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Epidemiologists in Short Supply, States Say
State health departments are plagued with "striking shortages" of epidemiologists that could undermine their role as public health's disease detectives.
According to a 2006 report by the Council of State and Territorial Epidemiologists, state health departments need to employ approximately 34% more epidemiologists—about 1,200 people nationwide—to provide adequate surveillance of community health hazards and investigate outbreaks of disease.
A combination of factors have contributed to this shortage, but a lack of funding for public health is at the root of the problem, says Matthew Boulton, M.D., a professor of epidemiology at the University of Michigan School of Public Health and coauthor of the report.
"In divvying up scarce resources, epidemiology has played second fiddle to public-health community programs," such as screening and vaccinations, Boulton said. Furthermore, modest salaries make it difficult for health departments to recruit young epidemiologists and harder to retain them once they are hired.
The shortage was first documented in 2001 when the Council of State and Territorial Epidemiologists completed its original survey of state epidemiologists. The following year, an influx of money from the federal government aimed at improving bioterrorism and emergency response led to a spike in the number of epidemiologists, particularly those working in bioterrorism and infectious disease. But as the funding has leveled off, so have the numbers of epidemiologists working at the state level.
"There was concern around building a lot of personnel infrastructure around this funding if it wasn’t going to be sustained. It's already apparent that it's not going to be. I think unfortunately we could see additional losses if we continue to see drops in that federal funding," Boulton said.
Much of the spending in epidemiology goes to infectious disease programs, even though chronic disease is the major killer in the U.S. But amid threats of pandemic flu, making cuts to infectious disease programs to bolster chronic disease surveillance seems a risky prospect. In addition to shortages in chronic disease programs, environmental health, occupational health, and oral health are particularly understaffed.
The shortages are mainly among state and local health departments and less so at the federal level, said Stephen Thacker, M.D., director of the office of workforce and career development at the Centers for Disease Control and Prevention. "The state and local health departments have pretty striking shortages," he said. "To say that the federal government doesn’t have issues [with epidemiologist shortages] might not be correct, but we certainly don’t have recruitment issues at CDC." In the past, the U.S. Food and Drug Administration and the Department of Agriculture have both requested assistance from the CDC in recruiting epidemiologists because of shortages in their departments.
To meet the demand for state epidemiologists, public-health schools are developing and expanding their epidemiology programs. Many schools recognize the increasing need for trained epidemiologists not only to fill the immediate shortage but also to address future public-health issues that will appear as the population ages, says Jorn Olsen, M.D., Ph.D., chair of the department of epidemiology at the UCLA School of Public Health. Epidemiology is one of the fastest-growing program areas in public-health education, according to a 2005 study by the Association of Schools of Public Health. Since 1995, the number of graduates from epidemiology programs has increased by 98%. The study also found that epidemiology programs had the highest number of applicants among public-health programs.
But the increase in trained epidemiologists can help alleviate shortages only if graduates have the incentive to take positions at the state level. And that will probably require greater investment in state epidemiology programs.
"Public health is considered an expendable service," Boulton said. "There needs to be a rethinking of the importance of public health in this country. When we do our job best, we tend almost to be invisible." Maybe that's the problem.
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