A Monday New York Times story headlined, “As Physicians’ Jobs Change, So Do Their Politics,” suggested that as doctors increasingly abandon their private practices and become employees of large health care institutions, they are no longer thinking like Republican-learning owners and instead thinking like Democratic-leaning workers. “Doctors were once overwhelmingly male and usually owned their own practices,” the article states, “but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening.”
The parallels with public education are instructive. A primary rationale for government taking over public education in the mid-1800s was the need for universal access to quality education. Horace Mann and other state political leaders argued that too much decentralization was undermining quality and allowing too many children to go uneducated. Their answer was a more centralized, uniform public education system owned and managed by local governments under the guiding hand of state governments.
The industrial revolution that transformed our way of life in the 1800s also transformed how the government organized and managed public education. By the early 1900s public education had become a government-run factory with educators being assembly line workers. In the late 1950s and early 60s, teachers began organizing industrial-style unions to protect themselves from the abuses of these politically-run factories, and in doing so became a core constituency of organized labor and the Democratic Party, which is where they remain today.
According to the Times story, health care and doctors are beginning to follow a similar path. But, ironically, while doctors are abandoning their private practices to join large health care factories, teachers and parents are increasingly using charter schools, homeschooling cooperatives, dual enrollment programs, publicly-funded private school options and virtual schools to create smaller, decentralized teaching and learning options. Schools, or learning networks, with fewer than 50 students are still rare, but they’re proliferating. Perhaps in a decade or two more teachers will own private practices than doctors. Then political debates over tenure, merit pay and employee evaluations will be more common in medicine than education.
Finding the proper balance between contradictory forces is a challenge we all face in our daily lives, so it’s not surprising to see doctors and educators struggling to balance big versus small, centralized versus decentralized, and government-owned versus practitioner-owned. Despite the power of ideology, pragmatic concerns will ultimately control how these tensions are managed, although doctors should spend time in school districts talking with teachers before abandoning their medical practices and joining large health care factories. Working on an assembly line has its downsides.