr. Jeff Howard, interim director and chief health strategist, at the group's January meeting.

Between July and December last year, the health department extended 54 offers to potential employees. Eleven of those were rejected, with most applicants saying the pay wasn't enough, according to Taylor Ingram, chief of staff for public health.

In fact, the department had 113 open positions in December, ranging from administrative positions at clinics to nurses and data scientists, Ingram said. Compensation comes in a range as well, but can be $2,000 to $13,000 a year less than similar positions elsewhere.

The trouble is that the city's compensation packages can't compete with the market value of the same positions at other institutions like privately-owned hospitals or practices, Ingram said.

The problem isn't unique to Louisville or even to public health. Industries like food and beverage, hospitality, retail and manufacturing have taken huge hits to labor as well. And the fact that the city's public health department is a government entity compounds the slow hiring process, Howard said.

"Those compensation packages that are governmental compensation packages, whether it be the city, state, etc., are just not competitive with the private market," he said.

Why does the health department have so many vacancies?

The "extreme amount of pressure" of working through the COVID-19 pandemic blanketed the public health sector with a feeling of "overall exhaustion," and it's still weighing on health officials, Howard said.

Statewide shortages are "not sustainable," either, according to the 2022 Kentucky Hospital Association Workforce Survey. Lack of staffing in medical-surgical, critical care, and licensed practical nurses exceed 25% in the commonwealth.

Nurses, the state's largest group of direct-care providers, have experienced one of the highest rates of burnout in the industry. The workforce survey reported that Kentucky hospitals had 24,440 full-time equivalent positions for registered nurses or licensed practical nurses across the state at the end of 2021.

In the Gateway area development district, which includes Rowan, Bath, Montgomery, Menifee and Morgan counties, turnover for nurses in 2021 was nearly 51%. The Cumberland Valley region – Jackson, Rockcastle, Laurel, Clay, Knox, Whitley, Bell and Harlan counties – saw a turnover rate of 31.5%. Four areas saw general employee turnover rates above 30% as well: Gateway, Kentucky River Barren River and Purchase districts.

Additionally, at least 58 nurses died by suicide in Kentucky between 2018 and 2021.

Burnout and lack of nursing faculty aren't the only factors that have contributed to the "perfect storm" of health care employee shortages, Howard said.

The health care sector has an aging population, according to the workplace survey. In 2021, Kentucky hospitals reported that about 14% of its registered nurse population were born between 1946 and 1965, putting more than 2,500 nurses at retirement age by 2030.

What is the impact of dozens of public health vacancies?

The impacts of public health employee shortages are tangible across the board, Ingram said.

Negative patient outcomes can include a reduction in the volume of services provided, longer wait times at clinics and an increased reliance on agency contractors to provide care, she added.

An increase in contracted employees also means that the health department pays more for similar services, causing a gap in pay equity for existing staff.

The health department's vacancies aren't due to a lack of trying, Ingram said. They have tried several avenues to attract health care professionals: sharing job postings on social media, advertising in weekly newsletters and using community partners to spread the word. But the department just can't compete with the salaries of private health care employers.

An opportunity for reform

Howard believes metro government should use the public health employee shortage as an opportunity to restructure hiring in the department.

"We all have to realize that public health cannot be everything. We cannot be the primary care health care provider. We can't be the response to COVID," Howard said. "We can't do all those things at once. We got to pick and choose niches in which we really serve unique needs in the community."

Bringing a more competitive hiring market to the system is something Howard would like to see, and that will require creative solutions like exploring part-time workers when full-time employees cannot be found.

And hiring isn't the only space for change in public health, Howard said. Addressing health equity outcomes will be key under Mayor Craig Greenberg's new administration.

"The number one determinant of health outcomes is housing and wealth," Howard said.

During his campaign, Greenberg promised a “safer, stronger and healthier Louisville," and appointed Nicole George to serve as deputy mayor for the city's public health department.

“One of the highlights of my first week as Mayor was getting to meet hundreds of my hardworking and dedicated colleagues throughout Metro Government. I am impressed by their commitment to our city and the people we serve," Greenberg said in a statement to The Courier Journal. "Like other organizations with thousands of employees, Metro Government has too many vacancies right now. We are working on strategies to recruit and retain more great people for our team. This is critical to providing the level of services we all expect from our local government."

Howard remained hopeful regarding the Greenberg administration's approach to restructuring public health.

"It would be hubris to the nth degree to suggest that we're doing it perfect," he said. "There are some ways that we can consider to do better, and I'm optimistic that this mayor will have an open mind towards what those things are. Our department stands ready to embrace whatever changes may come in our way."

Contact reporter Rae Johnson at RNJohnson@gannett.com. Follow them on Twitter at @RaeJ_33.

This article originally appeared on Louisville Courier Journal: Health department struggles to fill dozens of open positions