COVID's Push and Pull on the Public Health Workforce
October 14, 2021
Images courtesy of Nicole Snyder (L) and Jen Miller (R)
The pandemic has pushed hundreds of public health officials to leave their jobs. It’s also inspired thousands to pursue a career in public health. We listen in on a conversation between two women pushed in different directions by the pandemic.
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Dan Gorenstein: The pandemic has made many of our jobs a whole lot harder.
This is especially true in public health.
The Associated Press and Kaiser Health News have documented more than 300 state and local public health officials who have quit, retired or been fired since the pandemic began, often citing burnout, politics, sometimes physical threats.
Jen Miller: I realized that I just couldn’t imagine having another surge in me.
DG: And yet, applications to public health graduate programs have jumped 40% since March 2020.
Nicole Snyder: It made me start to think about who I am and what I’m doing and how I can help.
DG: Today, we bring you a conversation between one person who felt she had to walk away from public health and another who heard the call and ran towards it.
From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.
DG: Today’s episode is going to be different from any other Tradeoffs episode we’ve done before.
Instead of me interviewing a public health expert or digging into the research and data on this workforce, we’re going to listen to a conversation our producer Ryan Levi set up between two complete strangers.
JM: Hi, my name’s Jen Miller. I used to work for the Montana Department of Public Health and Human Services in the communicable disease section. And my next venture will be working as a nurse in a local hospital in Montana.
Nicole Snyder: Hi, my name is Nicole Snyder. I’m a professor of chemistry at Davidson College, which is about 20 minutes north of Charlotte in North Carolina, and I’m currently in the first year of a master’s in public health program at the University of North Carolina at Chapel Hill.
JM: I’m so excited for you! You’re gonna have so much fun.
NS: I’m excited too. It’s a lot of work, but I’m excited.
DG: Jen and Nicole both share a lifelong love of chemistry.
Nicole’s started in her dad’s garden when she was 10.
NS: I became very interested in what makes those plants grow? So he got me interested at a very early age. He bought a little PH test kit and allowed me to test the pH of the soils and see how the different plants impact the pH of the soil over time.
DG: Playing in the garden started Nicole on a path to getting a PhD, a 20-year teaching career and her own lab.
Jen’s path has been less of a straight line.
JM: I wanted to be a forensic chemist, that was my goal. It didn’t work out. I had one interview with the DEA in San Diego. Didn’t go my way. That’s all right.
DG: Instead she pivoted to nursing, working at a critical access hospital in eastern Montana before switching to public health in hopes of preventing people from landing in the hospital in the first place.
The two women have a lot in common.
They’re both in their early 40s, established, successful and passionate about their careers.
But the pandemic has affected them differently — pushing Jen away from public health and pulling Nicole in.
So we thought it would be interesting to put them in a Zoom together — individual examples of nationwide trends — and hear what they have to say about how COVID has changed their outlook on public health, and what questions and advice they have for each other.
Jen asks the first question.
JM: Nicole, you’re a chemistry professor and researcher, and by all means, it sounds like you’re incredibly successful at doing so. So what made you want to pursue a career in public health?
NM: You know, for me, a career in public health is an addition to my career as a professor. Teaching and collaborating with undergraduates is my passion. And so for me, I actually don’t plan to leave my position as a professor. But, you know, watching, watching the television and seeing military trucks that were moving bodies of the deceased from hospitals in Italy really impacted me in ways that are difficult to understand. It really shook me. And it made me start to think about who I am and what I’m doing and how I can help. And I felt like this would be a really great opportunity for me to be able to pursue my master’s in public health so that I might be able to take my work from the benchtop really out into the community.
What about you? How did COVID change your job because you’re on the front lines?
JM: It was concerning for me from the beginning. It started with the phone calls constantly. When we first onboarded testing for COVID-19 at our state laboratory, providers were required to call and request approval for testing to make sure they met criteria. So for weeks, all hours of the day, in the night, my phone would ring. You know, in your call list of your recent calls has a hundred slots and there for a while it was maxing out daily.
JM: Yeah. People calling me and screaming at me saying, you want me to die of COVID, you won’t test me because you want me to die. I’m like, no, you don’t understand. I don’t want anybody to die. Some of the other phone calls I remember, remember early on COVID toes and COVID fingers were a big thing where their fingers would turn blue?
JM: I remember a gentleman calling it was like nine o’clock on a Sunday night. And he said, my fingers are turning blue. I have COVID. I said, OK. I can’t do anything about your blue fingers and toes over the phone. If you feel like you need care, you need to seek it. And he just kept saying, you just don’t care about my blue toes, and I said, no, you don’t understand, I care very much. I just, there’s nothing I can do about it. There were times where you felt like you were making a difference because you were finding the clusters, you were finding all the connections, you were finding where they came from and you were stopping it. But it was such a powerless feeling, knowing that someone was suffering and not being able to really do anything about it other than to say you need to contact your health care provider or seek care. And knowing that the health care infrastructure was incredibly stressed at the time. It’ll be an experience that I’ll never forget.
NS: Just curious, do you feel like some of those perceptions that people had, especially the negative perceptions, do you feel like those have increased over time?
JM: Absolutely. There are people I’ll never talk to again. One person in particular, this was a man I had known all my life. That I grew up with his kids, and one of the big allegations was you’re just counting everybody who died during COVID as COVID, and that’s not true. And I had explained to him prior, look, I do these death certificate reviews to ascertain whether or not COVID was actually a cause of death. So, it was a personal affront to me to be told that we were lying. And a lot of people would say, you know, don’t take it personally, they’re just venting, I’m like, no, I feel like I’ve got a dog in this fight. So I did cut off all ties with that person. Because he refused to back down on his statements of this being fraud.
DG: When we come back, what ultimately pushed Jen to leave public health, and Nicole shares her hopes and fears about entering the field.
DG: Welcome back.
We’re listening in on a conversation between Jen Miller, who used to work for Montana’s state health department, and Nicole Snyder, a chemistry professor at Davidson College who also just started getting her master’s of public health degree at the University of North Carolina.
NS: Given some of these things that you’ve mentioned, is there one particular example or is it really the culmination of all of these things that you’ve talked about that have really helped to push you to leave public health?
JM: The event that really put me under was when COVID was starting to pick back up in July. I was trying to teach a class, which happens to be one of my absolute favorite things to do. I love teaching courses.
NS: Where do you teach? I didn’t realize that you teach.
JM: Oh, I don’t teach in a college setting. What I do is I’m responsible for setting up training for all the local health nurses and sanitarians in regards to communicable disease control. So we were teaching our EPI 101 course for the new public health staff. During that time, COVID was starting to pick up again, and I was also responsible for the breakthrough disease surveillance. And then we also had a mass rabies exposure event involving bats that involved a very large number of people. And so I realized that I just couldn’t imagine having another surge in me. It just wasn’t worth the stress anymore. I really loved what I did. I really did. And it’s just, I got to the point where I was starting to care less, which galled me horribly. And I didn’t feel like I was serving at the capacity that I should be for my state, for my government or the people that live here. And so it was time to step away.
NS: Do you think that there’s anything that you or anyone else you know could have done differently that might have helped you to stay?
JM: I think there was a little bit of a culture of we’re all stressed, you’re just going to have to deal with it, just from certain people, not everybody. So that is something that could potentially be addressed, but one of the biggest drivers was just the constant barragement from the public. I was tired of defending what we were doing to almost everyone who didn’t work in public health. And I, that one I don’t know how to fix. That’s more than a public health system issue. That’s a human issue.
JM: Nicole, earlier you mentioned that you wanted to pursue public health because it helps you move out of academia and then more into the community sector. What does that mean to you and what does it look like?
NS: Yeah, I mean, that’s a hard question to answer because I’m a month into this, right? When you’re first breaking into a career like this, it’s hard to know what kind of opportunities are there to do this work.
NS: You know, as much as I enjoy what I do, this is an isolated job. Even if you’re in front of a classroom of 200 people, being an academic can be a very isolating job and getting out into the community opens those doors. And I think as a person who works at the bench we make many different types of fundamental research discoveries that are very interesting and that have long term implications, but we’re 20 to 30 years away from something that might actually be meaningful in terms of disease targeting or diagnosis and treatment. I think that’s part of what’s been missing for me, right, is seeing that broader impact of the work that I know I can do actually play out in real time. I want to do more of that. I want to be able to make the kind of difference that you have made.
JM: I appreciate you saying so. I hope to get there someday where I feel like I did make a difference. I’m not quite there yet, but hopefully someday I’ll get there.
So you just talked about what excites you about going into public health, but what scares you, Nicole?
NS: I think what scares me the most right now is that in many ways it is a significant departure from what I’m doing now, right?
NS: I’m coming at this, you know, in my 40s. And so I’m trying to enter a new field with very limited experience, and so I worry about what that means long-term for me to be able to establish myself in the field and do the kinds of work that I want to do. And some of the things that you’ve talked about, just the constant uphill battle trying to get people to understand the importance of vaccination, right, the importance of masking, fighting these competing narratives, right? It’s just making the job, the job is hard, it is already hard. And so having these competing narratives, I think, is just making that more difficult. And so I worry about the next pandemic, right? And the things that we’ve learned about the ways that these diseases can move rapidly through our communities and how humans will inevitably respond to those in different ways and how that makes the work harder.
JM: Yeah, I think there’s room to argue for the concept of fresh horses. I think it’s wonderful that there are a large number of people interested in entering public health. And I think for those who may be experiencing burnout, it’s good to have someone to bring up and take their place. So I admire your passion and the inspiration that you’ve had for this.
NS: Thank you. So I guess I’ve just got one last question for you, Jen: What advice do you have for someone like me joining public health right now?
JM: Be passionate. Always be curious. Always be willing to turn over every stone. Love the people you’re serving. And dedicate your work to the advancement of public health science. And I think you’re well suited to that.
NS: Thank you. Thank you. I also want to thank you for your service, and I wish you all the best in your new career.
DG: Jen just started her new job working as a nurse at a hospital in Montana, and Nicole is balancing her first semester in her masters of public health program with her normal teaching duties.
Nicole has already emailed Jen asking about the infectious diseases Jen worked on as Nicole begins to plot her own public health journey.
I’m Dan Gorenstein, and this is Tradeoffs.
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Additional Reporting and Research on COVID-19 and the Public Health Workforce:
Underfunded and Under Threat (Associated Press and Kaiser Health News)
Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans (de Beaumont Foundation and the Public Health National Center for Innovations, October 2021)
‘We’re Coming for You’: For Public Health Officials, a Year of Threats and Menace (Anna Maria Barry-Jester, Kaiser Health News/This American Life, 4/25/2021)
Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic — United States, March–April 2021 (Jonathan Bryant-Genevier, Carol Rao, Barbara Lopes-Cardozo, et al; CDC Morbidity and Mortality Weekly Report; 7/2/2021)
What Will It Take to Recruit and Retain Public Health Workers? (Carl Smith, Governing, 8/12/2021)
The Pandemic Has Devastated the Mental Health of Public Health Workers (Michael Ollove, Stateline, 8/5/2021)
The Future of Public Health (Julie Rovner, What the Health?, 9/19/2021)
Over Half of States Have Rolled Back Public Health Powers in Pandemic (Lauren Weber and Anna Maria Barry-Jester, Kaiser Health News, 9/15/2021)
Driven by the pandemic and ‘the Fauci effect,’ applicants flood public health schools (Andrew Joseph, STAT, 3/17/2021)
Public health programs see surge in students amid pandemic (Michelle Smith and Kathy Young, Associated Press, 11/17/2020)
Jen Miller, RN, Former Communicable Disease Nurse Consultant, Montana Department of Public Health and Human Services
Nicole Snyder, PhD, Associate Professor of Chemistry, Davidson College; MPH Candidate, Gillings School of Global Public Health, University of North Carolina
The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode by Blue Dot Sessions.
This episode was produced and mixed by Ryan Levi.
Special thanks to Annie Russell.
Additional thanks to:
Hillary Nelson, Emily Paterson, Stefan Williams, Srilasya Reddy, Greg Holzman, Kelsey Johnson, Kayla Sandler, Meredith Welch, Cathy Slemp, Toore Adebajo, the Tradeoffs Advisory Board and our stellar staff!