Key findings from Public Health Medicine workforce survey cause for serious concern

Dropping levels of job satisfaction, high levels of burnout and a substantial proportion of specialists intending to retire in the next ten years are some of the key findings in the New Zealand College of Public Health Medicine (NZCPHM) workforce survey.

Public health medicine specialists work to support our communities to be healthy by focusing on the causes of disease and ill-health. They have an important role in investigating and mitigating disease outbreaks which is why they were at the forefront of Aotearoa New Zealand’s response to COVID-19 and are again for mpox and avian influenza. Beyond the response to further outbreaks of infectious diseases, or dealing with ongoing matters such as water safety, Public Health Medicine Specialists contribute to prevention and promotion initiatives, to equity, and to planning and decisionprocesses that are critical to effective clinical management. They work to improve health and reduce demand for healthcare services by working across a wide range of areas including alcohol harm minimisation, tobacco harm reduction, mitigation of climate change impacts, and the promotion of good mental health.

As of January 2024, Medical Council data show there were 190 Public Health Medicine Specialists with an Annual Practising Certificate in New Zealand. While the Public Health Medicine workforce is growing, the rate of growth is considerably slower than for other medical specialities. Since 2015, the Public Health Medicine workforce has grown by only 7.9% compared with 31% for the total specialist medical workforce.

Nearly half of those responding to the workforce survey (48.6%) indicated that they intend to retire in the next ten years. Projections show that at the current rate of entry and exit to the profession, the proportion of Public Health Medical Specialists per 100,000 population (currently at 3.7) will decline over the next ten years.

Overall job satisfaction has dropped sharply from 2019, the year of the last workforce survey. Just over half (52.5%) of respondents rated their overall job satisfaction as high or very high in the latest survey compared with nearly three quarters (74.1%) in 2019. Comments provided in the survey suggest this result reflects the impact first of the COVID-19 pandemic and then of the health system restructuring process.

Notably, only 27.3% of Medical Officers of Health reported high or very high job satisfaction.

Burnout at levels of seven or above on a ten-point scale were reported by 36.4% of this group. Many respondents raised limited understanding of public health by decision-takers and an under-valuing of the Public Health Medicine Specialist role as being key contributors to poor morale.

College President Sir Collin Tukuitonga says the latest survey findings are cause for serious concern.

“We saw the need for a strong public health medicine workforce during the COVID-19 pandemic.

“We need to support and invest in this key workforce if Aotearoa is going to successfully meet the multiple health challenges we are facing”.

“Public Health Medicine Specialists have a key role to play in supporting the health and wellbeing of New Zealanders and in helping our struggling health system” says Tukuitonga. “The specialty should be regarded as an essential front-line service, rather than being seen as a back-office function”.

The four-yearly survey was sent to all current and retired Fellows of the New Zealand College of Public Health Medicine and had a response rate of 60%.