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Time for a grand bargain to fire bad doctors, bad teachers, bad politicians, and bad CEOs?

In response to today's article in the New York Times discussing differences in skill among surgeons -- and reader comments asking why dangerously incompetent surgeons are allowed to keep working -- I am reposting below my 2010 essay on analogous problems in various professions.

Retention based on seniority is, in effect, a conspiracy between teachers' unions and people for whom lower taxes are more important than quality education for the kids in their community.

This post is inspired by two recent New York Times stories. One reports the battle between teachers' unions (favoring pay and job retention based on seniority) and educational reformers who want pay and retention to be based on other criteria, such as student test scores (Brill 2010). The other story reports that some incumbent politicians in the US lost primary battles to challengers in their own party (Zeleny and Hulse 2010). This is news because it hardly ever happens.

I want to make two points. First, US teachers and US politicians are in similar situations. Once they've been in the job for awhile, they can be hard to get rid of, even if their performance falls well below average. This is also true of university professors, medical doctors, and business executives, although pay in those occupations may depend more on current or past performance than it does for politicians or teachers.

Second, random changes to the current system could make things worse rather than better, for an economic reason I haven't seen discussed. More-thoughtful changes are another story.

How do poorly performing people manage to keep their jobs in these very different occupations? For teachers, basing retention on seniority makes it difficult or impossible to fire a poorly performing senior teacher, even if their contract doesn't explicitly promise the life-long employment that college and university professors typically enjoy.

What about politicians, doctors, and business executives? For politicians, seniority often translates into committee appointments that let them funnel government money ("pork") to their districts. So voters are reluctant to oust them, even if they are corrupt or incompetent. Business executives often appoint the boards that determine their salaries and job retention. Bad doctors (Kolata 2005; Leonhardt 2006) are presumably responsible for more than their share of the 120,000 Americans a year who die each year due to medical errors (Levy 1996), although fully 84% of all doctors can't be bothered to change their gloves to keep from transferring pathogens among patients (Yoffe 1999). But, like rapist priests, having to move to a community with less oversight is about the worst bad doctors have to fear.

Before eliminating tenure, seniority, or incumbent-politician advantage, however, consider their positive aspects. I would argue that the rights of incumbents to continued employment are trumped by those of thousands of students, citizens, stock-holders, or patients, but that doesn't necessarily mean we should reduce employment security.

If security of employment isn't a right, it is certainly a major perquisite. So, if we reduced the job security of teachers (or doctors, etc.) we would need to increase salaries or other benefits to attract equally qualified applicants. (And don't we want even more-qualified applicants than we have now?) Retention of teachers based on seniority is, in effect, a conspiracy between teachers' unions and people for whom lower taxes are more important than quality education for the kids in their community.

As alternatives to tenure or higher salaries, we could consider perquisites that would particularly appeal to the sort of person we want to attract to teaching. Consider sabbaticals. Someone who is really excited about teaching French or in biology might take a job that paid for summers in France or expenses to participate in lab or field research, even if their salary were lower.

Suppose we eliminate seniority as the sole criterion for retention? How would this affect the type of people who apply for teaching positions? It would depend on what the new criteria are.

Letting principals or deans fire teachers or professors at will would select for ass kissers. Furthermore, we would have to raise taxes, to pay more than the many lucrative ass-kissing positions in the private sector. A fellow faculty member once suggested that my project would get more money from the dean if I started going to his church. Someone else suggested that a major reduction in our budget might have had something to do with my public criticism of the dean's biotechnology-only approach to hiring. I don't want to believe either of those claims, but I was glad that I had tenure. If deans or principals could fire at will, students would be exposed to less diversity of opinion.

What about test scores as a criterion? If pay or continued employment for teachers depended on the absolute test scores of their students, then school districts with poorly prepared students would have trouble hiring any teachers at all, because they wouldn't expect to survive more than one year.

But why not base pay and retention on how a teacher's students perform on a test at the end of the year, relative to other students who had similar scores at the beginning of the year? This seems more promising, but it depends on the test. If the test were based only on memorization, than potential teachers who are good at helping students develop critical thinking skills or creativity would look for another profession. If there were tests that measured the full range of student's intellectual progress, however, then "teaching to the test" could be a good thing. This wouldn't be easy, but it might be possible.

University faculty are hired to produce new knowledge that benefits society, not just to transmit existing knowledge. It's probably easier to set minimum expectations for this function than it is to evaluate the quality of teaching in specialized fields. The quality and quantity of published research is already a major factor in determining pay raises for university faculty. But, if a professor hasn't published for several years, maybe he or she should be fired. Again, this risk would make university positions less attractive, so we would have to increase salaries or improve working conditions, to attract people as qualified as the current pool.

Similar arguments apply to other professions. Term limits are a really stupid idea, given the real benefits of experience. But reducing the ability of more-senior politicians to direct funds to their states would reduce the incentive for voters to re-elect a politician who is not representing their other interests. Pay-for-performance for doctors seems like a good idea, but it should be based on long-term patient outcomes, not numbers of procedures performed. Business executives would take a longer-term view if much of their compensation came in the form of dividends from stock that could never be sold, and which reverted to the company on their death. If the company prospered over the long-term, they'd get dividends for life.

The key point is that the criteria we use to determine salary and job retention will affect what type of people are attracted to a job, as well as how motivated they are to excel.

Brill S. 2010. The Teachers' Unions' Last Stand. New York Times 17 May.
Kolata G. 2005. When the Doctor Is in, but You Wish He Weren't. New York Times 30 Nov. 2005.
Leonhardt D. 2006. Why Doctors So Often Get It Wrong. New York Times 22 Feb. 2006.
Levy D. 1996. Medical groups act to curb errors. USA Today, 14 October 1996 .
Yoffe E. 1999. Doctors are reminded,' wash up!'. New York Times 9 November 1999.
Zeleny J., and C. Hulse. 2010. Specter Defeat Signals a Wave Against Incumbents. New York Times 18 May.

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