Managing the Public Health Workforce in San Antonio, Texas


Dr Brian Alsip

As assistant director for clinical and population-based services in the San Antonio, TX, Metropolitan Health District (Metro Health), Dr. Bryan Alsip takes a long-term strategic approach to workforce management. His goals: ensuring that that his department can meet the growing needs of the community and attract grants to maintain and improve services.

Meeting growing needs with smaller budgets

Like every local government agency, Metro Health continues to face budget cuts and increasing demand for services. With a 10 percent budget cut in fiscal year 2010 and another 10 percent cut proposed for 2011, Dr. Alsip must use creative workforce management strategies to meet the community’s growing needs for services. About 35 percent of Metro Health employees are paid from the city’s general fund, 65 percent funded out of grants.

“Grant-funded employees have become the rule rather than the exception,” says Alsip. “As general fund positions are reduced, we look at grants as a way to develop and maintain a skilled workforce.” But even grant-funded positions are subject to the “hiring chills” or delays in processing new hires that are imposed when the city’s general fund is cut.

Alsip believes in hiring permanent employees rather than using contractors, so they have rights and benefits and feel invested in their work. Metro Health hires from the communities it serves, and offers employees professional development opportunities to expand their skills and work experience.

Grant writing as a workforce development strategy

Metro Health has an impressive record of attracting outside funding from federal, state, and private sources. In fiscal year 2010, for example, the department won $37 million in federal funding, $2.6 million in state funding, and $1.8 million from private sources. Staff have learned how to write successful grant proposals, which funding sources to approach, and how to demonstrate to funders that a particular grant is a good fit for the department. Alsip looks for grants that will allow the department to hire new talent they can then develop from within, as well as funds that enable the department to meet national standards and gain accreditations, many of which include requirements for employee training and development.

Hiring local

Metro Health’s biggest competitors for talent are the state and local school districts, which, like Metro Health, hire sanitation workers, nurses, and school health aides. The schools have an edge in offering higher pay and a nine-month work year, but Metro Health offers other attractive benefits, including

  • supplemental language pay for Spanish speakers
  • a “Lunch and Learn” education program offering classes through local community colleges and universities that can be used for credit toward undergraduate degrees
  • reimbursements for undergraduate and graduate studies in public health or other degrees relevant to an employee’s position
  • generous pension benefits
  • travel to meetings and conferences, as required by many grant-funded programs.

Partnering with higher education

In addition to hiring staff from the communities it serves, Metro Health relies on higher education programs for free labor. The department partners with the University of Texas School of Public Health to provide practical educational opportunities or externships for MPH candidates and undergraduate students, and with the US Air Force School of Aerospace Medicine and US Army Academy of Health Sciences for physicians and nurses in training. The department gains a free supplement to its staff, the participants gain valuable work experience, and military medical students have a chance to work in a civilian environment.

In this way, Metro Health also builds a pipeline of future employees and closer relationships with the military and private public health communities, which serve as sources of valuable referrals and support for the future work of the department.

“While Metro Health is a public health department, much of our financial support comes from grants and much of our personnel support from partnerships with educational institutions,” Dr. Alsip notes. “Thanks to all of these entities and the dedication of our employees, we are able to continue to serve our clients well despite the economic recession.”

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