By on February 3, 2012 7:14 AM
The ratings game that has triggered fierce opposition from teachers is about to apply to doctors. Medicare intends to open its files to insurers, employers and consumers so that they can prepare report cards on individual doctors ("Prescription with side effects," Los Angeles Times, Jan. 30). The announcement has doctors up in arms for reasons that are uncannily similar to those expressed by teachers.
What stands out in both professions is that neither doctors nor teachers are miracle workers. Doctors who practice medicine in communities where patients become partners in health because of their backgrounds stand a much better chance of posting successful outcomes than doctors who treat patients in inner cities or in rural areas. For example, Loma Linda, Calif. is overwhelmingly populated by Seventh Day Adventists. They shun alcohol and smoking, and consume healthful diets. The National Geographic in 2005 identified Loma Linda as one of the world's healthiest towns, with many of its residents living into their 90s and past 100.
When McDonald's announced that it was coming to the town of 21,000, a group of preventive health professionals responded by considering putting a measure on the ballot to ensure that fast-food restaurants are kept to a bare minimum ("McDonald's proposal divides healthy Loma Linda," Los Angeles Times, Jan. 22). It's little wonder, therefore, that doctors there say they have a dream practice. In contrast, doctors in Watts wage an uphill battle because liquor stores and fast food franchises are ubiquitous and supermarkets are rare.
By the same token, teachers who teach in schools where parents are deeply involved in their children's education and possess the resources to provide enriching experiences in the form of summer camp, vacations and the like have a dream assignment. On the other hand, their colleagues who teach in schools located in impoverished areas are forced to attend to a host of factors that their students bring to class before they can begin to teach subject matter. In medicine, it's called performing triage.
Doctors know that treating the sickest patients will unavoidably have a negative effect on their report cards because Medicare's new strategy does not take into account the patients they see. Likewise, teachers who are in schools serving large numbers of disadvantaged students from chaotic backgrounds will be penalized because they cannot produce the results that teachers in affluent suburbs routinely post. Unless report cards in both fields take into account these factors, doctors and teachers will avoid working with those most in need of their respective services.
The value-added metric is supposed to credit teachers who demonstrate progress with their students, even though they haven't reached proficiency. But I wonder if it can ever capture the complexity of the task facing teachers whose students bring huge deficits in socialization, motivation and intellectual development to school through no fault of their own? Doctors have long known that the status of patients with factors beyond their control largely determines outcomes regardless of their professional expertise. Why are teachers treated differently?