Pay for Performance: Doctors Yes, Teachers No?

Just north of Denver, Jefferson County has become a battleground in the fight over performance-based pay for teachers.  The recently elected school board plans on implementing “[a] compensation system that recognizes and rewards our great teachers,” according to school board president Ken Witt.  The response of the local teachers’ union was for teachers to call in sick and enlist students in protesting what they describe as a proposed “patriotic curriculum.”

The protests are a convenient way to discredit the school board, thwarting them from implementing what the union truly fears: performance-based pay.

In the world of health care, performance-based pay measures are already being implemented.  The Physician Quality Reporting System (PQRS) will adjust physician Medicare payments up or down, based on specific quality measures.  Meeting these measures will give physicians a payment bonus of 0.5%.  Conversely, if such measures are not met, physicians will have their Medicare payments cut by up to 2%, euphemistically called an “adjustment.”

Compare that to the Jefferson County school board’s proposal to reward “highly effective” and “effective” teachers with larger and smaller bonuses, respectively, of up to 4 percent.  The salaries of ineffective teachers will simply remain the same, not being “adjusted” downward, as is the case for physicians.

Surprisingly, 99 percent of teachers in Jefferson County saw their take-home pay increase.  So every teacher is effective?  Do all students earn As and Bs?  If every teacher is a high performer, what does the union have to worry about?

Yet the teachers’ unions are still up in arms, while physicians, not happy about getting beaten by yet another stick, grin and bear it, without calling in sick or enlisting their patients to carry signs and protest.  And many physicians will see their payments decrease, unlike what the teachers experienced.

Medicare’s goal in assessing quality is “[h]elping to ensure that patients get the right care at the right time.”  In other words, improving the quality and efficiency of medical care.  Substitute “education” for “care” and “students” for “patients,” and a similar case can be made for incentivizing the delivery of quality education.  Are these not worthy goals for teachers and schools as well?

Just south of Denver, in Douglas County, more teachers are leaving the school district, but “[m]ost of those leaving are low-performing teachers,” according to the district.  Isn’t that the goal?  Would anyone be upset if poorly performing physicians left clinical medical practice?  Teachers complain over “[t]op-down mandates that have nothing to do with the teacher's performance or behavior in the classroom."  The same could be said about mandating that a retina surgeon check a box indicating that he counseled his patient about smoking cessation, as if the patient never heard such advice from his primary care provider or that such a “quality measure” trumps the surgeon’s ability to perform in the operating room, as in repairing a retinal detachment.

Performance-based pay is not a new concept.  In the business world, creating a profitable business, exceeding sales goals, or successfully reorganizing a company will be rewarded financially.  Likewise in sports, those who win or add value to their teams will be rewarded with the biggest contracts and most lucrative endorsements.

What are teachers afraid of?  Granted, teaching in some schools is more challenging, with students lower on the socioeconomic scale, many of whom don’t speak English.  But the same can be said of inner-city medical clinics that provide health care to the same disadvantaged populations.  Yet these clinics provide quality health care services to disadvantaged socioeconomic families, but without the whining and protests that we see from the teachers’ unions.

The 2010 film Waiting for Superman noted that “[i]n Illinois, where one in 57 doctors loses his medical license and one in 97 lawyers loses his law license, only one in 2,500 teachers loses his credentials, because of union rules” – the “rule” being tenure, guaranteeing the teacher his job regardless of job performance or effectiveness.  Imagine the outcry if incompetent physicians were ignored by state medical boards and allowed to continue to practice and harm patients.

The goal of Obamacare is to provide “[a]ccess to affordable, quality health insurance, and to reduce the growth in health care spending in the U.S.”  Imagine if the president created “Obama-learn,” with the same goals for education – including performance-based pay and accountability.  If it works for physicians, why not for teachers?

Dr. Joondeph is a retina surgeon at Colorado Retina Associates and serves on the faculty of Rocky Vista University School of Medicine.  The views expressed here are purely his own, and not those of Rocky Vista University. Twitter @retinaldoctor.