Merit Pay and Cholesterol

I’m working on a paper about whether merit pay has any place in independent schools.   Before I write the paper, I need to figure out what I actually think, so I’ve been reading a lot about merit pay and education.  As I read everything from randomized, controlled studies to blogs, I keep getting hit with comparisons of merit pay in education to other careers.  I think I’ve hit on the one that really puts it in perspective for me: my cholesterol.

I have high cholesterol, which one might consider an overall indicator of my health.  What if my doctor got merit pay based on my cholesterol level?

What tools does my doctor have to improve my health as measured by my cholesterol level?

  • Expertise: My doctor can try to impress upon me the importance of lower my cholesterol, my risks, and what I should do.
  • Face Time and Teaching:  My doctor can meet with me to share her expertise and tell me exactly what I need to do, what to eat or not eat, how much exercise I should consider.
  • Medication: My doctor can prescribe any number of medications for reduction of cholesterol.
  • Assessment: My doctor can test my cholesterol periodically to see if I have made progress.
  • Reinforcement/Punishment: My doctor can praise me when I do what she asks and she can rebuke me when I don’t.  Depending on how health insurance works in the future, I may pay more if my cholesterol levels stay high.

What does my doctor have to overcome?

  • My genes: Pretty much everyone in my family has high cholesterol. I’ve had cousins who had high cholesterol in elementary school.  There’s a good chance that there are some genetic forces at work that neither my doctor nor I can control.
  • My beliefs: I believe that there’s little I can do for my cholesterol.  I have a lot of reasons.  People in my family don’t tend to have heart disease in spite of our lipid counts. We do tend to have weird and uncomfortable side effects when we take statin drugs.  We don’t tend to see lower cholesterol as a result of regular exercise.  We don’t generally eat high-cholesterol foods.  Based on these trends, I tend to believe that efforts to lower my cholesterol through prescriptions, diet, and exercise will fail.  Carol Dweck would probably say I have a fixed mindset about my cholesterol.
  • My non-compliance: When I’m actually at an appointment with my doctor, I generally refuse to accept Lipitor or similar medications.  I will however, usually agree to something else that is supposed to lower my cholesterol, like taking fish oil.  Right now I am supposed to be taking fish oil every day.  I haven’t taken fish oil at all since two days after I last promised to start doing it.

Is it fair to measure my doctor’s effectiveness based on my cholesterol level?  No!

With all the tools and expertise that she has, my doctor cannot ultimately control my cholesterol.  If you want to know how good she is, you’d probably need to sit in the exam room and watch her have these conversations and ask me if I thought she was effective.  Simply looking at my number doesn’t tell you anything about her efforts, only about my actions.  I like my doctor a lot; she’s attentive and funny.  She cares a lot about my health. She tries hard to get me to take the measures listed above.  She knows when to push a little harder, like at the beginning of the summer when I have more time to exercise and cook healthy meals.  She knows when to let it lie, like when I’m in the office because of a nasty case of food poisoning.   My total cholesterol count of 290 doesn’t tell you any of this.  If you judged her based on it, you’d do her a huge disservice.

So, hopefully this metaphor makes sense.  Teachers have expertise, face time, teaching tools, homework, parent conferences, stickers, praise, assessments, and grades in their toolbox for helping students learn.   But they have to overcome factors like learning differences, individual motivation, home life, student stress, cultural biases about the value of education, and the value students place on the rewards available to teachers in order to “achieve” which is then measured by a students’ scores on a single day.

I’m still not sure how I feel about some kind of merit pay for teachers, but I understand how I feel about using standardized test scores as the only component of determining teacher effectiveness.  What do you think?  Share your thoughts about this metaphor, your experience with merit pay, or how your school measures about teacher effectiveness. Leave comments about my cholesterol and lipitor out of it, please.

3 thoughts on “Merit Pay and Cholesterol

  1. Very interesting analogy and you definitely have point! The problem is, I believe there are a lot more incompetent/unmotivated teachers than there are incompetent doctors. Because they are teaching children, they have strong unions, and their students have no choice but to be there, teachers can get away with a lot more ‘phoning it in’ than doctors. If a doctor is genuinely incompetent, people will stop going to them and look elsewhere. Kids don’t have that option. You have to incentivize competence somehow. In normal jobs it’s the fear of losing customers/income and the hope of earning more money. There has to be something incentivizing for teachers.

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