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Purpose: The purpose of this investigation was to examine the commissioning history of the professions of physicians, dentists, nurses, nurse practitioners, physician assistants and dental hygienists of the United States Public Health Service (USPHS), and to determine a critical pathway to commissioning new health care professions into the USPHS. The Advanced Dental Hygiene Practitioner (ADHP), recently developed by the American Dental Hygienists' Association, is an oral health care provider proposed for public health settings that shares the same goal as the USPHS of treating underserved populations in the U.S. With the establishment of the ADHP role, an opportunity for the ADHP to be commissioned into the USPHS may arise. Methods: Journal articles, books and Web sites documenting the history and commissioning process of the USPHS were researched. Interviews with key USPHS commissioned officers involved with the commissioning process of the selected health care disciplines were conducted. A qualitative comparative analysis to examine published documents and interpret interviews was performed to reveal patterns of events leading to commissioning. Systematic, time-oriented visual displays of data were constructed to identify critical pathways for commissioning new professions into the USPHS. Results: The need for health care professionals to provide quality health care to the Federal beneficiaries of the USPHS was found to be the driving force behind commissioning the selected health care professions into the USPHS. A critical pathway for commissioning new professions into the USPHS was identified. Conclusion: Understanding the commissioning process of new health care professions into the USPHS would assist with defining the critical pathway for future USPHS commissioning of the ADHP. Keywords: United States Public Health Service, Advanced Dental Hygiene Practitioner, Mid-level Health Professions, Access to Care, Dental Hygienists This study supports the NDHRA priority area, Health Services Research: Investigate how alternative models of dental hygiene care delivery can reduce health care inequities., Introduction The United States Public Health Service (USPHS) cites its earliest beginnings in the 1798 Act for the Relief of Sick and Disabled Seamen, which established a Marine Hospital System [...]

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