A good friend and colleague who is now in Chicago first gifted me with this parable. It's been in my thoughts lately as my wife pursues her medical degree. In fact, she and I have talked about this at length, and when making comparisons between how physicians and teachers are treated, she is just as astounded.
Parallels are occasionally noted between medical training and education, especially the capstone clinical experiences present in both professions. Let us pretend that physicians of all specialties were held to similar measures of accountability and enveloped with the same kinds of discourses that we see in education reform debates. What might that look like, and how would the general public, in addition to doctors, feel about that?
It would not take a skilled social scientist to observe that, despite exceptional achievements in treating disease and diagnostic technologies, for example, the medical profession is failing. It has failed in its tasks to disseminate good information about health, quash misconceptions, fight corporations and health lobbies that keep people sick, and prevent high rates of obesity, diabetes, and heart disease, particularly in low-income populations. What do we do about this? Well, I have a few proposals listed in no particular order:
- We must begin to hold all physicians accountable, regardless of specialization, to certain quantifiable measures of health, namely cholesterol levels, blood pressure, weight, and BMI. All patients assigned to a physician must meet specific annual minimum standards of health. Bad doctors will be those who do not meet their patients' annual minimums, and they may be subject to certain penalties if the health scores of their patients do not improve in a reasonable amount of time.
- It will be mandatory for the Department of Health and Human Services, as well as all of the major governing bodies in medicine, to set a goal for reaching universal health and well-being in the United States. That is, a target year will be identified in which every person will achieve the ideal values in cholesterol, blood pressure, and BMI. Future targets may include assessments of mental health. A specific interval of time will also be determined to assess all patients for these values. Although pharmaceuticals may be used to stabilize or improve health outcomes, the patient must not be on any medications at the time of assessment unless approved by an official of the administrative body of the national health assessments.
- Quantifiable variables will be utilized to evaluate all practices and hospitals. All of this information will be made public. Additionally, medical schools will be evaluated based on the quantifiable health of patients in the care of their graduates. Medical schools will subsequently be ranked based on the health outcomes of their graduates' patients regardless of specialty. Given more advanced statistical models, these numbers could ultimately be used to assess the impact of pre-medical programs at the undergraduate level.
- In certain high needs areas, such as family practice, emergency medicine, or in practices in low income areas, alternative routes to being licensed will be provided. Moreover, data will determine what skills are necessary to impart in the curriculum of such programs. For instance, if a certain community prevails in specific medical conditions over others, then time will not be wasted covering rare conditions so that alternative programs can operate expeditiously.
- Barriers to participation will be lowered in certain instances, in the form of direct subsidies or significant tax exemptions, for the opening of small hospitals or short-term care centers by private organizations or motivated members of the community.
- Any hospital or practice is subject to a turnaround plan if minimum health requirements are not met. Should the facility not meet those requirements of minimum annual health, the entire staff will be terminated and reconstituted with more competent practitioners. Moreover, staff may be required to enroll in continuing medical education in advanced and remedial level re-licensing courses, including basic physics, chemistry, and biology.
- In addition to in- or out-of-network information and basic demographics, an online data warehouse will be established that will provide all health data and outcomes for every licensed physician in the United States, regardless of specialty. The individual physician's education, license information, and health outcomes of patients will be listed. Should in-network physicians be deemed unfit for local health care consumers, the Federal government, with matching funds by health providers, will offer subsidies for consumers to see other practitioners.
- Finally, a certain percentage of any and all physicians' patients will be assigned to them, care of those who qualify will be fully covered by providers. This will ensure adequate racial, income, and overall demographic diversity of clientele. The annual minimum health outcome data of these patients will also be included in the physician's overall quality.
Did I miss any? What if we indeed held doctors and other professionals to the same bloat and condescension that we currently hold teachers? I can predict some of the responses that physicians might make: "We can't control what our patients do or eat outside of our offices to maintain minimum levels of health. Also, these variables -- BMI, cholesterol, blood pressure -- are limited and don't adequately measure a healthy person. And one other thing, you can't expect us to be evaluated based on all patients equally, regardless of family history, poverty, and other complications." As an educator, my sentiments exactly!
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