Jurs_Linnea_Final_Thesis_with_Abstract_4.19.20.docx

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Undergraduate Career Choice in Governmental Public

Health

Linnea Jurs, BSPH Candidate April 2020

Undergraduate Honors Thesis

Primary Advisor:

Dr. Melanie Studer, PhD, MHSA BSPH Program Director

Assistant Professor

Department of Health Policy and Management Gillings School of Global Public Health

University of North Carolina at Chapel Hill Secondary Advisor:

Dr. Karl Umble, PhD, MPH Assistant Professor

Department of Health Policy and Management Gillings School of Global Public Health

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Table of Contents

Abstract ………... 3

Introduction ……….…….… 4

Literature Review ………..……….. 5

Methods …..………..………... 9

Findings ………..………... 12

Discussion ……….………….. 17

Acknowledgements ……… 19

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Abstract

Objectives: The governmental public health workforce faces many challenges, including

recruitment and retention issues, a lack of diversity, and few professionals with an academic background in public health. Encouraging undergraduates and recent graduates to pursue a career in governmental public health has been identified as a strategy to strengthen this workforce. This study explored the barriers and facilitators to pursuing a job in a federal, state, or local

governmental public health agency for public health graduates.

Methods: The researcher conducted interviews, using an interview guide, with 10 participants.

Participants were individuals who graduated between December 2012 and August 2017 with a Bachelor of Science in Public Health degree in Health Policy and Management from the UNC Gillings School of Global Public Health. The Social Cognitive Career Theory (Lent, Brown, & Hackett, 1994) was used as a guiding theoretical framework for interview guide development and analysis.

Findings: The most common barriers to entering governmental public health were a “tedious

and difficult hiring process,” “difficulty obtaining a government job with only an undergraduate degree,” and a “lack of knowledge about governmental public health roles.” The most common facilitators were “government jobs were closely aligned with interests,”

“internship/capstone/work project related to government,” and a “positive family/personal financial situation.”

Conclusions: If the government wants highly qualified students to make a career choice in

governmental public health, then they must make the hiring process less time-consuming, hidden, and slow. If UNC Gillings hopes to contribute to the governmental public health workforce, they should provide more support for individuals wishing to go into governmental public health. They should also continue to provide internships and capstone projects located within the public sector.

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Introduction

The governmental public health workforce consists of individuals working in a federal, state, or local government health agency.1,2 Administrative personnel, public health nurses, environmental

health workers, public health managers, and laboratory workers make up over half of the

workforce.1 The workforce aims to protect and improve the health of the US population through

ensuring access to health services, monitoring diseases, and implementing policies and regulations.3

Unfortunately, recent studies on the governmental public health workforce have identified a disconnection between the present workforce and the public health needs of the US population.4-7

Major challenges facing the workforce include a lack of diversity among public health workers, recruitment and retention issues among agencies, large numbers of experienced workers retiring, and few workers possessing formal public health training.4-7

Diversity has been shown to improve outcomes and innovation in the workplace.8,9 It is crucial in

the public health context, as one of the main goals of public health is to combat health disparities that are experienced by underrepresented populations.10,11 Despite this, 70% of individuals

working in a State Central Office and 71% of individuals working in non-big-city regional health departments (RHDs) and local Health Departments (LHDs) are characterized as non-Hispanic White.12 Millennials, defined as aged 22-27, are also underrepresented in the workforce.

Millennials constitute 35% of the total US workforce but only 22% of the governmental public health workforce.4 Lastly, women make up the majority of this total workforce, but are much less

likely than men to attain an executive level position.4

Recruitment and retention of qualified professionals are a second challenge facing the workforce. The 2017 Public Health Workforce I think Interest and Needs Survey found that 24% of

governmental public health workers were considering leaving their organization in the next year for a reason other than retirement.4 Dissatisfaction with pay, a lack of opportunities for

advancement, and workplace environment are top reasons cited by individuals wanting to leave. Researchers have hypothesized that these reasons, along with a slow hiring process and high degree/work experience requirements for governmental positions are barriers to recruitment of qualified workers. In addition to the 24% of individuals considering leaving to pursue something different, 22% of workers were planning on retiring by 2023.4, 13 These recruitment and retention

issues are expected to contribute to a shortage of 250,000 governmental public health workers by 2020.5 This could lead populations to be vulnerable to both chronic and communicable diseases,

unprepared for emergency crises, and unable to access healthcare services.5

Lastly, only 14% of public health workers have formal public health training.4 This training is

necessary, as it helps workers develop the core competencies of public health.14 These core

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Increasing undergraduate education in public health has been suggested as one strategy to strengthen the governmental public health workforce. 5,15 Undergraduate public health education

commonly includes bachelor degrees in health education, general public health studies, public health management/administration, and environmental sciences.16 Over the last three decades,

there has been a substantial increase in the number of students graduating with public health bachelor degrees.16-18 There were approximately 745 degrees awarded in 1992 and 13,605

degrees awarded in 2017.17 Similarly, the number of universities awarding public health bachelor

degrees has increased from 83 in 2003 to 271 in 2016.18

The Council on Education for Public Health (CEPH) accredits undergraduate public health programs. To gain accreditation, programs are required to teach undergraduates a range of public health skills.19 CEPH utilizes the “Learning Outcomes Model” and the “Critical Components

Element” for public health bachelor degrees created by The Association of Schools & Programs in Public Health.18-20 The “Critical Components Element” emphasizes the importance of

providing undergraduates with relevant background knowledge, public health knowledge, a field experience, and skills related to cross-cutting areas (ASPPH).20 This model has shaped the

curriculum of many undergraduate programs. Individuals who graduate from these programs have strong public health competencies and great potential to fill in current gaps in the workforce.5, 15

Despite this great potential, individuals graduating with public health bachelor degrees rarely pursue careers in governmental public health.21 A recent dissertation reported that only 8% of

individuals who graduated between 2012 and 2017 with a bachelor of science in public health degree from the UNC Gillings School of Global Public Health have had an employment

experience in a federal health agency, and only 4% in a local health agency.21 More specifically,

only 4% of individuals graduating from the Health Policy and Management concentration have had an employment experience in a federal or local health agency.21 While this is currently the

only study that explores the career paths of individuals with bachelor degrees in public health, studies on masters/doctoral public health graduates have found similar results.22 A study

completed at Columbia’s Mailman School of Public Health found that in 2016, only 11.5% of masters/doctoral public health graduates went into governmental work.22 If we hope to use

undergraduate public health education as a way to strengthen the governmental public health workforce, then these statistics are troubling. My research seeks to explore the factors that influence public health bachelor degree graduates’ career choices and the barriers and facilitators to pursuing a career in governmental public health.

Literature Review

Career Choice Theory

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John Holland’s Theory of Vocational Personalities and Work Environments

John Holland’s Theory of Vocational Personalities and Work Environmentsproposes that most individuals are often one of six personality types: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional.23-25 Work environments can also be classified as one of the six

types.23-25 Holland theorizes that individuals desire a work environment that matches or fits with

their personality type. This match will allow the individual to “exercise their skills and abilities, express their attitudes and values, and take on agreeable problems and roles (p.4).” 24 Holland’s

theory suggests that an individual’s personality, including their principles and skills, is a major factor during career decision making.23-25

Donald Super’s Self Concept Theory of Career Development

Donald Super’s Self Concept Theory of Career Development theorizes that career decision-making is a lifelong process beginning in childhood.26-29 This process involves forming,

translating, and implementing an individual’s “self-concept.” 26-29 Super proposes that an

individual’s “self-concept” is created through interaction between environmental determinants, personal determinants, situation determinants, and the role of that individual in society (Super 1990).26-29 As an individual progress through life, they continually modify their self-concept, and

make career decisions based on the implementation of this self-concept (Super 1990).26-29 Super’s

emphasis on contextual factors, such as changing life roles (student, worker, homemaker, parent, etc.) and environmental (labor market conditions, etc.) and situational factors (socioeconomic, historical) has made his theory largely influential.26-29

Linda Gottfredson’s Theory of Circumscription and Compromise

Linda Gottfredson’s Theory of Circumscription and Compromise presents the idea that

individuals make career choices based upon a process of “circumscription” and “compromise.”30

Gottfredson describes “circumscription” as a process where individuals, often at young age, narrow down their career options into ones they view as acceptable to them and to society.30 This

process involves considering societal norms, such as gender stereotypes and views about career prestige. “Compromise” is a process in which these individuals choose a career that they view as accessible to them, even if it not one of their top interests.30 This theory is important due to its

exploration of how societal norms can be early barriers or facilitators that impact career choice.30

Dawis and Lofquist’s Theory of Work Adjustment

Dawis’ and Lofquist’s Theory of Work Adjustment theorizes that individuals make career decisions based upon their perception that a work environment will provide them with certain “requirements.”31,32 These requirements can include things such as proper compensation and a

safe environment. In return, the workplace expects that the individual has the ability to complete the work that needs to be done.31,32 In thinking about career choice, this theory suggests that an

individual may only choose a career if it meets their requirements, and will leave a job if it stops meeting their requirements.

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Lent, Brown, and Hackett’s Social Cognitive Career Theory is based upon Albert Bandura’s Social Cognitive Theory (1986).33-36 The “Vocational Choice Model” within the theory predicts

that “person inputs” (gender, race, etc.) and “background contextual affordances” (growing up in poverty, gender stereotypes, etc.) impact an individual’s learning experiences.33,34 These learning

experiences then impact an individual’s feelings of self-efficacy, their belief in their ability to accomplish something.33,34 The learning experiences and feelings of self-efficacy influence their

outcome expectations, what they expect from their abilities.33,34 Their outcome expectations and

self-efficacy beliefs then influence the development of their interests and the interests impact an individual’s goals, actions, and overall career attainment.33,34 “Contextual influences proximal to

choice behavior,” such as current financial status, support from family, etc., also influence an individual’s goals, actions, and therefore overall career attainment.33,34 Researchers have often

placed career barriers and facilitators as factors in the “person inputs,” “background contextual affordances,” and “contextual influences proximal to choice behavior,” categories within this career choice theory.35, 37

These five theories provide a useful framework to start thinking about the process from which an individual makes a career choice. They offer perceptions of potential barriers and facilitators to a career choice as well as an understanding of how barriers and facilitator could fit into a larger career choice process. In the case of this research question, it is now necessary to explore what is already known about the factors and processes that potentially lead to – or do not lead to – a career in governmental public health.

Public vs. Private Sector Career Choice

Since governmental public health is in the public sector, it is first important to understand the factors and processes that impact a career choice in the public or private sector. One factor is Public Service Motivation, an idea set forth in 1990 by Perry and Wise.38 They define PSM as

“an individual's predisposition to respond to motives grounded primarily or uniquely in public institutions.”38 Research on the existence of PSM is varied. A study in 2000 found that public

employees do possess PSM.39 It was found that they value the meaning of their work and

satisfaction derived from their work more than they value “extrinsic” factors such as high income. Private-sector workers were more likely to be motivated by high income and balanced work hours.39 Similarly, a 2003 study on the career plans of public policy students, reported that

individuals wishing to enter government work did so largely because they hoped to make an impact on communities.40 Individuals pursuing private sector work did so because they believed

the sector would provide more professional development opportunities, more engaging work, and a higher salary.40 In contrast to these two previously discussed studies, Gabris et al reported

that the effect of PSM on career decisions is very little to none.41They found that individuals

entering public and private sector jobs were influenced by the same factors.41 Since PSM as a

factor that influences career choice is debated, it will be interesting to explore further in relation to governmental public health as a career choice.

In addition, an individual’s financial status has been found to influence their likelihood of entering a public sector job.42 Rothstein et al found that graduates with loans have an increased

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graduates without loans.42 They are also less likely to pursue jobs in nonprofits, governments,

and education. This research raises the possibility that the presence of student loan debt could influence an individual's choice to pursue a career in the public sector.

Governmental Public Health Career Choice

Little literature exists about the factors or processes that influence an individual to pursuing a career in governmental public health. In 2017, Yeager et al reported that having “specific duties and responsibilities,” “competitive benefits,” “identifying with the organization’s mission”, and “job security” were the top factors impacting recruitment of nurses into state and local health agencies.43 A 2012 study on factors influencing recruitment of epidemiologists in state health

departments found that salary, few advancement opportunities, and limitations on raises were major issues preventing recruitment.44 This suggests that competitive salaries, upward career

mobility, and opportunities for raises are key determinants of job choice in epidemiologists.

Factors impacting retention of governmental public health workers are likely also important to individuals considering a career in governmental public health. According to data from the 2014 PH WINS survey, approximately 40% of state health department workers were “dissatisfied with their pay”4,13 This evidence, along with conclusions from other studies show that salary likely

influences both the initial career choice of governmental public health, as well as the choice to remain in governmental public health.44,45The strength of this influence is debated, though, as

Liss-Levinson et al found that salary was not a strong predictor of a workers desire to leave governmental public health.46 In addition to salary, job satisfaction, including feelings of work

importance, relationships with supervisors, and workload balance, has been cited as a determinant of whether workers remain in governmental public health.45,46Perceptions about

future job satisfaction, potentially tainted by research and the media, may lead individuals to dismiss working in governmental public health.

In addition to the factors mentioned previously, there are also life experiences that could be barriers or facilitators to an individual’s potential career choice of governmental public health. Though this hasn’t been investigated much in public health research, it has been in research on similar professions such as medicine, nursing, and public policy. First, internships, shadowing experiences, and mentoring organizations can impact an individual’s career choice.47-50 A 2012

survey of Singapore University students found that students who completed a public sector internship had a higher likelihood of desiring a public sector job than individuals who did not complete an internship.47 Similarly, a mentoring program in Canada that connected medical

students to primary care practitioners increased students’ interest in a career in primary care.50These examples show that the exposure of students to internships and mentoring

experiences in governmental public health could impact their choice to enter the field.

Summary

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financial state are all potential barriers and facilitators that could influence a graduate’s decision to enter governmental public health work. In my research, I hope to explore these barriers and facilitators in depth as well as investigate new barriers and facilitators that are absent in the current literature.

Methods

Study Population

The study population is students who graduated between December 2012 and August 2017 with a Bachelor of Science in Public Health degree in Health Policy and Management from the UNC Gillings School of Global Public Health.

Sampling of Study Population

The sample from the study population will be students who graduated between December 2012 and August 2017 with a Bachelor of Science in Public Health degree in Health Policy and Management from the UNC Gillings School of Global Public Health. In an effort to capture the stories of both graduates who have had or have not had a job in governmental public health, two purposeful sampling methods will be used as described in Patton (1990).51Purposeful sampling is

commonly used in qualitative studies. It involves the intentional selection of “information-rich” cases that will provide valuable information about the key research inquiry.51

First, an interview recruitment message will be sent via email to all students who graduated between December 2012 and August 2017 with a Bachelor of Science in Public Health degree in Health Policy and Management from the UNC Gillings School of Global Public Health. The student’s names and email addresses will be obtained from my primary advisor, Dr. Melanie Studer. She collected this data via publicly available sources of data including graduation announcements, LinkedIn, the UNC alumni directory, and BSPH program directors. This message will contain a secure Qualtrics form with contact information for the researcher, a description of the research study, a yes/no question asking if the individual has had a job in governmental public health since graduation, and a yes/no multiple choice question regarding the individual’s willingness to participate in a 30-minute interview about the perceived

barriers/facilitators in their journey to a governmental public health job.

The researcher hopes to receive a minimum of 10 responses that indicate an individual would be willing to participate in a 30-minute interview. If there is greater than 10 responses, the

researcher will use a stratified purposeful sampling method to divide the sample into two groups, one with individuals who have had a job in governmental public health and one with individuals who have not had a job in governmental public health.51 After this division, a maximum variation

sampling method will be used to select 5 cases from each group to interview, yielding a sample size of 10 total cases. A maximum variation sampling method involves the researcher selecting graduates with different characteristics in order to gain more information-rich data about the variety of barriers and facilitators that exist.51The researcher will choose a variety of cases that

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Theoretical Framework

The study design and data analysis plan will be guided by the “Vocational Choice Model” as described in the Social Cognitive Career Theory.34 This theory is explained in detail in the above

literature review and is shown visually in Picture 1. The researcher will be using this framework to help guide the development of the interview guide as described in the study design. During the analysis phase, the barriers and facilitators that emerge from the interviews will be placed into the theoretical framework. If they do not fit within the framework, the researcher will alter and critique the framework.

Figure 1: Vocational Choice in Social Cognitive Career Theory - Lent, Brown, and Hackett (1994)

Source of Image: Reference #33

Study Design

This investigation will use qualitative interviews to explore the barriers and facilitators that influenced the interviewees’ pursuing – or not pursuing – a job in a governmental public health agency. These barriers/facilitators are likely not isolated events or factors, but mix together in a unique process resulting in a job - or no job - in governmental public health. This process likely differs for each interviewee, and therefore qualitative interviews provide a method to gather each individuals’ stories.51

Interviews will be conducted using a semi-structured interview guide.51The semi-structured guide

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public health and one for individuals who have not worked in governmental public health. Both versions will include a key list of topics and questions that should be addressed during the interview.

The guide will include questions about an individual’s demographic characteristics, level of interest in governmental public health, and questions exploring “person inputs,” “background contextual affordances,” and “contextual influences proximal to choice behaviors” as described in the theoretical framework. These variables likely include factors such as salary, internships, job descriptions, Public Service Motivation, and others that have been identified in the literature review as potentially influential on career choice. Each interviewee will not necessarily be asked the same questions in identical order, as the guide provides flexibility for the researcher to tailor the guide based on each interviewees responses and the conversation flow.51

The interviews will be approximately 30 minutes long each, with flexibility for them to be longer or shorter depending on the interviewees’ responsiveness. They will occur via a Zoom video call. The researcher will ask each interviewee for verbal consent for the Zoom call to be recorded. With consent, each call will be recorded from start to finish. The recordings on Zoom will be automatically transcribed using computer transcription software. Both the recordings and transcripts will be password protected, ensuring that only the researcher, Linnea Jurs, her first advisor, Dr. Melanie Studer, and second advisor, Dr. Karl Umble can access them.

Analysis and Interpretation

The interviews will be analyzed using the “The Five-Phased Cycle” as described in Yin (2016).52

First, the researcher will compile the interview transcripts and organize them in a consistent format. She will upload the transcripts into computer assisted qualitative data analysis software. Second, she will disassemble the transcripts by assigning open and category codes to the

interview text.53 These codes will begin the process of looking for patterns and relationships

within the interviews. Next, the researcher will reassemble the transcripts and look for broader themes in which the codes could fit. During the reassembling phase, the researcher will use a matrix or table to display the themes.54 Quotes from the interviews will be also be used to

enhance the description of the study’s results. After reassembling the data, the researcher will interpret the themes that emerged. She will explore how they fit within the Social Cognitive Career Theory framework and how they influence the other variables within the framework. If they do not fit within the framework, she will explore how the themes may alter the process set forth in the theory or may call for a new theory. In conclusion, the researcher will discuss the population of individuals the interpretation can be applied to and the relevance of the findings.

Strategies to Ensure Validity and Reliability

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for the coding scheme created by the researcher.51 Secondly, the researcher will search for

interviewees whose responses do not fit within the themes identified in the analysis process. Admitting that not every case fits perfectly into the analysis scheme and exploring why it may not will increase the validity of the study.51

Ethical Considerations

The study will be approved by the UNC-Chapel Hill Institutional Review Board. Participants will be fully informed about the interview process and the storage/use of the interview data. They will provide verbal consent to this process at the beginning of their interview. The data will only be accessed by the researcher and her first advisor. Lastly, interviewees will be sent a copy of the thesis when it is completed.

Findings

Barriers to Pursuing a Job in Governmental Public Health after a BSPH degree

Interviewees identified many barriers to pursuing a job in governmental public health after their BSPH degree. The top three most commonly mentioned barriers were a “tedious and difficult hiring process,” “difficulty obtaining a government job with only an undergraduate degree,” and a “lack of knowledge about governmental public health roles” (Table 1).

Many interviewees expressed that the federal USA Jobs website was hard to navigate, featured unclear instructions, and long applications. To move on to the second round of the federal hiring process, resumes had to be perfectly edited to include certain keywords that matched job

qualifications. These keywords would be “flagged” by the USA Jobs system and would move the application forward in the hiring process. While the process was largely hidden in an effort to reduce unfair hiring practices, it resulted in students with few government connections to be unsure about how they were being evaluated. Interviewees also felt that getting an agency governmental public health job was extremely hard for individuals who were not a Veteran, participated in an AmeriCorps/Peace corps program, or had a Master’s degree (MPH, MPP, or MPA). They expressed that agencies view a Master’s degree as the “standard qualification.” Some believed that the extra skills obtained through the Master’s degree are necessary to be prepared for a governmental public health job. Related, many interviewees had a lack of knowledge of the career path of a government employee and could not visualize “entry level governmental public health jobs.”

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Facilitators to Pursuing a Job in Governmental Public Health after a BSPH Degree

Interviewees also identified multiple facilitators to pursuing a job in governmental public health after their BSPH degree. The top three most commonly cited facilitators were “government jobs were closely aligned with interests,” “internship/capstone/work project related to government,” and a “positive family/personal financial situation” (Table 2).

Individuals were much more likely to pursue a job in governmental public health if the job aligned closely with their interests. Interviewees who were passionate about designing or implementing health policy often believed that government was an effective avenue in which they could pursue these passions. One individual felt that the Peace Corps, a program run by the U.S. government, could provide her with the intercultural experience and language skills she desired after graduation. Multiple interviewees expressed interest in “systems” and felt that government work provides an avenue to impact and strengthen multiple systems in our society. Interviewees were also pushed toward government work if their internship/capstone/work project was related to government. For example, an individual’s public sector capstone project exposed her to interesting jobs that were outside of consulting, the field many of her classmates were pursuing. Last, having a positive financial situation, including no student debt, was a major facilitator to interviewees pursuing a job in governmental public health. Many interviewees said that most government jobs inherently pay less than private sector jobs. This pay gap was not a barrier for individuals who had zero student debt and financially stable families. These

individuals felt more confident following their interests/passions even if they did not come with an immediate financial reward.

An additional facilitator to entering governmental public health was “UNC Gillings connections and support.” For example, one individual said, “Dr. Slifkin, she connected me for conversations and shared my resume with them.” In addition, Dr. Umble, Dr. Weinberger, Dr. Studer, and Cathy Padgett were cited as influential mentors who encouraged interviewees to follow their interests and provided connections when able. “Public Service Motivation,” an

“individual's predisposition to respond to motives grounded primarily or uniquely in public institutions” was also a facilitator for three interviewees.38 One shared, “The government exists

to serve citizens and to serve folks that live in that government area. So that sort of service aspect is very appealing to me…And being able to both have that connection to public service and be for people and not companies.” A last facilitator was a “positive perception of career mobility,” primarily seen in individuals pursuing CDC fellowships.

Relation of Barriers and Facilitators to Career Choice

Many of the identified barriers and facilitators can fit within Lent, Brown, and Hackett’s 1994 Social Cognitive Career Theory. A “tedious and difficult hiring process” and “difficulty obtaining a government job with only an undergraduate degree,” are both “Proximal

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due to the challenge of the hiring process or the lack of jobs available for those without a graduate degree. A “lack of knowledge about governmental public health roles” fits into the “Learning Experience” category. Some interviewees felt that they had not been exposed, inside and outside of the classroom, to entry level roles in governmental public health. This made them have lower feelings of self-efficacy, their ability to be successful, in both obtaining a

governmental public health job and achieving high performance in one.

The facilitator of “government jobs were closely aligned with interests,” falls into the “Interests” category. Individuals’ interests did seem to be formulated by their self-efficacy expectations and their outcome expectations, ideas about where their actions will lead them or how they will be perceived by society. For example, an interviewee who believed that program implementation skills would “look good on a resume,” was pushed towards an interest in government agencies, because program/policy implementation is one of their main jobs. Interests seemed to influence goals, as seen in an interviewee who was passionate about health equity. She had a goal to work at the Health Resources and Services Administration, or at a job with a similar mission. Having an “internship/capstone/work project related to government,” falls into the “Learning

Experiences” category within the theory. Interviewees who were exposed to projects within the public sector had a higher self-efficacy expectations and outcome expectations in relation to government work. For example, an individual doing public sector consulting work for a private firm realized that there were “cool, innovative, and influential” positions in the federal

government that she didn’t realize existed. Last, a “positive family/personal financial situation” fits within the “Background Environmental Influences” category. This is a background influence because it primarily occurred because of their inherent economic/social privilege or choices made by their parents long ago. This “positive financial situation” allowed individuals to pursue learning experiences, especially unpaid/low pay experiences, that allowed them to explore their interests.

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Table 1: Top 3 Major Barriers to Entering Governmental Public Health after a BSPH Degree Top 3 barriers to

entering Governmental Public Health

Quotations

Hiring Process was tedious and difficult

“Navigating the whole USA jobs is another, it’s horrible.”

“They're very, very tedious. I definitely, I was a rookie and wasn't familiar with the process and it's a lot more detail than you put into other applications… I'm getting the USA jobs accounts set up, you'd spend a lot of time polishing your resume and I remember I had so many people in our program and our career services look over it. Well then you pretty much have to deconstruct it to put it into the USA jobs website.”

“They really vet your resume and make sure that the language matches the skillset. So you know, you'll work a long time to polish your resume and use particular language.”

“I think the government does not make it easy for young folks or recent graduates to join the civil service. The interview and application process for civil service or even temporary exempt positions is incredibly long. The process is unclear and there's no one telling you what is actually a priority in your application and what people will look at and what people don't care about.”

Jobs were difficult to obtain directly after an

undergraduate degree

“It's pretty hard to get hired into the federal government as someone straight out of undergrad and they have a lot of preferential hiring systems for veterans or people with disabilities or hire people through programs like the Presidential Management Fellows.”

“Frankly talking to some friends now who work in a state health, it's fairly difficult to get a job straight in DHHS or Medicaid just with a Bachelor's and it's not impossible, but it is harder.”

“I feel like it's really rare to see a recent undergrad at the CDC.”

“The system is kind of more set up for people to come in with Master's degrees.”

Lack of knowledge about

governmental public health roles

“I would say that another barrier would just be knowledge of the types of roles that are available. I wasn't really sure what typical tasks look like for someone…I didn't feel like I had good examples of people that had gone into that type of role either in the class above me or knowledge or resources provided to me in the program about my goals in going straight from an undergraduate degree into one of those roles.”

“Like I didn't really have an idea of what entry level jobs would look like.”

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Table 2: Top 3 Major Facilitators to Entering Governmental Public Health after a BSPH Degree Top 3 Facilitators

to entering Governmental Public Health

Quotations

When government jobs closely aligned with interests

“I did community organizing and realized that I wanted to know what decision makers were thinking when they were making decisions…And so I was looking for government jobs. I knew I was too impatient, sort of for federal or state, so I was looking for things in local government.”

“It was very much aligned with my interests. I think while I was in the BSPH program I was much more in the health policy rather than the health management side of my interests. So I had always kind of wanted to do something more policy oriented, more systems oriented and I had a lot of interest in like health equity, health disparities kind of stuff.”

“So I think leaving and sort of coming out of the BSPH program, the biggest thing I was excited about that was most in line with my interests was the Peace Corps.”

Internship, capstone, or work project related to government

“I know through when we did our capstone, and those types of things I saw like there are other avenues that you could pursue that were not related to consulting. And we worked with like local or state level agencies. And I've found that that was really helpful and informative for me to see that, you know, there are so many opportunities and you don't have to feel that you need to do only the private sector work.”

“So I had a great internship and this actually is probably what really pushed me to want to get more federal experience. But I worked in DC on the Senate committee for Health, Education, Labor and Pension. So I really enjoyed being on the Hill, but I kind of thought also at the same time, like it wasn't exactly a good fit just because it's a dog eat dog world…That really informed my choice to go get a job with a federal agency cause I said, well, I've seen the side of this policy, seen what tries to get the policy in place, but it's really the agency that carries it through and you know, provides the technical assistance and forms the rules.”

“So it was working on health policy in DC, specifically disability policy and social service programs, and also development. So it definitely did influence me. I kind of realized I didn't want to necessarily do health policy but I wanted to be more on the implementation or government side of things.”

Positive

family/personal financial situation (no debt)

“So I grew up upper middle income and was really lucky to graduate college without any debt and my parents paid for me to go to college. And I also knew that I had some savings for grad school. So with that incredible financial privilege in mind and all the privilege of being white and being upper middle class and my parents having postgraduate degrees…so salary was not influential to me”

“I'm fortunate that I don't have, I didn't have student debt. Combination between, my family was able to help support me, and then I also had a pretty significant amount of scholarship money. So that's a thing that was a big advantage for myself versus other people is that I didn't have debt.”

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Discussion

Summary

Overall, interviewees identified many barriers and facilitators to entering the governmental public health workforce after obtaining their BSPH. The most common barriers included a “tedious and difficult hiring process,” “difficulty obtaining a government job with only an undergraduate degree,” and a “lack of knowledge about governmental public health roles.” The most common facilitators include “government jobs were closely aligned with interests,” “internship/capstone/work project related to government,” and a “positive family/personal financial situation.” These barriers and facilitators are placed within Lent, Brown, and Hackett’s 1994 “Social Cognitive Career Theory” in order to illustrate how they influenced interviewees’ career decisions.

Relation to Current Literature

This study builds upon and strengthens current literature about factors impacting recruitment of individuals in governmental public health. An important finding of this study was that “lower salary” was not viewed by most interviewees as a barrier to entering the governmental public health work. This is different from previous, similar studies. 44,45 This may have been because

interviewees had more financial privilege than individuals in other studies, valued their interests over a salary, or did not have an extremely negative perception of governmental salaries. The finding that internships/capstone projects can impact an individual’s career choice reinforces literature on the importance of these learning experiences. 47-50 Last, Public Service Motivation, a

factor whose existence has been debated, was found in multiple interviewees pursuing a job in governmental public health. 38-41 While it was not the most commonly mentioned factor

influencing a career in governmental public health, it was a facilitator for some individuals.

Significance and Implications

This study is significant because it focuses solely on the barriers and facilitators for individuals who recently graduated with a BSPH. As stated in the introduction, millennials are

underrepresented in the governmental public health workforce.4 Also, only 14% of the workforce

has formal public health training.4 As a large percentage of governmental public health workers

are planning to retire or leave their positions in the coming years, recent public health graduates have potential to fill gaps in the workforce.5,15 Recent graduates can fill gaps only if they are both

interested in governmental public health and able to pursue jobs in governmental public health. My findings show that there are individuals interested in governmental public health who are able to pursue it after an undergraduate degree. There are also individuals interested in the field but unable to pursue it due to overwhelming barriers.

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time-consuming, hidden, and slow. They also need to make more jobs available to recent undergraduates, as most interviewees felt that jobs were only available to individuals with master’s degrees.

Some barriers, including a “lack of knowledge about governmental public health roles,” “lack of perceived support/resources from HPM Career Services,” and “negative perceptions of working for the government” should be addressed by the UNC Gillings School of Global Public Health. First, the researcher wants to acknowledge that the faculty and staff at UNC Gillings go above and beyond to provide mentorship and connections to students. Also, she recognizes that it is inherently much more difficult to promote government jobs than private industry jobs, due to a more hidden hiring process, lack of formal recruiting, and other factors. Despite this, UNC Gillings could do multiple things to provide more obvious support for individuals wishing to pursue a career in governmental public health. They could put on a “USA Jobs Resume

Workshop” before winter break. Students could seek help matching the wording and format of their resumes to what is desired by the federal government. They could do a class/panel on common entry level public health jobs on the local, state, and federal levels of government as many individuals are unsure of the roles potentially available to them. They could spotlight through the NewsBlast or on a bulletin board, faculty/alumni who have made careers in governmental public health in order to increase positive perceptions of government as a career choice. Last, they could try to strengthen connections with local health agencies in the state who may want to hire recent graduates from UNC Gillings, but do not have the resources to recruit on campus.

The identified facilitators, especially “Internship, capstone, or work project related to

government” and “Gillings connections and support” provide insight into how schools of public health can support individuals who want to pursue government work. UNC Gillings should keep providing capstone project and internship opportunities in the public sector. Faculty and staff should continue providing amazing mentorship and support to all students. Last, if the

government wants to recruit a diverse workforce, including individuals from a lower socioeconomic status, they will need to make their pay more competitive with the private industry.

Limitations

The small sample size (10 individuals) was the biggest limitation of this study. The researcher was also unable to interview any individuals who worked for a state health agency, leaving out that important perspective. A final limitation is that some interviewees indicated they had been very interested in governmental public health on the survey, but then did not seem to be during the interview. This led to some interviews being less fruitful in relation to identifying barriers and facilitators to governmental public health.

Future Areas of Study

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needed to perform certain jobs in governmental public health, or if a master’s degree is necessary. This information could also inform curriculum development or changes in

undergraduate programs. A second area of interest is whether government agency heads are even interested in hiring recent undergraduates.

Overall, I hope that this study will be utilized and supplemented by the UNC Gillings School of Global Public Health in order to strengthen local, state, and federal public health institutions. Increased recruitment of promising graduates into governmental public health will ensure that our society has a steady pipeline of knowledgeable, passionate, and diverse public health workers.

Acknowledgements

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