High profile departures leave Philly searching for a new slate of health leaders

After several high-level departures in the last year, Philadelphia officials are looking to fill top jobs at crucial agencies that deal with the health of the nation’s poorest big city, where homelessness, poverty, and racism contribute to poor outcomes for many residents.

Temporary leaders are currently in charge of four city agencies tasked with improving Philadelphians’ health, investigating deaths, and expanding housing opportunities.

Turnover in the top positions at the city’s operational departments is typical in a new mayoral administration, and Philadelphia officials say they have a short list of candidates to lead three of these agencies and expect to announce a hire for at least one soon.

The departments play an essential role in Philadelphia, where nearly 4,500 people in 2022 experienced homelessness and 10% were uninsured, and where there are significant racial disparities in a number of health outcomes, including life expectancy.

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Scandals within some of these departments in recent years have also raised the stakes for how important it is to find Philadelphia’s next public health leaders.

Public health experts say these jobs require a unique skill set that combines financial and management know-how with public health expertise and a deep understanding of what makes Philadelphians tick.

“Philadelphians are demanding of our public officials, as well we should be,” said Greg McDonald, a former assistant medical examiner in the city. “You have to be able to have a pulse of what Philadelphians are like.”

Exodus of public health leaders in Philly

Liz Hersh, who led the Office of Homeless Services (OHS) for eight years, left the office in October 2023.

Chief Medical Examiner Constance DiAngelo was just a year into the job when she resigned two months later, in December.

The director of the Department of Public Health, Cheryl Bettigole, left her position in February after nearly three years leading the agency.

And Jill Bowen, the head of the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) left for a position in Vermont’s state government in March.

Scandals in several of these departments in the last several years underscore the complexity of hiring new leaders into these roles.

In 2021, Bettigole’s predecessor, Thomas Farley, was at the center of multiple scandals, starting with the collapse of a partnership with Philly Fighting COVID. That group, led by a 22-year-old Drexel University student and tasked with overseeing the city’s largest vaccination site, failed to tell city officials that the personal information patients entered into its registration portal could be sold.

Months later, Farley resigned after revealing that, in 2017, he had ordered the cremation of remains of victims of the 1985 MOVE bombing that had been stored in the medical examiner’s office for decades — without telling the victims’ families. (An employee disobeyed the cremation order, and the remains were later found at the office.)

Sam Gulino, then the chief medical examiner, also left his position in 2021 over the handling of the remains. City officials did not give a reason for why DiAngelo, his replacement, left after just a year on the job.

More recently, following the departure of Hersh, the former director of the Office of Homeless Services, city officials learned that the agency had overspent its budget by $15 million. The agency is currently involved in three separate financial mismanagement investigations.

The Health and Human Services Department, which oversees collaboration between all these agencies, has identified candidates to lead the health department, DBHIDS, and OHS, city officials say.

“They are on track with their timeline and have identified an impressive list of candidates now on the short list,” a spokesperson for the Managing Director’s Office said in a statement, adding that the city expects to announce its pick for OHS’s executive director “soon.”

The chief medical examiner job is a civil service position and subject to a different hiring process, the city said.

“These searches and decisions require a significant vetting process given the size of the departments and the many programs [they] both manage and implement,” the spokesperson wrote. “All interim leaders are doing an excellent job as they continue to focus on all priorities of the departments and the new Parker Administration’s.”

The city declined to make the interim directors available for an interview.

A difficult job market

Leaders who can navigate the stress of a public-facing health job are in high demand and short supply, especially since the COVID-19 pandemic, said Lori Freeman, the CEO of the National Association of County and City Health Officials (NACCHO).

“The pandemic really had an impact on our public health workforce. It was a stressful time, a time when physicians had to deal with a lot of local, regional, and state politics in the way, and they wear you down,” Freeman said.

About a third of state and local public health employees said in a 2021 national survey that they were considering leaving their organization, and only 5% said it was because they were retiring. Among those looking to leave their jobs, 39% said the pandemic had contributed to their decision.

It’s a situation mirrored in the forensic fields. Forensic pathologists often make less money than another highly specialized doctor would, despite the fact that they attend medical school and undergo extensive training afterward, deterring many from the profession.

“There are 700 to 800 board-certified forensic pathologists in the whole country,” said McDonald, the former Philadelphia assistant medical examiner. He now works as Montgomery County’s chief forensic pathologist and as the dean of the School of Health Sciences at the Philadelphia College of Osteopathic Medicine.

Philadelphia’s long-understaffed ME’s office has attempted to attract more hires in recent years. When DiAngelo resigned in late 2023, the city noted that it had recently received new funding to hire more staffers, with an aim to prioritize homicide investigations.

And the office’s new facilities at police headquarters on North Broad Street could be another draw: “It’s much better than when I worked there,” said McDonald.

A specific skillset in high demand

Experts say that leading a big-city health agency requires a specific skillset that goes beyond understanding public health.

Big-city public health officials who oversee large agencies with millions of dollars in funding are often required to act like CEOs — but without the commensurate pay of one at a for-profit corporation. They must be skilled in management, finances, and strategic thinking, Freeman said.

The job can be a delicate balancing act, said James Buehler, who served as health commissioner under Mayor Michael Nutter and is now a teaching professor of health management and policy at Drexel University.

“You have to understand how local government works, and the position of your agency within that,” he said. “You need a bit of a thick skin and ready sense of humor and patience to navigate all those complexities.”

Good public health leaders, like good doctors, must understand their patients, Buehler said. They should have a deep knowledge of the health inequities in places like Philadelphia, where poverty and racism have contributed to poor health for large segments of the population, and of historical injustices like the MOVE bombing, he added.

“When I was health commissioner, my patient was the whole city of Philadelphia,” he said.

Staff writer Max Marin contributed to this report.