Web EpiMonitor

CSTE Finds A 22% Increase In Applied Epidemiologists Working At State Level

Salary Levels Reported

More Than One Thousand Epidemiologists Still Needed

The sixth report in a series of epidemiology capacity assessments carried out by the Conference of State and Territorial Epidemiologists (CSTE) was just released last month. Achieving a 100% response rate, this comprehensive assessment found that an estimated 3,370 epidemiologists were employed by state health departments in 2017, an increase of 22% over the 2,752 epidemiologists working there in 2013.

Despite the increase in epidemiologists, the current workforce was judged to be still below the ideal or desired level. The optimal number of state level epidemiologists was reported to be 4,568, a 36% increase over the actual number in 2017.

These paradoxical findings—the largest number of epidemiologists ever reported with still more needed—has caused confusion, according to Jessica Arrazola, Senior Program Analyst at CSTE and the staff lead for the assessment. Despite the large increase, new challenges are emerging such as those surrounding the collection and use of big data, she told the Monitor, and there is a need for staff with specialized skills such as informatics, research, and evaluation. The greatest training priority according to CSTE was in “…data analytics, defined as informatics and the application and translation of public health data.”

The State Numbers

The number of epidemiologists per 100,000 population increased to 1.04, higher than the 1.0 per hundred thousand that has been used as a benchmark. The report points out however that this overall rate masks the rates of equal to or less than 0.5 per 100,000 in six states, four of which have populations greater than 6 million. The actual number of epidemiologists per state ranged from a low of 5 to a high of 208. The median number of epidemiologists per state was 59.

Program Areas

The more than 3,000 epidemiologists working at the state level are dispersed in 14 program areas listed below:

Striking is the relatively large number of infectious disease epidemiologists which account for over half of all the epidemiologists employed (55%) and account for the largest share (338 or 28%) of the 1,119 new epidemiologists added since 2013. 

In contrast, new substance abuse positions totaled 64 or about 5% of the new jobs. In the area of mental health, the report claims that only 9% of the estimated need for epidemiologists has been filled. This contrasts with infectious disease which has 84% of the need met and substance abuse which has 48% of need met. According to the report, over 60% of the states are understaffed in the substance abuse area and “in the eight states with 2015 age-adjusted opioid mortality rates exceeding 25 per 100,000 population, the median number of substance abuse epidemiologists was two, with a range of 1-7.”

According to the report, “In many states, there is a misalignment between needs and resources. Moreover, heavy reliance on external funding, coupled with internal organizational issues, hamper states as they seek to meet designated priorities.”

As an example of this challenge, the report states that “federal funds constituted 77% of funding for all epidemiologic activities ranging from 46% in low states to 99% in high states. States themselves contributed only an average of 19% of epidemiologic funding with other external sources contributing a small fraction.

Salary Levels

The report provides information about salaries for epidemiologists according to the academic degree held by the employees and the level of seniority in the organization ranging from entry level to the State Epidemiologist position. (Table 4 in the report is provided below).

For epidemiologists with an MPH, the median of all the minimum salaries documented in that education category was $47K with a range in median minimum from a low of $35K to a high of $75K. In that same category, the median of the maximum salaries reported was $82K with a range in median minimum from a low maximum salary of $49K to a high maximum salary of $150K.

Doctoral Level Epidemiologists

For epidemiologists with a PHD, the median of all the minimum salaries documented in that education category was $58K with a range in median minimum from a low of $38K to a high of $69K. In that same category, the median of the maximum salaries reported was $98K with a range in minimum from a low maximum salary of $52K to a high maximum salary of $159K. Interestingly, the differences in the medians of the maximum salaries for MPH and PHD level employees was $16K and the high end of the MPH and PHD categories differed by only $9K.

Salaries in the MD and DVM categories were higher. Also, salaries increased with increasing seniority or level, with deputy and state epidemiologists having substantially higher median salary ranges that epidemiologists at senior level and below. Some of this difference could be attributed to the MD or DVM backgrounds of many state epidemiologists.

Methods--Who To Count

The definition of epidemiologist for purposes of this report was a definition offered by John Last in 2001, namely “an investigator who studies the occurrence of disease or other health related conditions or events in defined populations. The control of disease in populations is often also considered to be a task for the epidemiologist.

To be counted as epidemiologists were all persons employed by the state; all those working at the state level who are either federal assignees or contract employees; and state employees assigned to work at a local of regional level. To make the decision on who to include, respondents were instructed to focus on the functions performed and not on the job title.

Limitations

Limitations cited in the report included the fact that the count of epidemiologists excludes those employed by city and county health departments and may have excluded persons who were generalists not dedicated to a specific program area and any epidemiologists working outside the state health agency such as those in a mental health agency. Estimates of epidemiologists should be considered minimum estimates.

A separate assessment of epidemiologists in county or large city health departments has been undertaken separately and is expected to be released in the new two months, according to Arrazola. In some ways, the tasks for epidemiologists are different between the state and local levels. Local epidemiologists are more likely to be involved with local clinicians and doing more “shoe-leather” epidemiology or case investigations.  Whereas state epidemiologists provide additional support when needed for local outbreaks and lead surveillance across the state and for chronic conditions, injury, or substance use.

Recommendations

CSTE makes five recommendations in its report.

1. Develop a strategy to increase epidemiology capacity, especially in evaluation and research and in underdeveloped program areas such as substance abuse, mental health, and informatics.

2. Review and develop new recruitment and retention strategies for state health department epidemiologists.

3. Maintain efforts to establish training standards for applied public health epidemiologists and to provide training to ensure a sustained, qualified and competent public health epidemiology workforce.

4. Explore the gap between state public health mandates and state capacity to meet those mandates.

5. Conduct future assessments.

According to Arrazola, CSTE would like to see a coordinated, multi-party effort to address not only the shortage of epidemiologists but also the need for specialized cross cutting skills across the public health workforce as described by other recent assessments such as the Public Health Workforce Interests and Needs Survey. This is because the factors driving the current shortages and affecting recruitment and retention are relevant across disciplines subject to the constraints of working within governmental agencies, she noted.

To access the full report, visit:  https://bit.ly/2Jv9Lkq

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