Report Cards for Doctors and Teachers: New Metrics, Old Ideas

“The quarterly “report card” sits on my desk. Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. All my grades are well below my institution’s targets. It’s hard not to feel like a failure when the numbers are so abysmal.”

This lament from a physician (with a Ph.D also)  mirrors the sad to angry comments so many teachers have raised over being evaluated and, in some cases, even being paid on the basis of their students’ test scores.

The doctor’s complaints point to how health care providers are seeking ways to cut costs and increase quality of care through “report card” data. Corporate managers aim to “incentivize” (yeah, it’s a noun disguised as an ugly verb) physicians to practice “quality” medicine by concentrating on particular evidenced-based measures of efficient health care. For many doctors, these supposed “quality” measures narrow their practice and overlook the complexities patients bring to the exam room. As the above doctor pointed out:  “[They] focus on diabetes in pristine isolation [when] my patients inconveniently carry at least five other diagnoses and routinely have medication lists in the double digits.”

Now consider teachers. Many criticize the “quality” measure of standardized test scores failing to capture the full range of what they teach and students learn in their classes. Teachers also complain about how the metrics steer what is taught in lessons. Narrowness in content and test preparation make the test itself the curriculum, they assert. Researchers have confirmed that teachers are correct.

Moreover, aside from the obvious errors in measurement—and this is a crucial “aside” to consider–that accompany such narrow metrics for both teachers and doctors, there is a strong incentive for playing the numbers to look successful on “quality” measures since the numbers carry substantial consequences. Figuring out how to look good makes the numbers more important than the tasks of helping patients and teaching students. Or as one disgusted doctor, preferring to remain anonymous, wrote to the popular blog (KevinMD.com):

“Doctors have two major ways of responding to these report cards. We can change the ways we practice, such that our patients will have better cholesterols and cost our hospitals less [or] we learn from insurance companies. Cherry pick compliant, generally healthy patients, and gently encourage … the complicated patients to seek care elsewhere.”

Teachers, however, cannot pick their students but they can transfer to schools where students do well academically and working conditions favor teaching.

Determining which teachers are productive, i.e., “good” and which ones are inefficient, i.e., “bad” by reporting students’ test scores teacher-by-teacher as recently occurred in Los Angeles Unified School District and report cards on physicians are not shockers to anyone familiar with the history of the business model in schooling. That model of competition, incentives, productivity, and efficiency has seeped into the bloodstream of schooling over the past century.

Before World War I, it was Frederick Taylor’s “scientific management” movement where the stop-watch and time-and-motion studies permitted bosses to specify not only the tasks that had to be done but also how they were to be done. Progressives of the time saw “scientific management’ with its meticulous registering of statistics applied to every single work task as the Holy Grail, a system that would bring standards, productivity, regularity, and order to commerce and, yes, to all other institutions.

Educational administrators glommed on to scientific management. “Educational engineers” created lists of behaviors that principals would use to evaluate teachers, checklists of what made a school building good, and measured anything that moved or was nailed down. Those crude efficiency studies are no more. But the ideas of Taylorism are present today in “standardization, the split of planning from doing, … the setting of precisely defined tasks, the emphasis on efficiency, and productivity to the exclusion of all else” (p. 501, Kanigel)

So the national standards movement, pay-for-performance plans, reading curricula that provide teachers with scripts, and the constant drumbeat for online education and cyberschools offer evidence that Taylorism is alive and well. And don’t forget report cards for physicians.