When Money Is Not Enough: Reimagining Public Health Requires Systematic Solutions To Hiring Barriers

Public health departments in the US have experienced workforce shortages and challenges in recruiting new employees for decades. Reimagining the public health system will require sufficiently staffed health departments. This Commentary summarizes what is known about the issues that state and local health departments face during the hiring process, with a focus on civil service and merit-based hiring barriers. Although health departments have recently received funding to recruit new employees, they still struggle to hire them. Recommendations for change include tracking hiring process metrics; implementing formal quality improvement to strategically resolve delays; developing formal pathways for converting fellows, interns, and contractors into staff positions; and initiating workarounds in the short term and legal changes to hiring rules as necessary and feasible.