Before it's too late

Over the last decade I have felt a growing kinship with teachers. We face challenges from the government and third-party payers to demonstrate the quality of our service by assessing the outcomes of our patients. Likewise, teachers are being rated by how well their students perform on "standardized" tests.

While theoretically the philosophy behind using outcomes to rate quality makes sense, it doesn’t as well with education and health care delivery as it does with automobile assembly plants. An overemphasis on outcomes fails to acknowledge the fact that some children arrive at our offices and schools so disadvantaged that even the most talented teacher or physician will not be able to make a measurable difference in their outcome.

Sean F. Reardon, professor of education and sociology at Stanford, has written in the New York Times about the widening gap between disadvantaged children and the privileged few ("No Rich Child Left Behind," April 27, 2013). It is no surprise that children from rich families get higher grades on standardized tests. And, Mr. Reardon writes, "family income is a better predictor of children’s success in school than race." He adds that the gap between rich and poor kids’ performance has increased by 40% in the last 30 years. It is interesting that this gap between the poor and middle-income levels is decreasing but the discrepancy between the middle class and the rich has grown.

Mr. Reardon provides some convincing evidence that "schools don’t seem to produce much of the disparity." Schools are unlikely to provide the route out of poverty for the disadvantaged child, he maintains, adding that "rising income inequality explains, at best, half of the increase in the rich-poor academic achievement gap."

One factor that might explain some of the disparity is that rich families have been increasing the time and money they spend on enriching activities for their children at a much faster rate than that of poor and middle class families. The rich seem to have taken our messages about the importance of early development more seriously and have bought Baby Einsteins, limited television exposure, and read "Goodnight Moon" until their eyes no longer focused. While not of all their investments have made a difference, the sheer volume of their efforts has paid off in better school success.

Mr. Reardon suggests that we rethink "our still-persistent notion that educational problems should be solved by schools alone." Instead he recommends that we emulate rich parents and "invest as a society in our children’s education from the day they are born." His recommendation clearly lobs at least one ball into our court, because as pediatricians we have an early and influential relationship with families during those critical first thousand days of a child’s life. We must redouble our efforts at encouraging parents to provide an enriching environment for their children, and we need to provide them with the strategies for creating that environment.

Because many parents can’t or don’t follow through with our recommendations, we must continue to advocate for government programs that provide early educational enrichment for their children. Recently, some politicians have suggested that we limit or eliminate Head Start, because there is a study or two that suggest it may not be effective. If these studies are valid (which I doubt), I suspect Mr. Reardon would say that by the time a child was old enough for Head Start the die would be cast.

We are in a position to do our colleagues in education a big favor by helping to provide more children who are ready to benefit from their skills. Their outcomes will look better, and in a generation we will be repaid with a cohort of better-educated parents who will make us look better when it comes time to judge our outcomes.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

Over the last decade I have felt a growing kinship with teachers. We face challenges from the government and third-party payers to demonstrate the quality of our service by assessing the outcomes of our patients. Likewise, teachers are being rated by how well their students perform on "standardized" tests.

While theoretically the philosophy behind using outcomes to rate quality makes sense, it doesn’t as well with education and health care delivery as it does with automobile assembly plants. An overemphasis on outcomes fails to acknowledge the fact that some children arrive at our offices and schools so disadvantaged that even the most talented teacher or physician will not be able to make a measurable difference in their outcome.

Sean F. Reardon, professor of education and sociology at Stanford, has written in the New York Times about the widening gap between disadvantaged children and the privileged few ("No Rich Child Left Behind," April 27, 2013). It is no surprise that children from rich families get higher grades on standardized tests. And, Mr. Reardon writes, "family income is a better predictor of children’s success in school than race." He adds that the gap between rich and poor kids’ performance has increased by 40% in the last 30 years. It is interesting that this gap between the poor and middle-income levels is decreasing but the discrepancy between the middle class and the rich has grown.

Mr. Reardon provides some convincing evidence that "schools don’t seem to produce much of the disparity." Schools are unlikely to provide the route out of poverty for the disadvantaged child, he maintains, adding that "rising income inequality explains, at best, half of the increase in the rich-poor academic achievement gap."

One factor that might explain some of the disparity is that rich families have been increasing the time and money they spend on enriching activities for their children at a much faster rate than that of poor and middle class families. The rich seem to have taken our messages about the importance of early development more seriously and have bought Baby Einsteins, limited television exposure, and read "Goodnight Moon" until their eyes no longer focused. While not of all their investments have made a difference, the sheer volume of their efforts has paid off in better school success.

Mr. Reardon suggests that we rethink "our still-persistent notion that educational problems should be solved by schools alone." Instead he recommends that we emulate rich parents and "invest as a society in our children’s education from the day they are born." His recommendation clearly lobs at least one ball into our court, because as pediatricians we have an early and influential relationship with families during those critical first thousand days of a child’s life. We must redouble our efforts at encouraging parents to provide an enriching environment for their children, and we need to provide them with the strategies for creating that environment.

Because many parents can’t or don’t follow through with our recommendations, we must continue to advocate for government programs that provide early educational enrichment for their children. Recently, some politicians have suggested that we limit or eliminate Head Start, because there is a study or two that suggest it may not be effective. If these studies are valid (which I doubt), I suspect Mr. Reardon would say that by the time a child was old enough for Head Start the die would be cast.

We are in a position to do our colleagues in education a big favor by helping to provide more children who are ready to benefit from their skills. Their outcomes will look better, and in a generation we will be repaid with a cohort of better-educated parents who will make us look better when it comes time to judge our outcomes.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

Over the last decade I have felt a growing kinship with teachers. We face challenges from the government and third-party payers to demonstrate the quality of our service by assessing the outcomes of our patients. Likewise, teachers are being rated by how well their students perform on "standardized" tests.

While theoretically the philosophy behind using outcomes to rate quality makes sense, it doesn’t as well with education and health care delivery as it does with automobile assembly plants. An overemphasis on outcomes fails to acknowledge the fact that some children arrive at our offices and schools so disadvantaged that even the most talented teacher or physician will not be able to make a measurable difference in their outcome.

Sean F. Reardon, professor of education and sociology at Stanford, has written in the New York Times about the widening gap between disadvantaged children and the privileged few ("No Rich Child Left Behind," April 27, 2013). It is no surprise that children from rich families get higher grades on standardized tests. And, Mr. Reardon writes, "family income is a better predictor of children’s success in school than race." He adds that the gap between rich and poor kids’ performance has increased by 40% in the last 30 years. It is interesting that this gap between the poor and middle-income levels is decreasing but the discrepancy between the middle class and the rich has grown.

Mr. Reardon provides some convincing evidence that "schools don’t seem to produce much of the disparity." Schools are unlikely to provide the route out of poverty for the disadvantaged child, he maintains, adding that "rising income inequality explains, at best, half of the increase in the rich-poor academic achievement gap."

One factor that might explain some of the disparity is that rich families have been increasing the time and money they spend on enriching activities for their children at a much faster rate than that of poor and middle class families. The rich seem to have taken our messages about the importance of early development more seriously and have bought Baby Einsteins, limited television exposure, and read "Goodnight Moon" until their eyes no longer focused. While not of all their investments have made a difference, the sheer volume of their efforts has paid off in better school success.

Mr. Reardon suggests that we rethink "our still-persistent notion that educational problems should be solved by schools alone." Instead he recommends that we emulate rich parents and "invest as a society in our children’s education from the day they are born." His recommendation clearly lobs at least one ball into our court, because as pediatricians we have an early and influential relationship with families during those critical first thousand days of a child’s life. We must redouble our efforts at encouraging parents to provide an enriching environment for their children, and we need to provide them with the strategies for creating that environment.

Because many parents can’t or don’t follow through with our recommendations, we must continue to advocate for government programs that provide early educational enrichment for their children. Recently, some politicians have suggested that we limit or eliminate Head Start, because there is a study or two that suggest it may not be effective. If these studies are valid (which I doubt), I suspect Mr. Reardon would say that by the time a child was old enough for Head Start the die would be cast.

We are in a position to do our colleagues in education a big favor by helping to provide more children who are ready to benefit from their skills. Their outcomes will look better, and in a generation we will be repaid with a cohort of better-educated parents who will make us look better when it comes time to judge our outcomes.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.