How to Make Teachers More Like Doctors
Over the past 150 years, teaching and medicine have grown less and less alike.
For her exceptional book on the history of teaching, Dana Goldstein chose the title The Teacher Wars: The History of America’s Most Embattled Profession. In so doing, she joined an ongoing debate with reformers such as Stanford University’s Eric Hanushek, who wrote an article entitled “The War on Teachers is a Myth.” The stakes in this debate are high, ironically, because teaching polls as one of the most respected professions in the country. If political ideas are labeled a “war on teachers,” they are likely doomed to failure.
A recent sub-argument within this debate has been the comparison of teachers with doctors. As Noah Berlatsky pointed out at The Atlantic, “healthcare has its critics, but few of them are calling for doctors to be replaced.” Have reforms stripped teachers of their autonomy in ways that doctors would not tolerate? Or is there a reason doctors don’t face the same criticisms as teachers? Is Harvard University’s Jal Mehta correct when he argues that education could overcome its perceived failures by becoming more like medicine?
A careful answer to this question would start with the similarities between the two professions. Taxpayers spend huge sums of money on both, though spending for healthcare is twice as high as for education—$1.2 trillion versus $595 billion. Both teaching and medicine require initial financial sacrifice by practitioners: Teachers earn relatively modest starting salaries, while physicians spend 7-12 years after college accumulating debt in medical school and residencies. Back-loaded income for physicians and benefits for teachers only partially make up for this, so both sectors face retention and recruiting challenges, especially when it comes to specialized needs like obstetricians in rural areas, or mathematics teachers in urban areas. Despite that, public opinion surveys suggest that the two professions earn greater goodwill than any in America.
The similarities extend to the early history of both professions through the 1850s, as recounted for teachers in Goldstein’s book and for doctors in Ira Rutkow’s Seeking the Cure: A History of Medicine in America. Both schools and hospitals charged fees for services, lightly supported by local governments and churches. Unfortunately, neither profession was particularly effective or well regarded. As Rutkow wrote of medicine in the 1860s, “if patients were not being bled and blistered to exhaustion they were at the mercy of alternative practitioners whose theories were equally unsound.” This parallels the observations of a 19th century German principal Goldstein mentions in her book: After visiting American schools, he concluded that teachers were being trained in morality rather than pedagogy or curriculum, and that students were barely exposed to higher-level mathematics or language arts. To summarize, hospitals and schools in the mid-1800s seemed to offer little more than religious comfort: Poor children remained poor after attending school, and sick patients generally stayed sick or got worse after visiting hospitals.
Beginning in the 1860s, however, the two professions diverged. Healthcare remained decentralized and diverse, with varying levels of government support and regulation. Professional standards evolved through changes in self-regulation within the American Medical Association guild, and through changes in medical schools. In 1910, the publication of the Flexner Report led to higher standards for medical curricula and the closure of half of the nation’s medical schools. The embrace of advances in heart surgery and other medical techniques inspired some doctors to become prosperous through innovation. Around the same time, medical malpractice lawsuits evolved to enforce minimal standards of care throughout the profession. Although the poor continued to receive substandard care largely through charities, better-off Americans began to benefit from scientific revolutions. For doctors, their professional status went from what Rutkow describes as “riffraff” in the late 1860s to that of prosperous life-givers a century later.
For better or worse, education took a different path over the same hundred years. During this critical century, America emancipated 4 million slaves (constituting 12 percent of the country’s population at the time), continued its westward expansion, and admitted tens of millions of foreign nationals.
Public schools became the crucible of this nation-forging period. The first element of this was compulsory education, starting with Massachusetts in 1852, expanding to Native American nations starting in 1877, and reaching the entire country by 1918. To ensure cultural assimilation of these diverse populations, schools were run according to curricula dictated by the powerful. Additionally, each generation of political leaders expected public schools to implement the dominant racial vision of the time, which varied from Reconstruction in 1866, through Jim Crow, to the aftermath of Brown v. Board of Education in 1954.
This period also gave rise to the operations and pedagogy of schools as we know them today. Progressive Era ideas in the late 1800s and early 1900s drove a “factory” model of education, where ringing bells moved students through a series of lectures until they were released into jobs in agriculture or industry. To avoid the political corruption of the Gilded Age, teachers were given lockstep pay and tenure starting in Massachusetts in 1886. Over the same period, the workforce was deliberately transitioned from primarily male to primarily female, with leaders arguing such workers would be more “nurturing” and less expensive. The low wages that resulted from these decisions led teachers over time to ally with the industrial-style unions that became powerful in the private sector from the 1930s through the 1950s.
Overall, the resulting school system contrasts sharply with the hospital system. Culturally, teachers are expected to be surrogate mothers, overcoming racism and poverty. Professionally, teaching conforms to a specific blue-collar factory model of teaching, with no incentives to consider or enforce new ideas about quality or approach. Structurally, each neighborhood school is a government-backed monopoly, setting the stage for frustrated parents. The elites who created and control this system are insulated from its defects, as they can choose private schools or geographic enclaves where parents exert informal controls.
These diverging histories and results have led to two sets of arguments for moving education in the structural direction of medicine. The first centers on school choice. Advocates argue that if schools embraced the competition that has marked the healthcare system, they could come up with better practices and adapt to different students’ needs. Making this work in practice would depend upon smart regulation and funding, especially for vulnerable populations such as special needs students. But in an ideal scenario, teachers would be able to choose their own pedagogical and curricular approaches, and parents would be able to decide whether those approaches were the best fit for their children.
The second set of arguments relates to labor norms and involves reorienting teaching from a factory assembly-line model to a more diverse, professional model. The goal here would be to create a more clearly defined career path. The best teachers would become master teachers, as Education Secretary Arne Duncan has proposed, passing along their insights to many others in their profession. The school system would also need to hold principals and superintendents accountable for attracting, coaching, and retaining great teachers.
In order for this to work, the American Federation of Teachers would have to expand beyond its blue-collar model and become more of a guild, like the American Medical Association. The AMA advocates for physicians, much as the AFT does for teachers, but it also articulates and disseminates standards of quality.
Changes like these may sound dramatic, but they are no further reaching than educational transformations that have taken place in other countries. Best of all, by giving teachers more agency and dignity, they could offer teachers more of a chance to work with parents on students’ behalf instead of being the objects of a needless war.