Actively involved in health workforce policy and research at the state and national level, Hannah Maxey, PhD, MPH, RDH, is an assistant professor and director of Health Workforce Studies at Indiana University School of Medicine in Indianapolis. She completed her doctoral degree in 2015, and her dissertation examined the effects of state regulation of the dental hygiene workforce on dental service delivery, access to care, and oral health status of patients at federally qualified health centers.
Maxey has an active research agenda. She is the principal investigator for a number of ongoing research projects focused on the integration of oral health with primary care, strengthening the health system through primary care-based chronic disease management, Indiana primary care needs assessment and health workforce studies, and the status of the state’s area health education centers. She has published a number of papers and has presented her work at national meetings.
Active in professional service, Maxey is an oral health section counselor for the American Public Health Association and serves on the American Association of Public Health Dentistry’s Council on Practice. She is also a member of Delta Omega, the Honorary Society in Public Health. Recognized for her contributions to improving oral health, Maxey received the Oral Health Champion Award from the National Network for Oral Health Access this fall.
Your research focuses on the health care workforce. What fascinates you about this subject?
The health workforce is the intersection of health sciences (medical, dental, etc) and health-care delivery and the point at which access to care occurs. The policies that define and regulate this workforce (accreditation of academic programs, scope of practice, supervision requirements, governance, reimbursement policies) directly influence patient and population health. Through health workforce research, I am able to generate objective data that can be used to inform policies that affect access to care. I want to work in an area that provides the opportunity to make the greatest impact for the largest number of people possible. Health workforce research fits this bill.
If funding were not a factor, what would your dream research project be?
Oral health care services must be integrated into the larger health care delivery system. While I believe oral health should be part of all aspects of patient care, I think it especially belongs in primary care. Primary care is focused on disease prevention, health promotion, and chronic disease management.
As a workforce trained in dental disease prevention, oral health promotion, and periodontal disease management, I believe dental hygienists can and should be practicing as part of the primary care team. To that end, I am working to develop a new workforce model in which the primary care team includes a dental hygienist who serves as both an oral health specialist and flexible care team member. In the model, a dental hygienist provides comprehensive preventive dental services—such as fluoride varnish and dental sealant application, prophylaxis, and patient education—as part of the primary care visit. The dental hygienist is a fully functioning primary care team member who is also cross-trained to support other aspects of the primary care visit. This model seeks to fully integrate oral health into primary care, not just co-locate services. The vision is that the model will eventually expand to include nonsurgical periodontal therapies for patients’ chronic conditions as part of their routine primary care visits. This model increases accessibility of dental care and fosters a culture where oral health is in fact part of overall health— not a specialty health service.
What advice would you give dental hygienists who are interested in research?
First, identify the topic(s) you are interested in researching. Once you know your area of interest, read as much as you can about the topic, but be sure the information is from reliable sources such as peer-reviewed journals. The next step is to find a mentor who is conducting research in your area of interest. Just reach out to him or her. Send an email or make a phone call. Most researchers are incredibly passionate about their work and will gladly talk with you. They can advise you on which graduate degree is best for you and provide other details on the subject. Developing a strong connection with a mentor is extremely important to becoming a successful researcher.
How did you begin your career in research?
I didn’t start out wanting to be a health policy researcher. When I graduated from dental hygiene school, I wanted to “save the world’s oral health.” I went into private practice for 2 years and then took a full-time position at a community health center. Other than the community dental hygiene course I completed in dental hygiene school, I had very little experience with public health. Practicing at a community health center opened my eyes to the enormous disparities that exist in oral health. After 9 years of clinical practice and finding a calling in public health, I began working on a Master of Public Health (MPH) in Health Policy and Management. When I applied to graduate school, I thought I would probably use the knowledge gained from my MPH to develop and implement community-based oral health programs for underserved populations.
What factors influenced your decision to earn a doctoral degree, and has it helped you professionally?
While working on a master’s degree, I came to realize that many health policies and programs are not founded on objective information. In the absence of objective data on important health issues, interest groups (with conflicts of interest that potentially threaten their objectivity) present anecdotal information that may not be widely generalizable. At this point, I realized that in order to save the world’s oral health, I needed to become a health policy researcher who contributed objective data to oral health policy discussions. I knew I would need to pursue a doctoral degree to equip myself with the tools needed to launch a career in research.
What do you think are the most important issues impacting the profession of dental hygiene today?
Health system transformation is the most important issue impacting dental hygiene now. As a profession, we must grasp the opportunity to demonstrate our value to the larger health care delivery system. This means stepping out of our comfort zones (ie, the dental hygiene operatory) and into a whole new arena. It will require dental hygienists to take risks. We will have to engage in discussions with health system leaders and advocate for policy changes.
Restrictive professional regulation is a significant barrier in some states. It is not only a barrier to professional practice, but directly impacts access to care in underserved communities. Health system transformation provides an opportunity to critically examine the policies that regulate the health workforce within the context of the triple aim in health care: reduce cost, improve access, and enhance quality. We need to change the direction of professional regulation discussions from profession focused to patient and population health centric by determining what policies support the best oral health outcomes at the lowest cost with the highest quality of services.