We’re Pushing Back Against Dangerous HHS Workforce Reductions

What happens when the top federal agencies dedicated to medicine, health care and health research suddenly and messily contract? Negative public health impacts are certain, even if it’s too early to quantify them. 

But it isn’t too soon to talk about one result: the mobilization of the Academy’s advocacy and membership against indiscriminate, potentially dangerous mass firings across HHS. You can join this effort: Use our Speak Out tool to ask your members of Congress to oppose the firings and instead ensure that HHS remains fully staffed.

What’s Happening: a ‘Massacre’ 

On Feb. 14, the Trump administration began implementing federal workforce reductions, in line with a Feb. 12 executive order. Media reports have characterized the results so far as a “Valentine’s Day massacre”: thousands of fired probationary workers within HHS, including staff at CMS, the CDC, the FDA, the National Institutes of Health, the Epidemic Intelligence Service and the Substance Abuse and Mental Health Administration. 

The AAFP and family physicians rely every day on HHS, whose mission is to “enhance the health and well-being of all Americans by providing for effective health and human services, and by fostering sound, sustained advances in the sciences underlying medicine, public health and social services.” Gutting HHS has great potential to negatively affect public health. Official figures and systematic impacts remain unclear as I write this, but this action stands to limit or hinder health care coverage, health research, public health preparedness and emergency responses, alternative payment models, and other parts of the U.S. health system.   

‘Probationary’ Doesn’t Explain It 

An important thing to note about probationary, the term the administration has applied when outlining these reductions, is that it does not mean green. In the parlance of government staffing, it encompasses both recent hires and tenured employees who have transferred or been promoted into new jobs. In neither case should it be assumed that we’re talking about fresh-out-of-school employees, as opposed to experienced professionals serving the public. There are hundreds of thousands of probationary federal workers — the institutional memory of the government as well as its future.  

As a Feb. 18 New York Times story put it, this ousting of probationary workers has “excised the next generation of leaders” at the CDC, the NIH and the FDA, among other HHS agencies. In that same article, David Fleming, M.D., chairman of a high-level CDC advisory committee, said, “It seems like a very destructive strategy to fire the new talent at an agency, and the talent that’s being promoted. A lot of energy and time has been spent in recruiting those folks, and that’s now tossed out the window.” 

And what is the ostensible cost benefit of all this? Payroll for all federal employees was about 3% of the 2024 fiscal year federal budget.  

Outside probationary workers, the upheaval includes several notable leaders. 

• The head of the FDA’s food division has resigned in protest. 

• Renee Wegrzyn, the first head of the Advanced Research Projects Agency for Health, anchoring the previous administration’s cancer “moon shot,” was fired. 

• Amid conversations within the administration and among the House Republican majority about reducing not just NIH headcount but also its funding, that agency’s deputy director retired last week, effective immediately. 

• The NIH’s deputy director of extramural research, with oversight of grant awards, also quit last week.  

• Aimee Eden, Ph.D., M.P.H., director of the Agency for Healthcare Research and Quality’s National Center for Excellence in Primary Care Research — an important hub for primary care researchers, responsible for funding and initiatives that benefit family medicine — was fired. (Eden was previously a researcher at the  American Board of Family Medicine.) 

Research Under Threat 

Eden’s involuntary exit and the departures at the NIH occur in an environment in which primary care research is already inadequately funded, as the brand-new Robert Graham Center scorecard confirms. (I’ll talk more about this new report soon in a separate post.) 

The NIH’s research, which is respected worldwide, touches every area of medicine, with meaningful downstream benefits to family medicine patients. More than 90% of its $48 billion budget backs biomedical research at universities, hospitals, research organizations and private companies nationwide, across a vast array of topics. Its tens of thousands of grants fund hundreds of thousands of jobs and yield almost $100 billion in economic impact. NIH funding contributed to research for some 99% of drugs approved during the 2010s. 

The limits to NIH money now under discussion could have severe consequences. Apart from recent temporary suspensions to research projects and delayed approvals for new clinical trials for cancer treatments, the White House wants to cap at 15% administrative support for research institutions, which would mean billions in funding stripped from scientists. As with HHS, the diminution of this largest public funder of U.S. biomedical research will ripple through the entire health care system, affecting family medicine practices and patients as well as their shared communities. 

Pushing Back 

Over recent days, the AAFP has been working closely with the Group of Six to better understand these workforce reductions and their potential impacts on our respective member constituencies. The Academy also has engaged in direct advocacy with Congress, urging lawmakers to leverage their oversight responsibilities so the public can grasp the rationale and process behind these ill-informed decisions, and so there can be accountability for the results. 

The members AAFP Board of Directors will be in D.C. the week of Feb. 24 and plan to raise these concerns (as well as advocate for important funding needs) as they keep appointments with members of Congress and their staff.  

We aren’t alone in our objection to the HHS firings. The disruption is generating considerable static, with some federal employee unions contending that the firings are illegal and suing the administration. In a Feb. 16 statement, eight former HHS leaders who worked under the previous administration, including the former CDC, CMS, FDA and NIH heads, agreed that the firings would cause U.S. health and well-being to “suffer.”  

If one thing is clear in this challenging moment, it’s that family physicians must engage with policymakers on several crucial topics. You can join our call to action, especially as we look to push back on the legislative attack on Medicaid. And if you want to go further, consider joining the AAFP’s new Advocacy Ambassadors program.