Awarding Average

There were 117 awards during high school graduation this week, felt sort of like if healthcare had an awards night and honored everyone who showed up wearing scrubs. There were 11 art awards, 16 English, 14 science and 30 for music. If your instrument made a sound – award. If you sang low and high - award. And if you could write a sentence, run a mile and make a half decent oral argument why Pluto ought to be a planet, which it obviously should, then that was like 3 awards. There was a writing award for best prose, one for best persuasion, and even one for best passion. Even math had a moment, with honors for best parallelogram and best impersonation of Matt Damon’s Will Hunting. Really? Only history seemed to be light on the honors. There was the ancient civ award, US history and then one of those awards you love as a parent but you also feel embarrassed about, the “this kid really showed interest and tried and showed creativity award” given to the student who when asked to name his favorite era, said “Bill Buckner. Because I’m a Met fan.” Back when I graduated high school there were 5 awards: history, math, English, gym and the arts. Music, band, orchestra, singing were all one award and James McKenzie’s cool solo drum set to the Moody Blues got him the nod. There was no science award, even though green was a Pictionary category. The history, math and English awards all went to Becky Kerstein, our valedictorian. I got the gym award. I feel like healthcare is in a bit of similar situation these days, doling out more awards than a rural high school with mostly average students whose parents think all their kids are above average. We’re giving extra reimbursement just for “sharing data,” enhanced rates for opening up a clinic, and a $1,000 payment just if you offer medication assisted treatment, each month. Many major specialists can now negotiate up to a 50% share of savings if they can keep patients from going to the hospital, which adds up to tens of thousands of dollars in bonus payments if you are good at your job. We’ve set a bar and it’s low enough many are hitting it. But we are about 4 years out if I had to venture a guess from a moment when that bar needs to move or we learn that all those awards and rewards we got were nice, but aren’t coming anymore. Some of us will keep innovating. Some are like Becky and James, one a college professor, the other a former Julliard teacher. Some may not get bonuses and revert to being average again, and paid just because, which is nothing to sneeze at – at least when you’re in healthcare. That’s because we need average. Average means access, and it helps us know who to reward. Maybe in 4 years we ought to devise a new set of honors to recognize the mediocre doctors and nurses among us. We can celebrate by applauding clinicians who do just enough, but rarely more, like clinicians who spend the least amount of time talking to patients but still somehow manage to make a halfway decent diagnosis without the help of a fancy lab or imaging center. How bout them apples….