WASHINGTON, DC (May 7, 2020) – A novel workforce tool created by researchers at the George Washington University Milken Institute School of Public Health (Milken Institute SPH) estimates that the nation will need a total of 184,000 COVID-19 contact tracers in order to help society safely reopen and limit the size of future waves of the virus. The tool will help state and local health departments determine the number of staff needed to effectively identify and trace people who have been in contact with new cases of COVID-19 and slow the spread of the virus.
“We know the virus that causes COVID-19 is highly contagious and spread by human contact,” said Edward Salsberg, MPA, a senior research scientist at the Fitzhugh Mullan Institute for Health Workforce Equity (Mullan Institute), which is based at Milken Institute SPH. “This new tool will help public health officials plan for the workforce needed to identify those most at risk and ease up on community-wide social distancing measures yet still keep the public safe.”
Using data on the number of COVID-19 cases, the estimated number of contacts per infected persons and other information, the team of researchers at the Mullan Institute have created the Contact Tracing Workforce Estimator. The tool was developed in collaboration with the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO).
Using the new estimator, state and local public health officials will be able to plug in the number of COVID-19 cases and other data to help them gauge the number of staff needed to effectively trace contacts of all infected people in their jurisdiction. In addition, the estimator helps public health officials understand the factors, such as the need for social services, which can impact the number of contact tracers needed to slow the spread of infection.
Effectively stemming the viral spread requires that everyone in contact with a person who has tested positive is identified and contacted as soon as possible, ideally within 24 hours. A contact tracer provides information, recommends testing if that person has symptoms, and advises these individuals to quarantine for up to two weeks.
Up until now, lacking extensive testing and contact tracers, most communities in the United States have closed many businesses and schools and told students and employees to work or attend classes remotely. Public health experts know that social distancing and isolating people can help prevent the spread of the virus, but these blunt strategies also cause great economic and personal hardships.
To help pave the way for a safe reopening of restaurants, schools and businesses, state and local leaders need an expanded ability to test for the virus that causes COVID-19 and an army of contact tracers who can quickly identify people who have been exposed.
Recently, experts at ASTHO estimated that state and local health departments had only a few thousand contact tracers prior to the start of this pandemic—well below the number needed to confront the current cases of COVID-19. Without enough trained contact workers, infected people, including those who do not realize they have the virus, can spread the disease to many others in the community—a problem that could result in a second wave of infections.
“Returning to some semblance of normalcy is contingent on our nation’s public health capacity to contain future outbreaks through testing and contact tracing,” said Michael Fraser, chief executive officer at ASTHO. “Contact tracing is core work of state, territorial, local, and tribal public agencies. Public health does this type of work every day but there is an urgent need to scale up the workforce capacity needed to meet the challenge of COVID-19. This estimator tool will help health agencies prepare for the support they need in a more precise way using their local and state experience and capacity as a start.”
The contact tracing workforce includes case investigators, who interview people diagnosed with COVID-19 and then figure out how many people they might have come in contact with while contagious, and contact tracers, who notify and follow up with these contacts. Many workers have a public health background while others may complete focused trainings. Contact tracing has been used to quash emerging outbreaks of Ebola and SARS in the past and public health officials say that when coupled with adequate testing it could become a powerful method of preventing new cases of COVID-19—especially as the economy starts to reopen.
“Although state and local jurisdictions will soon begin to ease stay-at-home orders, this pandemic is far from over. As people are given the green light to patronize businesses and return to other public establishments, risk of COVID-19 transmission remains a threat,” noted Lori Tremmel Freeman, Chief Executive Officer at NACCHO. “As such, it is critically important for public health officials to be able to scale up and mobilize a well-trained contract tracing workforce with enough personnel to fulfill this important protective measure without overburdening or burning out the individuals doing the work.”
The Contact Tracing Workforce Estimator, was developed by a team at the Mullan Institute, including Candice Chen, Eric Luo, Nicholas Chong, Sara Westergaard, Clese Erikson, Patricia (Polly) Pittman and Edward Salsberg. The tool uses a unique combination of various factors to estimate the number of contact tracers needed to fight COVID-19.
This interactive tool and map project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services as part of an award totaling $450,000 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
Milken Institute School of Public Health, Beyond Flexner Alliance Announce 2021 Awards for Excellence in Social Mission in Health Professions Education
WASHINGTON, DC (April 20, 2020) —The Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University and the Beyond Flexner Alliance today announced the selection of the Josiah Macy Jr. Foundation Awards for Excellence in Social Mission in Health Professions Education.
The purpose of the Josiah Macy Jr. Foundation Awards is to recognize outstanding leadership in promoting social mission in health professions education. Social mission is defined as activities or initiatives that teach, model, or improve community engagement, diversity, disparities reduction, value-based care, or engagement with the social determinants of health. Social mission enhancement means making programs not only better, but fairer.
This year’s nomination process was highly competitive with nearly double the number of submissions. The awards will be presented in five categories: individual excellence, program excellence, institutional excellence, lifetime achievement and a new category recognizing an early career rising star.
Robert M. Rock, MD
Robert Rock co-created a one-of-a-kind course at Yale on health disparities for PA, MD, and APRN programs. The course intentionally includes interprofessional educators and led to the creation of an interdisciplinary student group for all graduate students, faculty, and the New Haven public for community building and action toward health equity. His efforts have helped to create a sense of belonging and empowerment for students who carry identities traditionally not exemplified in medicine.
Joseph Kiesler, MD
Joseph Kiesler’s commitment to equity and social justice has inspired thousands of learners and faculty. From providing care to the homeless and backside racetrack workers to his leadership in establishing a national model of interprofessional service learning at the University of Cincinnati College of Medicine, Kiesler is a true champion of the core values of social mission in education.
Green Family Foundation Neighborhood Health Education Learning Program
Florida International University Herbert Wertheim College of Medicine, Miami, FL
The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Florida International University Herbert Wertheim College of Medicine demonstrates national leadership in integrating social accountability and interprofessional education through a service-learning experience in underserved communities. NeighborhoodHELP is a household-centered care approach that highlights a social mission in health professions education while caring for vulnerable populations.
Charles R. Drew University of Medicine and Science
Charles R. Drew University of Medicine and Science (CDU) is a beacon of hope for students who wish to pursue a career in health professions and advocate for those whose voices are silenced. Formed from the ashes of the Watts Riots of 1966, CDU has graduated more than 575 physicians, 1,200 physician assistants, and over 1,000 nursing professionals. With a mission of academic excellence coupled with community responsibility, CDU develops students into change agents who are poised to be champions of health equity.
George Blue Spruce, Jr., DDS, MPH
George Blue Spruce, Jr., DDS, MPH, the first Native American Dentist in the United States, realizes that as a trailblazer he bears the responsibility of illuminating the health professions pathway for American Indian children who are unaware the path exists. He has dared American Indian children to become a dentist, and his unique leadership has left a legacy promoting social mission in health professions education.
The awards will be presented at the Beyond Flexner 2021 Conference in Phoenix, Ariz., at a special recognition event the evening of April 26, 2021. The Beyond Flexner Conference is a comprehensive meeting for health professionals working to create a more equitable health care system for all.
Each awardee receives $2000 and a commemorative plaque. The awards are supported by the Josiah Macy Jr. Foundation, which is dedicated to improving the education of health professionals for a healthier public.
The Beyond Flexner Alliance is a national movement, focused on health equity and training health professionals as agents of more equitable health care, based at the Fitzhugh Mullan Institute for Health Workforce Equity at Milken Institute SPH.
WASHINGTON, DC (April 16, 2020) – As the U.S. healthcare workforce struggles to care for a rise in COVID-19 cases, there are growing reports that there are not enough workers to meet the surge in demand. Some hospitals are reporting they do not have enough respiratory therapists to operate ventilators. And rising numbers of nurses and other health care workers in New York and other states have fallen ill and are quarantined, or simply unable to report to work due to family needs.
To meet the potentially explosive demand for healthcare workers, researchers at the George Washington University Milken Institute School of Public Health (Milken Institute SPH) have created a novel tool that will help states and the federal government estimate the need for health care workers under different scenarios of patient infection rates and health worker attrition. The estimates provided by the new tool will help state and federal pandemic experts plan for large spikes in illness and potential shortfalls of key ICU personnel, such as respiratory therapists, intensivists, critical care nurses and others.
“This pandemic has put extraordinary pressure on our health workforce,” said Patricia (Polly) Pittman, PhD, director of the Fitzhugh Mullan Institute for Health Workforce Equity, which is based at Milken Institute SPH. “Our interactive tool will help identify potential worker shortages during peaks in demand. Ultimately, the information gleaned from this model will pave the way toward solutions to anticipate and prevent problem by shoring up just-in-time capacity.”
Using data from the Institute for Health Metrics and Evaluation on the projected demand for services, and data from the American Hospital Association and publicly available datasets to estimate supply, Pittman and her colleagues looked at the availability of respiratory therapists and intensivists trained to work with critically ill patients. They also plan to prepare analyses of five additional professions, all needed to care for COVID-19 patients. The tool assumes surge capacity professional to patient ratios, and allows users to modify health worker attrition rates based on local information to show potential deficits in staffing.
When the team plugged in estimates for respiratory therapists needed during the COVID crisis they found that five states (New York, New Jersey, Connecticut, Massachusetts, and Michigan) are at risk for not having enough of these workers even under the lowest COVID demand scenario and no workforce attrition. An additional 12 states are at risk for not having enough respiratory therapists under the mean demand scenario without any workforce attrition.
As for intensivists, three states (Louisiana, New Jersey, and New York) are at risk for not having enough even at the lowest COVID demand scenario and no workforce attrition. Ten states are at risk for not having enough intensivists under the mean demand scenario without any workforce attrition.
While other models have estimated the need for hospitalization, beds or respirators during the pandemic, this is the first tool to estimate potential health workforce deficits and surpluses, said Pittman, who is also Professor of Health Workforce Equity at Milken Institute SPH.
The tool could help state and federal policy leaders prioritize efforts to meet demands during the COVID pandemic. For example, New York and Illinois are aggressively reaching out to retired health professionals to find those willing to come back into the workforce and help out during the crisis. Other states are considering waiving training requirements or extending licensure expiration dates through the end of the pandemic.
Once the pandemic has passed, the modeling tool could be adapted to anticipate workforce needs for other emerging epidemics.
“The virus that causes COVID-19 will not be the last time we see a relatively unknown disease-causing virus start spreading in a potentially explosive manner,” Pittman said. “This tool will help public health, state and federal leaders plan for the healthcare workforce we all need to keep us all safe during this pandemic and in the future.”
To find out more about the tool and view an interactive map of shortage states click here.
The State Health Workforce Deficit Estimator is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $450,000 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
Milken Institute School of Public Health Announces Fitzhugh Mullan Professor of Health Workforce Equity
WASHINGTON, D.C. (March 11, 2020) — The Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University today announced Patricia (Polly) Pittman, PhD, will be the first Fitzhugh Mullan Professor of Health Workforce Equity. Pittman, a professor of health policy and management at Milken Institute SPH and director of the Fitzhugh Mullan Institute for Health Workforce Equity (Mullan Institute), will be officially installed in the professorship at a ceremony to be held at Milken Institute SPH today.
Pittman is a renowned expert in health workforce issues and policy, conducting research on health systems, recruitment of health professionals, and workforce innovations. Pittman co-founded the GW Health Workforce, which is now known as the Mullan Institute, with the late Fitzhugh Mullan, MD, to further research and education in the area of health workforce equity. The Institute was renamed in April 2019 to honor Mullan, a professor of health policy and management and pediatrics at GW’s Milken Institute SPH and the School of Medicine and Health Sciences (SMHS). Mullan, a public health pioneer revered for his lifelong commitment to social justice, health equity and health workforce policies, died last November.
“I am honored to be installed into this professorship and to continue our work calling attention to the importance of the health workforce as an essential mechanism for addressing health equity,” Pittman said. “During these times of global disease threats, policymakers suddenly remember how important the people who deliver care are. Our work is to keep the focus on the workforce, and to critically examine which policies and programs are helping to ensure that health workers have the opportunity, competencies and the courage to address the needs of the least advantaged populations.”
The Fitzhugh Mullan Professor of Health Workforce Equity is a professorship made possible by a $3 million grant from The Atlantic Philanthropies. This professorship will advance the initiatives of the Mullan Institute, conduct research aimed at strengthening health workforce equity in the United States and around the world, and collaborate with faculty and students at Milken Institute SPH, SMHS, GW’s School of Nursing and across GW.
“Thanks to The Atlantic Philanthropies’ continued support, this professorship allows us to build on our research and work toward solutions for health disparities at home and across the world,” said Lynn R. Goldman, MD, MS, MPH, the Michael and Lori Milken Dean of Milken Institute SPH. “I cannot think of a more qualified person to install as this professor than Polly Pittman, who has worked tirelessly to build a stronger health workforce.”
The endowed professorship was part of a $10.1 million award from The Atlantic Philanthropies granted to the Mullan Institute in October 2019 to amplify its mission to advance and promote health equity issues on a global scale. The award also strengthens the Beyond Flexner Alliance, an organization focused on efforts to integrate social justice into education and medical practice, and the Atlantic Fellows for Heath Equity program, which develops global leaders to understand and address health disparities. The Atlantic Fellows for Health Equity program was established by an initial $25 million grant from The Atlantic Philanthropies.
“We’re excited about Polly’s leadership at the Mullan Institute. We are witnessing today, in immediate and personal ways, the significance of a strong health workforce dedicated to the most vulnerable among us,” said Christopher G. Oechsli, president and CEO of The Atlantic Philanthropies. “Polly brings the evidence, experience and values that will underpin this critical effort.”
In 2018, The Atlantic Philanthropies welcomed the Atlantic Fellows for Health Equity into the global Atlantic Fellows Program, which encompasses seven programs operating across five continents. More than 250 fellows participate annually in the programs that work toward fairer, healthier, more inclusive societies. The Atlantic Philanthropies committed nearly $700 million to support the work of the global network of Atlantic Fellows over the next 20 years.
WASHINGTON, D.C. (Jan. 22, 2020) – Lawmakers have the opportunity to improve labor conditions within the international nurse-staffing industry by adding employment rules to a bipartisan bill currently under debate in the Senate, concludes a commentary published today in the New England Journal of Medicine.
The Fairness for High-Skilled Immigrants Act, currently pending a vote in the U.S. Senate, would remove caps on employment-based visas from any single country and reserves 4,400 employment-based visas for immigrant nurses. If signed into law, the proposed legislation would be a win for the international nurse-staffing industry, but may also exacerbate current unfair labor practices, writes Patricia (Polly) Pittman, PhD, FAAN, the commentary’s author and a professor of health policy and management at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).
International staffing agencies often recruit workers from low-income countries with limited employment options. The workers contractually agree to low-paying jobs that make it difficult for them to leave later on. Nurses who do try to leave are often sued by the agency, leading to garnished wages and seized bank accounts.
“There is a unique opportunity right now to address the unfair treatment and exploitation of many immigrant health care workers,” Pittman said. “Under the current standard industry practices, nurses are forcibly retained by staffing agencies for about three years by way of exorbitant contract breach fees that labor migration experts compare to debt servitude.”
In September 2019, a court decision shed light on the unfair practice when a federal judge ruled that a New York nurse-staffing agency unfairly treated more than 200 nurses recruited from the Philippines. The court ruled that the agency violated the Trafficking Victims Protection Act by including unlawful provisions in the nurses’ contracts.
In the commentary, Pittman and co-author Adam R. Pulver, JD, an attorney at Public Citizen Litigation Group who has represented immigrant nurses in staffing-related cases, write that the proposed legislation in Congress could address the unfair treatment if they consider “five key measures for any legislation authorizing additional visas for international nurses.”
“Our experience speaking with and working with nurses shows that agencies rely on foreign nurses’ unfamiliarity with the U.S. legal system to get them to agree to contracts that no American nurse would,” Pulver said. “These are commonsense measures that Congress should pass now.”
The five measures are 1) No recruitment or contract-breach fees are permitted, with U.S. government visa fees paid by employers; 2) Employment contracts should last no longer than one year; 3) Nurses should have a job at a specific organization and location identified by the agency before arriving in the United States; 4) The job should begin within one week of the nurse arriving in the United States; and 5) contracts should not prohibit nurses from taking legal action against the agency if needed.
“Recruitment and staffing agencies should compete in a fair and free labor market with competitive wages and safe working conditions,” Pittman said. “No health care worker should be subjected to such unconscionable practices.”
The commentary, “Unethical International Nurse-Staffing Agencies — The Need for Legislative Action,” was published Jan. 22 in the New England Journal of Medicine. The authors’ views expressed in the commentary are their own and do not represent their affiliated universities or institutions.