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To reduce federal debt and expenditures, the Trump administration mandated an unprecedented, large-scale layoff across federal agencies in February 2025. As a result, approximately 1,300 probationary employees at the Centers for Disease Control and Prevention (CDC), nearly 10% of its workforce, received dismissal notices.

The decision to cut probationary employees and the subsequent programming and staffing cuts in March 2025 worsened an already existing public health workforce shortage. Based on the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), 27% of public health professionals planned to leave their organization, excluding those planning to retire, within the next five years. Research indicated that 24% of those public health professionals were planning to leave for non-governmental jobs, which impacts future governmental public health leadership and strains the overall workforce within public health agencies at all levels.

The CDC’s workforce boasts some of the top experts for disease control and health information, with over a third of the 13,000 employees holding a master’s or doctorate degree responsible for protecting Americans from outbreaks and other public health threats. In 2023, with public health agencies still recovering from the COVID-19 response, the CDC’s budget was slashed by $1.8 billion—a 22% reduction, with nearly 80% of the CDC’s base budget shared with state and local health departments.

In addition, the CDC recently pulled back $11.4 billion from state and local health departments, nongovernment organizations, and international recipients. While these funds were allocated in response to the COVID-19 pandemic, public health agencies depended on them for critical initiatives such as modernizing data systems, improving immunization access, and bolstering laboratory capacity to prepare for the next public health emergency.

Burnout in state public health agencies

Many of those working within public health agencies at the local and state levels are questioning how the restructuring and funding cuts at the federal level may impact their roles. Staff may be feeling discouraged as their coworkers are laid off and programs are shut down, halting the past few years of progress and investments. It is likely that with fewer resources, feelings of job insecurity, excessive workloads, and even moral injury, the remaining staff will face greater levels of burnout. Burnout was the number one reason for leaving the field cited by public health professionals in 2021.

With staff burnout, position turnover, and elimination of funding and resources, the existing workforce is scrambling to plug the gaps. State public health agencies rely on partnerships with federal agencies, such as the CDC, for guidance and expertise to address state and local public health challenges. The sudden dismissal of CDC employees coupled with program closures has dismantled training programs that were integral to bolstering the workforce of state and local public health departments. For example, the Public Health Associate Program trained, deployed, and supported recent college graduates and other early career workers for two years. As a result, public health agencies will be forced to shift responsibilities, priorities, and resources.

Future public health professionals, including those in college and postgraduate public health studies, are now facing doubts and questions regarding the stability of their chosen career path. In a recent survey by the Federal News Network, nearly 82% of federal employee respondents agreed that the mass federal terminations will make it harder to recruit young and mid-career employees and will overall result in an increased workload for an already understaffed workforce. Both experienced professionals and those considering public health careers are navigating an uncertain future within the public sector.

Migration of public health staff to the private sector 

The private sector (i.e., hospitals, not-for-profits, for-profits, and other areas outside government) offers a growing number of public health job opportunities, and federal workers are expected to naturally migrate to those jobs with roles ranging from consultants and epidemiologists to environmental specialists.

A Colombia University Mailman School of Public Health study found that most public health occupations in governmental agencies pay workers substantially less compared to workers in the same occupations in the private sector. In addition to better compensation, public health jobs in the private sector can potentially offer more dynamic work environments and faster career advancement.

Furthermore, while millions of federal workers were ordered to return to offices post-COVID, work-from-home (WFH) policies and trends remain steady in the private sector. WFH policies and expectations will impact federal agencies’ ability to recruit new talent and maintain a steady hiring pipeline. In five years, 30% of the workforce will be represented by Gen Z. A recent survey from Slack indicated 12% of workers want to return to the office full time, 51% of Millennials and Gen Z workers want hybrid roles that allow for most of their time spent working from home, and 30% of Gen Z want to stay remote full time.

Strategies for attracting top talent to the public health workforce

Public health agencies have a powerful opportunity to inspire the next generation of professionals to join the governmental workforce. To build a pipeline of committed talent, agencies must take proactive steps—establishing dynamic mentorship programs, creating hands-on internship opportunities, and sharing compelling success stories that highlight the profound impact and fulfillment of serving in public health.

Additionally, fostering a supportive workplace culture is essential. Agencies can prioritize employee well-being through innovative peer support initiatives designed to combat burnout, ensuring that professionals not only enter the field but thrive within it. By championing these strategic actions, public health agencies can cultivate a resilient, motivated workforce dedicated to protecting and improving community health.

Public health professionals are uniquely equipped to navigate complex environments. This resilient workforce has withstood a global pandemic, chronic staff turnover and shortages, and unstable federal funding throughout the past decade. Despite these challenges, public health workers remain motivated to prevent disease and injury, promote health and well-being, and protect their communities from health risks and threats.

The foundations of public health training—critical analysis, effective communication, and strategic problem-solving—provide public health workers the skills needed to navigate uncertainty, respond quickly, and survive difficult times. After all, public health has always moved forward despite the challenges and limited resources encountered along the way.

BerryDunn's public health consulting team is comprised of former state and local health agency leaders and public health professionals with administration, informatics, policy and program development, and project management expertise. Contact our team to learn more about how we can help you design public health strategies that take into account diversity, equity, and inclusion and help promote health, prevent disease, and improve the quality of life for your citizens.

The Supporting Affordability and Fairness with Every Bet (SAFE) Act is a proposed federal legislation designed to establish minimum standards for sports betting across the United States. It aims to ensure responsible gambling practices, protect consumers, and uphold the integrity of sports betting nationwide.

This article summarizes key compliance requirements outlined in the SAFE Bet Act and examines how the American Institution of Certified Public Accountants (AICPA) System and Organization Controls (SOC) 1 and SOC 2 standards help operators report internal controls over financial reporting (SOC 1) and security, availability, confidentiality, processing integrity, and privacy (SOC 2).

Key compliance requirements of the SAFE Bet Act

State sports wagering programs: States must implement federally compliant sports wagering programs, including measures to prevent underage gambling, promote responsible gambling, and support problem gamblers.

Artificial intelligence (AI) regulations: The act prohibits AI-driven tracking of gambling behaviors for personalized promotions and the use of AI to develop gambling products such as microbets.

National self-exclusion list: A national self-exclusion list allows individuals to voluntarily exclude themselves from sports betting, providing an essential tool for managing gambling-related risks.

Affordability checks: Bettors must undergo affordability checks to ensure wagers do not exceed 30% of their income, preventing excessive gambling and protecting vulnerable individuals.

Advertising restrictions: Strict regulations limit sports betting advertisements during primetime hours and live sporting events. Additionally, promotional terms like “bonus” and “no-sweat” are restricted to prevent misleading marketing.

Internal control development and reporting for sports wagering operators

Beyond compliance requirements, the SAFE Bet Act mandates that sports wagering operators document and maintain robust internal controls to ensure adherence to all applicable laws, regulations, and policies.

Section 103, paragraph 16, requires operators to submit an annual written system of internal controls to the state and undergo an independent third-party or regulatory audit at least once every three years.

With over 20 years of experience assisting gambling operators with independent third-party attestation reports, we have observed that most states now require annual independent audits. These audits typically assess controls related to financial reporting (SOC 1) and security, availability, confidentiality, processing integrity, and privacy (SOC 2).

SOC audits and SAFE Bet Act compliance

SOC audits reinforce sportsbook operators’ commitment to financial reporting, data security, privacy, and operational integrity, aligning with the SAFE Bet Act in several ways:

Security and privacy: Both SOC audits and the SAFE Bet Act prioritize consumer data protection. SOC 2 audits evaluate security and privacy controls, ensuring responsible data handling. The SAFE Bet Act mandates anonymized reporting and restricts AI-driven tracking, supporting privacy safeguards.

Compliance and transparency: SOC audits offer a structured method to evaluate and report compliance with security standards. Likewise, the SAFE Bet Act requires annual sports wagering reports, fostering transparency and accountability.

Consumer protection: Both frameworks emphasize consumer protection. SOC 2 audits assess controls for safeguarding data, while the SAFE Bet Act introduces affordability checks and advertising restrictions to prevent exploitation and promote responsible gambling.

BerryDunn can help you stay compliant with the SAFE Bet Act

The SAFE Bet Act establishes rigorous compliance standards for United States sports betting, focusing on responsible gambling, consumer protection, and integrity. SOC audits provide sportsbooks with a proactive approach to compliance, trust-building, and enhanced security measures.

BerryDunn has more than 25 years of specialized experience in providing auditing and consulting services to gaming, sportsbooks, and lottery clients. We provide the insight necessary to help you ensure the security and integrity of a successful gambling operation. Our professionals bring over two decades of expertise in assisting gambling clients with audit requirements, including SOC, NIST, PCI, and ISO 270001. Learn more about our team and services. 

This article is part two of a series to help businesses navigate trade strategies amidst tariff changes. Part one discussed Transfer pricing and tariffs: Strategic considerations for businesses. Next up: First sale declarations.    

In today's globalized economy, businesses face an ever-changing landscape of tariffs, trade policies, and international supply chain challenges. For companies navigating these complexities, foreign trade zones (FTZs) present a strategic opportunity to reduce costs, improve logistical efficiency, and enhance overall competitiveness. 

Understanding FTZs 

FTZs are specially designated areas under the supervision of US Customs and Border Protection. These zones exist outside the formal US customs territory for tariff purposes, allowing businesses to import goods without immediately incurring duties.  

Within an FTZ, companies can store, process, assemble, or manufacture products, postponing duty payments until the goods officially enter the US market. If products are re-exported instead, businesses may bypass US duties altogether. By leveraging FTZs, companies can exert greater control over their financial obligations, minimize risk, and streamline operations. 

Why should manufacturers consider FTZs? 

The benefits of utilizing an FTZ are particularly pronounced when dealing with volatile trade conditions, high tariffs, or complex customs procedures. Businesses operating in an FTZ can take advantage of several key benefits: 

• Duty deferral and reduction: Since duties are not paid until goods leave the FTZ, businesses can improve cash flow and allocate resources more effectively. Additionally, if goods undergo a manufacturing or assembly process within the zone, companies may pay reduced duties based on the finished product’s classification rather than the individual component costs. 
• Streamlined customs processing: FTZs offer logistical efficiencies by enabling businesses to consolidate shipments. This can result in expedited customs clearance, reduced paperwork, and overall smoother trade facilitation. 
• Re-exporting without US duties: Companies that import goods for re-export purposes can avoid US duties entirely, allowing them to maintain a competitive edge in international markets. 

In an era of uncertain trade policies, FTZs provide an essential tool for businesses seeking flexibility, predictability, and cost savings. 

How BerryDunn can help 

While the advantages of FTZs are compelling, the process of establishing operations within an FTZ requires careful planning and compliance. Regulations governing FTZs involve detailed application procedures, inventory tracking requirements, and operational best practices. 

Our team can help guide businesses through the FTZ approval process, ensure compliance, and maximize the full benefits these zones offer. From initial consultation to implementation and ongoing management, we help companies optimize their supply chain strategies while remaining compliant with US trade laws. 

Let’s talk strategy 

Trade policies fluctuate, and tariff changes can significantly impact business operations. Taking a proactive approach to mitigate these risks is essential. Foreign trade zones provide a critical advantage, turning potential obstacles into opportunities. 

If your company is looking to enhance efficiency, manage costs, and strengthen global trade operations, exploring FTZ solutions could be the right move. Contact us today to discuss how we can help your business navigate complexities and unlock valuable savings. 

Hospitals across the country are facing mounting financial pressures in delivering primary care services, often shouldering annual losses of 5–7%. Primary care providers are essential for the health of the community and for the financial health of the hospitals to which they refer patients for services. As hospitals strive to balance their budgets and sustain primary care, there are options for hospitals to take that could ease financial burdens while preserving provider presence in the communities they serve. This article explores actionable models and strategies to reimagine primary care delivery in a way that benefits both patients and hospital systems.

The current landscape of primary care in hospitals

The national shortage of primary care providers has disproportionately impacted rural communities, leading to worsening access gaps. In addition, many small practices have struggled with mounting administrative burdens, burned-out physicians weary from long hours, and concerns over sustainable revenue. These challenges have driven hospitals to step in, offering indispensable resources such as EHR systems, IT support, malpractice insurance, and HR administration. Additionally, hospitals have benefited from enhanced reimbursement opportunities through provider-based billing and critical access hospitals through Method-II billing. Some of these benefits, like Medicare’s ongoing push to site-neutral payments and increased Medicare managed care, are eroding the benefits hospitals once enjoyed through and employed physician model.

However, the reality has often been more complex than anticipated. Physicians employed by hospitals increasingly seek work-life balance, leading to declines in the daily patient volumes. At the same time, patient appointments are backing up due to the complexity of cases and ongoing public health crises such as substance abuse epidemics. Commercial payors and employees are also steering patients toward less costly ancillary providers, further eroding the advantage of containing patients within the walls of the hospital through their primary care network. With fewer openings for new patients, communities have turned to urgent care centers and emergency departments for their primary care needs, further straining healthcare systems and exacerbating costs.

Exploring innovative models for primary care

The traditional model of employing primary care providers is not sustainable for many health systems. The costs, recruitment challenges, decreased reimbursement, and other pressures are forcing hospitals to evaluate other options. Not having a robust primary care network is not an option for hospitals and the communities they serve. The pendulum of employing as many primary care providers as possible is swinging due to the above-mentioned challenges and hospitals are starting to explore other partnerships to strengthen their financial health and communities access to primary care services.

One approach, for communities with Federally Qualified Health Centers (FQHCs), is to forge a new relationship. These federally funded clinics offer robust reimbursement for Medicare and Medicaid services, grants to support their operations, and behavioral health payments that are not available to hospitals. While hospitals cannot directly own FQHCs, innovative partnerships can form mutual win-win relationships for both the FQHC and hospital. FQHC partnerships are particularly effective in serving underserved populations, making them a strong option for hospitals aiming to achieve both financial stability and community health goals.

Our team works with a Maine health system that is an example of a hospital/FQHC partnership. The FQHC employs all primary care in the community. The two share many resources, like executive leadership and IT support. Through collaboration and partnership, each organization is able to focus on what they do best and what is best for the community.

Hospitals might also consider establishing FQHC Look-Alikes, which offer similar reimbursement advantages without formal federal funding. This model allows hospitals to maintain primary care access while sidestepping ownership restrictions. Successful implementations show that this approach can bridge gaps in underserved communities while helping to ensure operational feasibility.

For hospitals located in rural areas, Rural Health Clinics (RHCs) present another option. RHCs are designed to provide care through mid-level practitioners and can deliver targeted services that address the needs of specific rural populations. However, while RHCs enjoy favorable Medicare and Medicaid reimbursement rates, their scope is limited to rural areas, potentially excluding urban hospitals from reaping similar benefits. On the other hand, Critical Access Hospitals (CAHs), which receive cost-based reimbursement from Medicare, offer a more expansive opportunity for sustaining primary care in rural settings. Leveraging Method-II billing within CAHs can provide additional financial uplift.

The path forward for employed physician models

While alternative models like FQHCs and RHCs take time to establish, many hospitals may find value in retaining employed physician models and optimizing them to minimize losses. This could include:

• Streamlining coding and charge capture processes to prevent revenue leakage.
• Implementing scheduling templates to reduce appointment delays and ensure optimal utilization.
• Enhancing patient access through strategic no-show reduction initiatives and better liability collections.
• Revising compensation structures to align physician incentives with quality metrics and financial performance.
• Continuing to explore accountable care models
• Enhancing physician compensation models to reward both outcomes and productivity
• Reducing costs by eliminating unnecessary overhead and leveraging technology that decreases costs and improves access and productivity

Primary care is the heartbeat of any community-focused healthcare system, yet hospitals face mounting pressure to sustain these services without absorbing perpetual financial losses. Whether through partnerships with FQHCs, leveraging CAH designations, or refining employed physician models, the path forward requires creativity, collaboration, and a commitment to both fiscal and social responsibility. By understanding the unique needs of their communities and exploring innovative strategies, hospitals can strike a balance that ensures improved access, higher quality care, and minimized financial strain.

BerryDunn’s healthcare team understands the unique challenges that healthcare organizations are facing. From labor shortages to regulatory changes and financial viability, our team of audit, tax, clinical, and consulting professionals is committed to helping you meet and exceed regulatory requirements, maximize your revenue, minimize your risk, improve your operations—and most importantly—facilitate positive outcomes. Learn more about our team and services.

In today's rapidly evolving business landscape, boards of directors are more than just stewards of governance—they are the strategic compass guiding an organization toward enduring success. As the challenges facing companies grow increasingly complex, from disruptive technological trends to shifting societal expectations, the board's role has never been more critical. 

This series is designed to empower board members with the insights and tools necessary to navigate change with confidence. Our experts, each a leader in their respective field, will share real-world examples, practical frameworks, actionable advice in a Q&A format, and lessons learned from their personal and professional journeys.  

Employee well-being: The key to a productive and healthy workforce 

Our board leadership series begins with BerryDunn’s Workforce and Well-being practice lead, Vienna Morrill, who shares insight on how well-being programs can contribute to a thriving workforce.  

Q: What’s the most important thing that boards need to know about employee well-being?  

A: A culture-first approach is essential—well-being programs and benefits are less meaningful unless employees feel empowered to use them. Leadership commitment is critical; having a visible leader championing well-being helps normalize it as part of the workday rather than as an afterthought. Manager engagement is equally important, as managers must understand the value of well-being and take responsibility for fostering it within their teams. Importantly, well-being cannot be just an HR initiative; it requires active participation from leaders, managers, and employees themselves. An organization’s well-being strategy should integrate well-being into every aspect of the employee experience, with multi-dimensional benefits that address physical, mental, social, financial, and career needs, and be aligned with broader initiatives related to employee engagement and experience. A maturity model—such as assessing your organization’s current well-being program—can further help boards identify gaps and drive continuous improvement. 

Q: How do you ensure that well-being initiatives are inclusive and accessible to employees with different needs, backgrounds, and work styles? 

A: Organizations need to know their people and seek input. By developing and maintaining psychological safety in the workplace, organizations are better positioned to get meaningful feedback from employees about their well-being needs and programming preferences. Psychological safety begins with an environment where people feel comfortable showing up as themselves. In today’s fast-paced world of work, this often requires greater intention around creating opportunities for people to get to know each other, develop connections, and build a sense of community.  

Additionally, if you have employees or teams who are actively involved in specific diversity and inclusivity initiatives, it’s important to include them in the well-being planning process. Often, these initiatives can work hand-in-hand and be mutually beneficial. If budgets are limited, it’s best to focus on embedding well-being into the overall employer brand and employee experience before focusing extensively on “above and beyond” programs, resources, and benefits. Building a culture where well-being is viewed as a normal, expected part of work naturally supports inclusivity, helping to ensure every employee has access to the resources and support they need. 

Q: For those organizations that continue to have a large remote or hybrid workforce, what are some ways to support the work-life balance of all employees? 

A: The physical workplace offers valuable opportunities to showcase your well-being strategy and reinforce the culture you want to cultivate. However, when much of your workforce is remote, frequently traveling, or outside a traditional office environment, your approach should be anchored in location-agnostic programming to ensure broad reach and inclusivity. For example, focus on delivering consistent, organization-wide messaging that highlights your commitment to employee well-being, and establish clear feedback channels to surface needs and guide continuous improvement.

One of the largest challenges for remote and hybrid employees is often the blurring of boundaries between work and life. Organizations can set clear boundaries for work hours by encouraging practices such as logging off from collaboration platforms after hours and establishing norms around calendar sharing and personal time. For those in the office, creating a healthy physical environment reinforces the overall commitment to well-being. Additionally, encouraging remote employees to take stretch breaks, engage in local professional communities, or visit the office periodically for meaningful engagement can help maintain a healthy balance.

Q: How do you incorporate movement and exercise into the daily routine of employees who work at desks for long hours? 

A: Encouraging movement is vital for desk-bound employees, as opportunities to step away from screens, stimulate circulation, and refresh focus are essential for physiological and psychological health. This is an area where leaders and managers can be particularly influential by modeling that it’s okay to step away from your desk – whether by openly sharing that they are taking a break for physical activity, inviting others to join them, or speaking to its importance. Organizations can promote the idea of taking assignments offline—such as walking while brainstorming or listening to podcasts during breaks—to integrate exercise into the workday. Allowing flexibility so that employees can take planned, consistent breaks to move can not only improve time management and clarity of thought but also counteract the negative effects of prolonged sitting. 

Q: What are some common financial challenges employees face, and how can employers support them through education or benefits programs? 

A: Financial well-being starts with ensuring fair and competitive salaries that address factors like pay equity, cost of living, and benefits affordability. Employers can further support their teams by offering resources, tailored education, and benefits that assist with managing debt, saving for the future, and mitigating financial stress. A holistic approach might include personalized financial counseling, credit and debt management resources, and incentives such as matching student loan repayments through 401(k) contributions. Additionally, employers should make sure that employees are aware of and know how to access online tools and resources integral to their existing benefit platforms, empowering them to make informed financial decisions. 

About Vienna 

Vienna has long valued well-being, a passion born from early struggles with focus, fatigue, and depression that spurred her to explore how lifestyle habits impact both physical and mental vitality. Through a journey of personal growth, she discovered that nurturing the body with proper nutrition, hydration, sleep, and exercise could transform everyday energy and resilience. Over time, her perspective broadened to include the importance of community, meaningful relationships, and living authentically in alignment with one’s values. In her previous work as an IT Management Consultant, she observed that even routine technical challenges carried deep human implications, reinforcing her belief that employee well-being is a dynamic, personalized pursuit. Combining personal insights with professional experience, she has become a strong advocate for fostering holistic well-being in the workplace, convinced that a healthier team is the key to sustained business success. 

BerryDunn partners with organizations to create work environments where business success and personal growth coexist and where people are confident knowing their workplace positively contributes to their well-being. We take a comprehensive approach to our workforce and well-being work, considering how business needs, organizational capacity, and the employee experience work together to drive your business forward. Learn more about our team and services.