Building and Sustaining Strong Public Health Agencies: Determinants of Workforce Turnover

Context: Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers. Objective: To analyze patterns and predictors of voluntary turnover among public health workers. Design: Descriptive analysis and linear probability regression models. Participants: Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS). Main Outcome Measures: Intended retirement and voluntary departure; pay satisfaction; job satisfaction. Results: Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P < .001) and 24 (P < .001) percentage-point decreases, respectively, in the probability to report the intention to leave. Our findings suggest that if all workers were satisfied with their job and pay, intended departure would be 7.4%, or less than half the current 18% rate. Controlling for salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction. Conclusions: Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction.