In the World of “You Can’t Manage What You Can’t Measure,” When Will You Be Able to See Your Doctor’s VAM Score?

Teachers live in a cocoon; all day with our students and with other teachers, we socialize with teachers, we complain to teachers, we go to teacher union meetings and the assault on teachers seems endless, from trying to abolish tenure, to denigrating our unions to assessing our performance by serpentine algorithms.

And, we’re jealous, other professions, lawyers and doctors don’t seem to have these problems, we’re sure the American Bar Association (ABA) and the American Medical Association (AMA) would never permit it.

In reality we have a lot more in common with lawyers and doctors.

Law schools are churning out potential lawyers in spite of the paucity of jobs. Yes, a few students graduate from elite law schools and serve as clerks for prestigious federal judges and are snapped up by white shoe firms at hefty six figure salaries. The vast majority of new lawyers, as well as experienced lawyers struggle to make a living; after all, lawyers never retire! Law firms are folding and some lawyers end up as teachers.

Law is not a growth industry as alternative dispute resolution procedures spread the need for lawyers lessens.

How much do lawyers earn?

Pursuant to Article 18B of the County Law, the Assigned Counsel Plan has been providing quality legal services to indigent persons within the Bronx and New York County Criminal Courts since 1966. The Plan provides compensation to private attorneys for representing indigent clients charged with criminal offenses.

Attorneys are compensated at a rate of $60 per hour for misdemeanor matters and $75 per hour for felony matters. The Plan provides legal assistance for trial court matters as well as appellate matters.

Court-appointed lawyers who represent “indigent persons” make only a little more than teacher per session!!

What about the American Bar Association (ABA)? Doesn’t the ABA control access into the profession? Why can’t the ABA influence the incredibly low pay and surplus numbers of lawyers?

When lawyers need to be heard, the ABA is their voice both nationally and globally. We work to promote judicial independence and ensure funding for the Legal Services Corporation. We also promote the international rule of law through programs in more than 40 countries that focus on access to justice, human rights, anti-corruption, judicial reform and more.

The ABA has very little to do with the everyday life of lawyers.

Well, if the ABA is impotent at least the professional organization of doctors, the American Medical Association has clout. Not really.

Value-Added Measurement (VAM) is not limited to teachers. The statistical technique, commonly called super crunching, or regression techniques. “… the statistical regression not only produces a prediction, it also simultaneously reports how precisely it was able to predict,” has invaded every workplace (Read review of Super Crunchers here)

The world of medicine is following the world of teaching. The feds are creating algorithms to measure every aspect of healthcare. Just as the “measurement” of teachers is supposed to improve the teaching profession the world of measurement will improve the field of medicine, and, save dollars.

Physician Performance Measurement and Reporting is a value-based purchasing strategy that enables health care stakeholders to evaluate physician compliance with clinical, evidence-based care guidelines, which can lead to lower costs and improved outcomes, and informed consumers who seek care from physicians who follow these guidelines. This strategy can be utilized by a variety of stakeholders—physicians, health plans, employers, patients, and others—to improve care, monitor outcomes, and align incentives. As such, physician measurement is an end unto itself, but also a foundation for other value-based purchasing strategies that seek to reward high performing physicians.

The world of medicine eerily replicates the world of education,

Like it or not, measuring physician performance is now a key part of the conventional wisdom on improving our health care system. Borrowing from management guru Peter Drucker’s mantra “You can’t manage what you can’t measure” health care policy makers have embraced performance measurement as being central to managing our heretofore unmanageable health care system.

The measurement of physician practice, you guessed it, comes from the feds. Remember, every doctor, one way or another works for the feds. The days of the individual practitioner are long gone. Doctors work in group practices or for hospitals and the rules and regulations are drafted by the federal bureaucracy and embedded in the Affordable Care Act.

Dr. Bob Centor is an outspoken critic of the entire data-driven medicine movement.

I am obsessed with performance measurement and why it not only rarely works but often causes negative unintended consequences. As I have pondered this question recently, computers cannot replace physicians as diagnosticians.

Centor may be absolutely right, it doesn’t matter – the world of medicine is changing dramatically.

Ironically lawyers and doctors no longer have clout, their organizations, the ABA and the AMA are distant, governments in cities, state capitals and Washington set policies. One of the few organizations that are fighting back is the teacher unions. The imposition of the Common Core and harsh testing environment has angered parents across the country, mayors and governors worry about the backlash and are backing away from the “you can’t manage what you can’t measure” mantra and teacher unions are working closely with parents and community organizations.

The use of VAM and edTPA may be lagging; however, in the field of medicine, in a few years, your doctor’s “score” will be a few mouse clicks away.

Will doctor’s offices, like restaurants, have an “A,” “B” “C” or “Pending” on their door?

3 responses to “In the World of “You Can’t Manage What You Can’t Measure,” When Will You Be Able to See Your Doctor’s VAM Score?

  1. Of course human expertise will always be an absolutely necessary component of diagnosing illness. Having said that, I think there are two major differences between the way data is being used in medicine compared to its use in education:

    1) At the moment, at least, doctors do not work under the threat of losing their jobs because the data indicates they are doing it poorly. Ostensibly, the point of collecting the data is . . .

    2) To determine what treatments caused the patient to get better. If a specific treatment can quantified as inefffective in achieving that goal, then
    it won’t be paid for. Unlike education, the goal of medicine is well-defined – eliminate the illness – and usually accompllished, or not, in a time-frame where cause and effect seem clear.

    Is #1 above true, at least in part, because the public perceives doctors as policing their own? I think it is; I think the public believes the AMA and the BAR are charged with removing from their respective professions those who are guilty of malpractice. That is not the perception the public has of teachers’ professional organizations.

    I know this post has motivated me to write because this spring the Representative Assembly of the Virginia Education Assocation voted against a Business Item that would have put the Association on record as demanding the state establish a peer-reviewed evaluation system.

    I had a very wise professor during the time I was working on my Masters degree who said teachers will never have the respect of the public that the job deserves until we are seen as controlling who is in and who is not in our profession. I was finishing my 5th year of teaching then, and I didn’t quite get what he meant, That was a dozen years ago, and now I get it.


  2. Marc Korashan

    I absolutely agree with KenS. As teachers we need to take control of our profession. The NBPTS was meant to be a step in that direction, but it is a supplemental, not an entry level certificate. Right now entry to teaching is controlled by politicians who pass laws that determine who is a qualified teacher.

    It doesn’t take a lot of history to realize that these politicians are not interested in limiting entry to the field only to the best and the brightest. In the late seventies and eighties there was a shortage of applicants and any one applying for the job (who could fog a mirror with their breath) could get hired. Then NCLB demanded that every teacher be highly qualified, but in order to fill all the classroom positions any one coming into the profession through TFA or the Teaching Fellows or any Transitional B certificate was immediately deemed “highly qualified” even though they had never taught before.

    If the politicians were truly interested in reforming education they would start by making the working conditions more attractive to people who want professional careers. They would work with teachers and their union representatives to develop a clear understanding of how schools work and where we need more time to be more effective with students.

    In medicine, doctors practicing in hospitals have to review their work in front of colleagues at “morbidity and mortality” conferences when patient outcomes are not good. These meetings are a mandatory part of their work day. Teachers who need help to reach a difficult student have to seek it from colleagues on their own time or during their preparation times as there is no time for professional consultation built into the teaching day. Any true professional consults with colleagues and works with them collaboratively to ensure that they are doing the best they can. Build time for that into the teaching day and see if we don’t improve our lessons and our outcomes.

    It is time for the teacher unions to start this kind of work. Define the entry criteria for the profession, create models that mentor and coach new teachers; consider reduced caseloads for new teachers so that they can focus more sharply on students and lesson planning,, oh and build in peer review of on-going work and as part of annual performance reviews. We need to step up, take charge and not be afraid to identify those who need help to be better teachers and those who may need to leave the profession.


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