On March 21, 2010, former NYUCD full-time faculty member Gustavo D. Cruz, DMD, MPH, was in the room when then-democratic majority leader Nancy Pelosi struck her gavel down, acknowledging the House votes needed to pass the The Affordable Care Act, which President Barack Obama signed into law two days later.
Dr. Cruz's intimate access to this pivotal moment in US healthcare history was made possible through his experience as a Robert Wood Johnson (RWJ) Health Policy Fellow, a position he held for 15 months, from the fall of 2009 though December 2010.
The RWJ Health Policy Fellows program is a national program supported by the Robert Wood Johnson Foundation (RWJF), America's largest philanthropy, whose mission is to improve the health and health care of all Americans, with direction and assistance from the Institute of Medicine (IOM).
Founded over 40 years ago, the RWJF launched its Health Policy Fellows program in 1974. This highly prestigious Washington, DC-based program offers mid-career health professionals and behavioral and social scientists the opportunity to actively participate in health policy processes at the federal level and gain hands-on policy experience. Each year the program selects six fellows. In its 37-year history, 15 dentists have been selected, including Dr. Cruz.
The timing of Dr. Cruz's fellowship could not have been more fortuitous. "We arrived in Washington during this historic moment, when there was a huge effort to transform the healthcare system and the delivery of health care in this nation. To be part of that conversation, the passing of the law and its early implementation, was quite exciting," said Dr. Cruz.
The fellowship began with a rigorous three-month training period. "It was very intensive, like obtaining a crash master's degree in public health policy," said Dr. Cruz. During this period, the fellows heard lectures from over 100 experts in policymaking, from various think tank members, conservative and liberal groups, patient advocates, physician and dental organizations, etc. "Basically, all the stakeholders came and shared their knowledge with us," said Dr. Cruz.
Not only did the fellows hear from these policymakers in formal settings, but they also had direct access to these players during their fellowship tenure. "We were invited to call or e-mail them anytime we needed help or information. I'd just say, ‘I am a Robert Wood Johnson Fellow,' and believe it or not, they do take your call," said Dr. Cruz, with a chuckle.
Following the training period the fellows graduated to become part of the RWJ Human Capital Program and were assigned to the House, the Senate, or a government agency. Dr. Cruz received an offer to work at the United States Department of Health and Human Services (USDHHS), together with another fellow, an MD with a background in family medicine. "Because of everything happening with overhauling the healthcare system, the Department of Health and Human Services decided to take two of us. This kind of made us pioneers, and it really could not have happened at a better time," said Dr. Cruz.
In this capacity Dr. Cruz and his colleague attended all the meetings, including briefing sessions at the White House. They had direct access to the presidentially appointed Secretary of Health and Human Services, Kathleen Sibelius, and worked especially close alongside her counselors, Rima Cohen and Dora Hughes.
"Along with shadowing all the experts, we were sometimes asked to help in the briefings, if an issue fell within our line of expertise," said Dr. Cruz. In addition, they worked on special projects related to the implementation of The Affordable Care Act.
When this initial assignment ended in the fall of 2010, Dr. Cruz's fellowship was extended for three additional months, and he was placed at the Pan American Health Organization, where he was able to learn about oral healthcare policymaking in an international arena, and also obtain advice on specific projects.
Dr. Cruz's path to healthcare policymaking in Washington, DC, was paved by his career at NYUCD, which began in 1996 with his appointment as an associate research scientist and subsequently associate director of the NYUCD Northeast Research Center for Minority Oral Health. "At this point, very few scientists were investigating the oral health care of immigrants," said Dr. Cruz. "This gave me the opportunity to look at healthcare disparities and lack of access to care, which triggered my interest in seeing how that research could be translated into policy."
In 2000, Dr. Cruz joined the NYUCD Department of Epidemi-ology and Health Promotion as an associate professor and director of public health promotion. Dr. Cruz also served as director of the Global Oral Health Concentration (2007–2009), part of the master's in Global Public Health Program at NYU. Along with other healthcare faculty, Dr. Cruz was instrumental in developing this five-year dual degree program. "We really started from scratch, as there were no models for us in developing the courses, particularly in the oral healthcare concentration," said Dr. Cruz. "So it was extremely rewarding to help get those courses up and running."
Among his numerous research projects at NYUCD, Dr. Cruz undertook the largest-ever study on the oral health of immigrants in the United States, analyzing caries and periodontal disease in over 1,500 immigrants living in New York City. The study linked tooth decay and gum infections to ethnicity and country of origin.
In accepting the RWJ Health Policy fellowship, Dr. Cruz was required to leave his tenured faculty position at NYUCD, although he continues to hold a position as adjunct professor of epidemiology and health promotion.
When Dr. Cruz's extended fellowship came to an end in December 2010, a little bit of luck intervened again. He was offered the position of chief of the oral health branch at the USDHHS/HRSA (Health Resources and Services Administration) Bureau of Health Professions Division of Medicine and Dentistry.
"Because of The Affordable Care Act, the amount of funding for training at both the predoctoral and postdoctoral levels expanded tremendously," said Dr. Cruz. "Someone was needed to oversee this large number of grants, as well as to help create an oral health branch that would oversee various goals, such as expanding the oral health workforce."
Dr. Cruz's career in dentistry can be divided into three distinct acts. "I practiced dentistry for 15 years prior to entering academia, and then research and academic administration for the second act," said Dr. Cruz. "Entering the healthcare policy arena feels like a natural progression."
The HRSA's oral health mission, "to improve the nation's health by assuring access to comprehensive, culturally competent, quality oral health care for all, as an integral component of comprehensive health care," provides the perfect mandate to carry Dr. Cruz through his third act.