'No Child' Law Is Full Of Cavities

By John Taylor
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, so 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.

This column is a satirical commentary on the federal Elementary and Secondary Education Act, often misleadingly called the ‘No Child Left Behind’ law. John Taylor recently retired as superintendent in Lancaster County, Pennsylvania, after 33 years as an educator.

“Did you hear about the new state program to measure effectiveness of dentists with their young patients?” I asked. “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 who are the best dentists. It 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 asked.

“Well, it’s so obvious,” he said. “Don’t you see that dentists don’t all work with the same clientele; so much depends on things we can’t control? For example,” he said, “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. Also,” he said, “many of the parents I serve let their kids eat way too much candy from an early age. To top it all off,” he added, “so many of my clients have well water that is untreated and has no fluoride in it.”

I couldn’t believe my dentist would be so defensive.

“I am not!” he said. “My best patients are as good as anyone’s, my work is as good as anyone’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.

“In a system like this, I will end up being rated Average, Below Average, or worse. My more-educated patients who see these ratings 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?”

“Well, how else would you measure good dentistry?” I asked.

“Come watch me work,” he said. “Observe my processes.”

“That’s too complicated and time consuming,” I said. “Cavities are the bottom line, and you can’t argue with the bottom line.”

“You don’t get it,” he said. “Doing this would be like grading schools and teachers on an average score on a test of children’s progress without regard to influences outside the school – the home, the community served and stuff like that. 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 legislators,” he said. “I’ll use the school analogy - surely they’ll see the point.”

He walked off with a look of hope mixed with fear and suppressed anger – the same look I see in the mirror so often lately.

Resource page on the ESEA law

Posted January 30, 2004