Thursday, March 22, 2007

No Dentist Left Behind

My dentist is great! He sends me reminders so I don't forget checkups. He uses the latest techniques based on research. He never hurts me, and I've got all my teeth.

When I ran into him the other day, I was eager to see if he'd heard about the new state program. I knew he'd think it was great.

"Did you hear about the new state program to measure effectiveness of dentists with their young patients?" I said.

"No," he said. He didn't seem too thrilled. "How will they do that?"

"It's quite simple," I said. "They will just count the number of cavities each patient has at age 10, 14, and 18 and average that to determine a dentist's rating. Dentists will be rated as excellent, good, average, below average, and unsatisfactory. That way parents will know which are the best dentists. The plan will also encourage the less effective dentists to get better," I said. "Poor dentists who don't improve could lose their licenses to practice."

"That's terrible," he said.

"What? That's not a good attitude," I said. "Don't you think we should try to improve children's dental health in this state?"

"Sure I do," he said, "but that's not a fair way to determine who is practicing good dentistry."

"Why not?" I said. "It makes perfect sense to me."

"Well, it's so obvious," he said. "Don't you see that dentists don't all work with the same clientele, and that much depends on things we can't control? For example, I work in a rural area with a high percentage of patients from deprived homes, while some of my colleagues work in upper middle-class neighborhoods. Many of the parents I work with don't bring their children to see me until there is some kind of problem, and I don't get to do much preventive work.

Also, many of the parents I serve let their kids eat way too much candy from an early age, unlike more educated parents who understand the relationship between sugar and decay. To top it all off, so many of my clients have well water which is untreated and has no fluoride in it. Do you have any idea how much difference early use of fluoride can make?"

"It sounds like you're making excuses," I said. "I can't believe that you, my dentist, would be so defensive. After all, you do a great job, and you needn't fear a little accountability."

"I am not being defensive!" he said. "My best patients are as good as any one's, my work is as good as any one's, but my average cavity count is going to be higher than a lot of other dentists because I chose to work where I am needed most."

"Don't get touchy," I said.

"Touchy?" he said. His face had turned red, and from the way he was clenching and unclenching his jaws, I was afraid he was going to damage his teeth. "Try furious! In a system like this, I will end up being rated average, below average, or worse. The few educated patients I have who see these ratings may believe this so-called rating is an actual measure of my ability and proficiency as a dentist.

They may leave me, and I'll be left with only the most needy patients. And my cavity average score will get even worse. On top of that, how will I attract good dental hygienists and other excellent dentists to my practice if it is labeled below average?"

"I think you are overreacting," I said. "'Complaining, excuse-making and stonewalling won't improve dental health'... I am quoting from a leading member of the DOC," I noted.

"What's the DOC?" he asked.

"It's the Dental Oversight Committee," I said, "a group made up of mostly lay persons to make sure dentistry in this state gets improved."

"Spare me," he said, "I can't believe this. Reasonable people won't buy it," he said hopefully.

The program sounded reasonable to me, so I asked, "How else would you measure good dentistry?"

"Come watch me work," he said. "Observe my processes."

"That's too complicated, expensive and time-consuming," I said. "Cavities are the bottom line, and you can't argue with the bottom line. It's an absolute measure."

"That's what I'm afraid my parents and prospective patients will think. This can't be happening," he said despairingly.

"Now, now," I said, "don't despair. The state will help you some."

"How?" he asked.

"If you receive a poor rating, they'll send a dentist who is rated excellent to help straighten you out," I said brightly.

"You mean," he said, "they'll send a dentist with a wealthy clientele to show me how to work on severe juvenile dental problems with which I have probably had much more experience? BIG HELP!"

"There you go again," I said. "You aren't acting professionally at all."

"You don't get it," he said. "Doing this would be like grading schools and teachers on an average score made on a test of children's progress with no regard to influences outside the school, the home, the community served and stuff like that. Why would they do something so unfair to dentists? No one would ever think of doing that to schools."

I just shook my head sadly, but he had brightened. "I'm going to write my representatives and senators," he said. "I'll use the school analogy. Surely they will see the point."

(Note: This is not an original piece of writing. This periodically shows up in the inbox of my school email. Teachers forward it on to other teachers, but I didn't know if anyone outside the profession ever saw it, so that's why I decided to share it here. If you want to know what it's like to be a teacher under NCLB, this conveys the ludicrousness and frustration of the whole mess. Apply the ideas to YOUR profession and imagine the outrage YOU'D feel!)


  1. That was brilliant. Absolutely brilliant. You need to submit that to...I don't know, some important professional journal or such. I wish every parent, teacher, and administrator could see it.

  2. I wish I could take credit for it! I added a note at the end of the post -- teachers HAVE seen this. It's the doctors and lawyers and POLITICIANS who need to read it and realize how crazy NCLB is!!!!!!!!!!

  3. AAARGH! This makes me so frustrated.

    This piece is brilliant. But, would a politician get it? I don't think so. (Well, maybe John Edwards. He's the only one talking about the elephant in the room--there are poor people in this country and NCLB isn't going to help their kids or their schools.)

    The dentist analogy is perfect. In my mom's final year of teaching (2005-2006), all but 3 of her children spoke another language as their primary language. The number of these home languages? 12. The three native speakers of English? Two of them lived in foster homes. How in the world is mom supposed to bring them up to 3rd grade level? She has to show them the word for "girl" and "boy" on the bathroom doors. Needless to say, her school is a "failing school" under NCLB, despite the fact many dedicated, wonderful, intelligent teachers work there.

    What happened to the idea that school was to bring these 20 kids speaking 12 different languages to proficiency in English and citizenship by the time they're 18? Mom used to teach about her favorite artists, countries, and cultures in her classroom. But at the end she couldn't. It was all about the test.

    Why (again, I give Edwards the exception here) can't politicians admit that poverty, addiction, and dysfunction at home are the problem and direct their funds that-a-way. Kids need to feel safe, clean, and not hungry in order to learn. Teachers can't fix that, although they try beyond all expectations.

  4. That was a great description. Yes, it is ridiculous to rate the teachers by student progress, but that seems to be the norm. I had a great friend who told me about this. This causes teacher burnout, and the best teachers, who are needed at the schools with the most challenging students, all want to work at the schools where they can get their bonus. This is what happens in NC. You only get your teacher bonus if the whole school passes. Yikes! That is why I decided NOT to become a media specialist.

  5. I'm not really ready to start counting down to the end of my career, but this nonsense, this unrelenting, soul-deadening NONSENSE has made me start thinking about not being a teacher any more.

    That said, it is also scary what state legislatures are doing to teacher retirement funds and insurance coverage after retirement. I might not be able to afford to EVER retire!


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