In a forthcoming book, I compare the practice of primary care physicians to that of K-12 teachers. For some readers, the comparison may be a stretch since so many differences separate the two professions. [i]
Consider the following:
*Doctors go to school eight years (undergraduate and graduate) to secure an M.D. and then spend another two to six years (of which most are clinical practice) learning a specialty; most teachers spend five years (of which six months to a year are in supervised classroom practice) to earn a bachelors and then a master's degree in education; those who receive alternative certification have little to no time in supervised teaching prior to entering the classroom.[ii]
*Doctors see patients one-on-one; teachers teach groups of 20 to 35 students all day.
*Most U.S. doctors get paid on a fee-for-service basis; nearly all full-time public school teachers are salaried.
*Evidenced-based practice of medicine in diagnosing and caring for patients is more fully developed and used by doctors than research on teaching and learning available to and accessed by teachers.[iii]
*Medicine has been largely male-dominated until the past quarter-century while K-12 schooling has been female-dominated for over a century and a half.[iv]
*In terms of both social status and respect, polls rank doctors higher than teachers.[v]
While these educational, organizational, demographic, and societal differences are substantial in challenging comparisons, there are fundamental commonalities that bind teachers to primary care doctors. First, both are helping professions that seek human improvement. Second, profound structural changes in funding, technology, and professional autonomy have occurred in both occupations that have penetrated doctors’ offices and teachers’ classrooms.
Helping professions.
From teachers to social workers to therapists to doctors, these professionals use their expertise to transform minds, improve skills, deepen insights, cope with feelings, and mend bodily ills. In doing so, these helping professions seeking human improvement face at least two predicaments.[vi]
*Expertise is never enough. A primary care physician facing a chain-smoking patient knows that this behavior has a high probability of leading to lung cancer—even the patient knows that—yet the doctor’s knowledge and skills are insufficient to get the private equity fund CEO to quit.
Some high school teachers of science with advanced degrees in biology, chemistry, and physics believe that lessons should be inquiry driven and filled with hands-on experiences while other colleagues, also with advanced degrees differ. They argue that uninformed students must learn the basic principles of biology, chemistry, and physics through rigorous study before they do any practical work in class.
In one case, there is insufficient know-how to stop a patient from smoking and, in the other instance, highly knowledgeable teachers split over how best to have students learn science. As important as expertise is to professionals dedicated to helping people, it falls short—and here is the second predicament--not only because expertise is insufficient but also because professionals seeking human improvement in any helping profession need their clients, patients, and students to engage in the actual work of learning and becoming a better, healthier person.
*Helping professionals are utterly dependent upon their clients’ cooperation.Physician autonomy, anchored in expertise and clinical experience, to make decisions unencumbered by internal or external bureaucracies is both treasured and defended by the medical profession. Yet physicians depend upon patients for successful diagnoses and treatments. If expertise is never enough in the helping professions, patients constrain physician autonomy and effectiveness.
While doctors can influence a patient’s motivation, if that patient is emotionally depressed, resistant to recommended treatments, or uncommitted to getting healthy by ignoring prescribed medications and prevention of harmful behaviors--the physician is stuck. Autonomy to make decisions for the welfare of the patient and effectiveness of treatment become irrelevant when patients cannot or do not enter into the process of healing.
For K-12 teachers who face captive audiences among whom are some students unwilling to participate in lessons or who defy the teacher’s authority or are who uncommitted to learning what the teacher is teaching, then teachers have to figure out what to do in the face of students’ passivity or active resistance.
These predicaments common to the helping professions are the basis for my comparing, what appears at first glance, two very different occupations. Beyond serving in helping professions and facing similar predicaments, there is yet another reason why I compare teachers to primary care physicians. Both occupations have undergone similar structural changes.
For decades, just as policy elites have tried to reshape teaching through reforming old structures and creating new ones, health care policymakers have tried similar ventures in medicine. New structures in funding, use of technologies, and managerial control have affected professional autonomy in the practice of medicine without altering those insoluble predicaments that physicians face daily with their patients.
And that is why I will compare doctors and teachers in my next book.
[i] I chose primary care physicians to focus on. Included in primary care are internists, pediatricians, and other physicians who are the first contact for patients with non-emergency medical problems. These physicians diagnose and treat common illnesses and medical conditions. They collect information from patients on their symptoms, their medical history, do physical examinations, and basic medical tests like blood work and X-rays. They then make a diagnosis and plan with patients what next steps to take in treatments including referral to specialists. Primary care doctors also counsel and educate patients on preventing illnesses and encouraging healthy behaviors. They build relationships with patients over time getting to know them as individuals, family members, workers, and whole human beings. They provide services in their offices, emergency rooms, hospitals, and nursing home care. I exclude those doctors who practice surgery, psychiatry, obstetrics, cardiologists, oncologists, and scores of other specialties. My rationale is that primary care physicians as first contacts with patients and as generalists are most similar to K-12 teachers who, using their expertise, get to know students, develop relationships with them, and figure out how best to teach knowledge and skills and help students learn both.
[ii] Kenneth Ludmerer MD and Michael Johns MD, “Reforming graduate Medical Education,” JAMA, 2005, 294(9), pp. 1083-1087; Linda Darling-Hammond, et. al., “The Design of Teacher Education Programs,” in Linda Darling-Hammond and John Bransford (eds.) Preparing Teachers for a Changing World (San Francisco: Jossey-Bass, 2005), pp. 390-441.
[iii] David Sackett, et. al., “Evidence-based Medicine: What It is and What It isn’t,” BMJ, 1996, accessed February 11, 2012 at: http://www.bmj.com/content/
[iv] Ann Boulis and Jerry Jacobs, The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America (Ithaca, NY: Cornell University Press, 2008).
[v] Tom Van Riper, “America’s Most Admired Professions,” Forbes.Com, July 28, 2006 accessed February 11,2012 at: http://www.forbes.com/2006/07/
[vi] The dilemmas that professionals face in the helping professions are well known among the inhabitants of each occupation. The work of David K. Cohen has brought together these cross-professional quandaries in Teaching And Its Predicaments(Cambridge, MA: Harvard University Press, 2011). He examines teachers, psychotherapists, social workers, pastors, and organizational developers who “work directly on other humans in efforts to better their minds, lives, work, and organizations.”(p. 4). Although he initially excludes medical doctors from human improvement, he does allow that occupations change over time and that doctors may be included: “Physicians conventionally defined their work in terms of patients’ physical health and many still do, but increasingly they see that physical health can depend on how well patients understand their problems and how firmly they commit to the solutions; hence physicians work more and more on understanding and mutual commitment” (p. 19). He is correct in that the thinking about medical practice has moved from physician-centered to patient-centered where doctors routinely include patients’ questions, concerns, and views in diagnosing and treating illnesses. See, for example, Christine Laine, MD and Frank Davidoff, MD, “Patient-Centered Medicine; A Professional Evolution,” Journal of American Medical Association, January 10, 1996, 275(2), pp. 152-155
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7 de março de 2012
Why I Compare Primary Care Physicians to Classroom Teachers by larrycuban
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