by Melanie Padgett Powers, writer
Denise Lopez, DrPH, did not have an easy or clearcut path leading to her current role as laboratory director of Tulare County, California, Public Health Laboratory.
Her story, along with so many others’ tales of how they fell into—and then fell in love with—their public health laboratory career is one-of-a-kind. These are often journeys filled with opportunity, serendipity and supportive mentors.
But for every success story, there are people inside and outside of public health who don’t know about the opportunities at public health laboratories or how to access them. APHL and other public health leaders are working to change that, providing clearer, more supportive pathways into public health laboratories, then up the ladder into management, and finally to a public health laboratory director position, if desired. They are creating multiple ways to lift up employees who need more experience, leadership training, degree programs or other avenues to grow—and stay—in public health laboratories.
As a kid, Lopez loved science and set out to major in biology in college. However, at age 19, she was a single parent with
a severely developmentally delayed daughter who needed around-the-clock care. Fortunately, Lopez was able to live at home with her parents, who were incredibly supportive. They took care of their granddaughter in the evening so Lopez could take night classes, first at a community college an hour away, later transferring to nearby Fresno State.
But a master’s degree, let alone a doctorate, was not in her plans. She knew she needed to land a good job, preferably as a clinical laboratory scientist, after graduating college so she could pay for her daughter’s care. So, in her junior year, when she recognized that she needed more clinical laboratory experience on her resume, she hatched a plan: She would get the highest grade on the first exam in her medical microbiology class and then approach her professor immediately after to ask to work in her laboratory. And, it worked—she got the best grade and connected with her professor.
That professor, Mamta Rawat, PhD, pointed Lopez to a fellowship program through the US Environmental Protection Agency (EPA) that would pay her tuition and a stipend as she earned a master’s degree. With that support, Lopez continued her education. When she finished her fellowship and earned her master’s, a trainee microbiologist position opened in the Tulare County, California, Public Health Laboratory. She was hired and completed the required six-month training program to become a state-certified public health microbiologist.
“That was the first time that I’d heard of a public health microbiologist, and I’d never even really thought of public health or understood what public health was,” Lopez said.
Lopez had been familiar with the role of diagnostic testing for individual patient care. But as she learned about the wider focus of public health, she was hooked. “I saw how public health data are used for public health action at a population level, providing services egardless of means or health insurance, and tackling problems like outbreaks or persistent diseases at a larger scale,” she said. “That was just so exciting to me, and it gave me a feeling of a greater sense of purpose in what I was doing.”
Programs to Build the Pipeline
Public health infrastructure continues to face sustained erosion in funding and support. Many public health laboratories have been understaffed, underpaid and underappreciated for years, doing what they could with fewer resources. When COVID-19 arrived on US shores, laboratory personnel faced intense pressure to ramp up, despite few immediate resources. The strain has been evident in many laboratories, as staff have resigned or retired. Since the pandemic began, nearly half of the laboratory director positions—59 out of 134 member laboratories—have turned over, according to APHL.
Even before the pandemic, almost one-third of state public health laboratory personnel in 2016 indicated an intent to leave within the next five years, according to the APHL workforce report Focus on Public Health Laboratories. After controlling for other factors, more men and millennials (compared to Generation Xers) indicated an intent to leave. In a 2021 APHL report examining millennials in the public health laboratory workforce, barriers to retention included salary and lack of a career path for employee growth or promotion.
In recent years, several programs have been developed or expanded to improve career opportunities for laboratory personnel. The APHL Emerging Leader Program (ELP) is a 12-month leadership development program for laboratory professionals. Each year, 12 to 15 individuals are selected to form a cohort class. The cohort participates in skill development workshops, networking opportunities, leadership exercises and project development.
Kim Smith, MS, joined the Houston Health Department’s Bureau of Laboratory Services in 2013 as a microbiologist II and has worked her way up to her current role as laboratory supervisor of compliance. In her previous role as a microbiologist IV, she was in an administrative role as a quality control officer. She started getting involved and interested in the larger public health context of what the laboratory provided the community.
Smith was accepted into the 2020 ELP cohort. While the pandemic forced her cohort to become virtual-only, that didn’t dampen the experience. If anything, she was more immersed in it with weekly Zoom meetings. One of the most valuable aspects of the program, she said, was identifying your work personality and learning how to work well with others based on different work personalities.
It was helpful, she said, “just learning about leadership in general, and what those characteristics are and making sure that if I don’t possess them, that I at least try to change the way that I think. The type of leader that you are is important because you shape others and others are looking to you for direction. So, I want to make sure that I’m investing in myself so that I can be the best leader for everyone who is in my organization, and ELP helped me define that a little bit more.”
Each ELP participant is paired with a coach, which has also been valuable for Smith. Having a coach “teaches you how to approach certain situations and solve it yourself with the direction of your coach, or with someone just asking you the right question,” she said.
When Andrew Cannons, PhD, HCLD(ABB), current laboratory director of the Florida Department of Health’s Bureau of Public Health Laboratories, was accepted into the 2010 ELP cohort, he had a lot of career experience but not any specific leadership training.
After earning his PhD at the University of Bradford in the UK, he moved to the US in 1987 for a postdoctoral position at the University of South Florida (USF) to study how plants use nitrates as a nitrogen source. Nothing to do with public health.
In the late 1990s, the state’s public health director at Tampa, Philip Amuso, PhD, was completing his PhD at USF and asked Cannons if he could sit in on his undergraduate molecular biology class. Amuso also did some research projects in Cannons’ lab, and the two became friends. When Cannons began to look for new job opportunities, Amuso told him about a new role as scientific director of the Center for Biological Defense, a new US Department of Defense project based at USF looking at biological defense techniques. His laboratory and office would be housed in the state public health laboratory’s building, making it easy for the two organizations to assist each other when needed.
As Amuso planned for retirement, Cannons began to consider becoming the new laboratory director and earned his high-complexity laboratory director certification. In 2012, he became director, with ELP providing him leadership training the year before.
Eleven years later, now as a director, Cannons has encouraged several employees to apply for ELP. So far, five of them have gone through the program and remained at Florida public health laboratories.
ELP is clearly developing future public health laboratory leaders. As laboratory scientists consider future career opportunities—moving into managerial and supervisory roles—they will need the leadership skills that come with managing a budget, motivating staff, advocating for funding, building relationships with external partners and understanding legislative processes.
After going through the program, Smith, who now has two direct reports, is contemplating her career goals, which may include earning her doctorate so she can become a laboratory director.
“I think people should apply for ELP especially if you want to be in a leadership role because you need that core training,” Smith said. “It helps you see yourself in a different way and establishes the foundation of leadership; it’s not just a job title that makes you a leader.”
Expanding the APHL-CDC Fellowship Program
Another program that has helped recruit, educate and retain people in public health laboratories is the laboratory fellowship program offered in partnership by APHL and the US Centers for Disease Control and Prevention (CDC). The program trains and prepare scientists for careers in public health laboratories. The fellows focus on areas that include bioinformatics, environmental health, food safety, infectious disease, newborn screening, informatics, quality management systems and biorisk management.
In 2021, APHL received federal American Rescue Plan funding that allowed it to dramatically expand the fellowship program, benefiting the fellows, the laboratories and the public health workforce overall. Currently, there are 137 fellows in 36 states, representing approximately 45 laboratories. Before the pandemic, there were approximately 20 fellows in as many labs.
The New Jersey Division of Public Health and Environmental Laboratories has been hosting one or two APHL-CDC fellows per year for about 15 years. However, in 2022, the division is hosting 10 fellows, thanks to the new federal funding. Other new funding has allowed the division to hire more staff, which means more mentors for the fellows, explained Laboratory Director Thomas Kirn, MD, PhD. In addition, the division used COVID-19 funding to create its own postdoctoral fellowship program, which currently has two fellows.
The benefits to the laboratory are numerous, beyond growing the workforce. During their one-year fellowship—with the option to extend it to two years—the fellows undertake public health initiatives that the laboratories often don’t have the resources to do.
“For laboratories that are lacking expertise in existing areas, adding a fellow onto your team can allow you to expand the reach of your services, as well as the opportunity to shape the next generation of scientists in a way that is most beneficial to your laboratory and public health in general,” said Gretchen W. Cote, MS, bioinformatics principal scientist, Department of General Services, Virginia Division of Consolidated Laboratory Services.
Kirn highlighted another benefit that might not seem as obvious to laboratories newer to the program: the effect on staff morale. Fellows bring an excitement to the laboratory, with fresh ideas and enthusiasm, he said.
“From a job satisfaction standpoint, our current employees enjoy mentoring fellows; that’s kind of a value-add to their job, even though it’s a little more work,” he said. “It gives our staff the opportunity to be mentors and teach.”
The program also promotes knowledge sharing throughout the laboratory, with fellows providing regular updates and presentations. “It really creates a nice collaborative environment where people are learning about different areas of the laboratory,” Kirn said.
In addition, the public health community, in partnership with APHL and CDC, is very supportive of the public health fellows, Cote said. “Participating in the fellowship program as a host allows you to become part of that community to the ultimate benefit of not only your laboratory, but your fellow.”
It also feeds the laboratory pipeline directly. In New Jersey, several fellows have stayed on as employees. Three of the current project managers were once APHL-CDC fellows in the department. Another former New Jersey fellow is now a laboratory director in another state.
Victoria Stone, PhD, is a former fellow who stuck around. With an interest and background in antimicrobial resistance (AR) she became an AR fellow at the Tennessee Department of Health Laboratory Services in 2017.
After her one-year fellowship, she was hired by the laboratory for her current role as a consultant in the molecular department. She also now mentors the new AR fellow. “Coming from being a fellow, I can relate to what they’re going through, and I can build strong relationships with them,” she said. “I can give them a lot of feedback because I’ve been where they’ve been. … I think a lot of the fellows that are coming in are coming straight out of school like me and don’t really have a lot of work experience or don’t know that much about public health. So, me being able to help them learn and become confident in their skills and knowledge is rewarding. It’s nice to be a part of that.”
In Virginia, Christian Alcorta, MS, is a second-year fellow of newborn screening data analytics and bioinformatics, under Cote’s mentorship. A biology major and math minor with an interest in coding, Alcorta completed a master’s degree in bioinformatics in August 2020. His primary fellowship project is to revamp the laboratory’s second-tier assay for cystic fibrosis. He hopes to stay in the Virginia laboratory after his fellowship ends next summer.
“I really, really love the people that I work with and the environment that I work in,” he said. “As long as I continue feeling like I’m learning new things, I plan on staying because it’s a very good work environment, and everyone is extremely supportive.”
The fellowship is Alcorta’s first experience working in public health, but likely not his last. “I knew next to nothing about public health. … It was not really something that I had thought much about, and now being in that environment, it definitely is something that I care about and feel strongly about.”
He likes that his work has a real-world impact on people; in this case, screening newborns for diseases. “It has made me feel more strongly about public health and made me feel more inclined to stay in public health,” he said.
Providing a Path to a DrPH
As people rise through the ranks in laboratories, there is one requirement that can stop them in their tracks. Without a doctoral degree, they often cannot become a high-complexity laboratory director because they do not meet the requirements for board certification or to oversee the Clinical Laboratory Improvement Amendments (CLIA) regulations.
In California, Lopez would likely have hit that career ceiling. With a family dependent upon her income, she could not interrupt her full-time public health laboratory career to move somewhere to obtain a PhD. The nearest doctoral program is 200 miles away.
But that’s where the University of South Florida came in. In 2017, USF accepted its first cohort of students into its new doctor of public health (DrPH) program focused specifically on public health and clinical laboratory science and practice—the only one in the country focused on laboratories. The program was purposefully developed to be mostly online, allowing current public health laboratory employees to earn their DrPH while staying in their current roles.
Several public health leaders united to campaign for such a program after a 2011 workforce survey from APHL and the University of Michigan illustrated major pipeline issues. More than half of public health laboratories expected up to 15 percent of their workers to retire or leave within five years. They cited the two most common barriers to recruitment as lack of opportunities for promotion and lack of a career path for advancement.
USF was a good fit for a new program. “We already had an existing DrPH program that was in leadership, and that program is also 100 percent online because the program wants to attract people who are already working in the field,” explained Jill Roberts, PhD, MS, MPH, CPH, director of the DrPH program and associate professor in the USF College of Public Health. “We recognize that we can’t pull those people out of their jobs. The whole point of the program is for them to advance in their jobs, not to disrupt their careers.”
USF has been a leader in online education, Roberts said, also offering an online Graduate Certificate in Infection Control program that is the largest certification program for the College of Public Health. The DrPH laboratory program continues to grow, from a handful of students admitted each year to its largest class of 10 students starting in fall 2022. New scholarships through APHL from American Rescue Act funds are partially responsible for the increase. The scholarships pay tuition plus a stipend, which can help cover the travel costs for the three required one-week on-site institutes at USF. Several of the past two years’ cohorts are receiving funding. (Roberts welcomes any questions about the DrPH program: email@example.com.)
Since 2017, five students have graduated from USF with their DrPH and three have become laboratory directors. More directors are expected as they graduate—and no longer hit that career ceiling.
“The public health laboratories are underappreciated, they’re underfunded, and the individuals who work there are underpaid,” Roberts said. “So for us to be able to give them an opportunity to see some fruits of their labors in their dedication to those laboratories is fantastic.”
From her home and office in the Central Valley of California, Lopez earned her DrPH and passed her boards. She became laboratory director on August 1, 2022. She had been managing the laboratory while their retired former director stayed on part-time to serve as the CLIA director.
Her DrPH has not only helped her career, it has given her laboratory more stability with a full-time director who has no plans to leave the area she grew up in. And it’s filled in a missing educational piece, offering an opportunity to her laboratory staff who were able to earn a bachelor’s degree nearby and a master’s in public health online but didn’t have a feasible doctorate option.
“Especially when you’re talking about upward mobility for people that live in traditionally underserved areas, rural agricultural communities, the key to that upward mobility is access to higher education,” Lopez said. “And this was a piece that was missing for our laboratory and so many other laboratories that are located far away from universities. It opens the door not only for the laboratory to have a sustainable path of succession for highly qualified individuals, but also to lift up members of our existing community, as opposed to just relying on recruiting talent from without.”