Capital News Service

of the Michigan State University School of Journalism

Michigan’s doctor shortage worsens

By CHENQI GUO
Capital News Service

LANSING- Michigan is facing a loss of physicians as cuts in Medicaid and Medicare reimbursement continue.

Several thousand physicians have left the state after their residency programs or during their practices, according to Gregory Forzley, board chair of the Michigan State Medical Society (MSMS). The situation could be worse since an 8 percent cut in Medicaid and Medicare reimbursement rates was approved on Sept. 30, 2009.

“The top three specialties with the biggest shortage are cardiologist, family doctor and general surgeon,” said Jessy Sielski, manager of communications and media relations for MSMS.

The total number of physicians licensed in Michigan is 42,960 and about 27 percent of them work outside Michigan, according to the state’s 2009 physician licensure report.

“Based on surveys and the result of tracking, if physicians-in-training go out of state for a residency program, they tend not to come back,” said Forzley, a Grand Rapids family physician.

As a result, doctors who stay in Michigan are taking as many patients as possible. About 61 percent of physicians providing patient care in Michigan report their practice was full or nearly full in 2009, compared to 42 percent in 2005. That means some patients will find it harder to find sufficient care

MSMS represents 14,000 medical doctors.

It is also cooperating with universities and medical programs to identify physicians to fill available spots.

Many universities are opening new medical schools or expanding, including Central Michigan, University of Michigan, Michigan State colleges of Human Medicine and Osteopathic medicine, Oakland and Western Michigan,Sielski said.

“Physicians may get better financial rewards if they partner with universities and they may not know about it. This is what we want to make them aware of,” Forzley said.

“We’ve talked about how to encourage and educate medical students on why Michigan is a good place and give them a better business sense and a better understanding about what to look for in practice, ” he said. “There is a need for good medical programs and enough residency positions, as well as financial assistance to help cover students’ large loans.”

He said one challenge is that even though the number of medical students has increased, there aren’t enough creative programs to forgive their debts and encourage them to stay here.

© 2010, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.

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Federal funds to boost medical technology in Michigan

By DE’MARJA PATRICK
Capital News Service

LANSING – As tens of thousands of citizens and thousands of physicians leave the state, the Michigan State Medical Society (MSMS) hopes that federal stimulus dollars will increase medical technology in hospitals and improve health care for those who stay.

The Obama administration has put $19 billion into the push for information technology, but doctors and hospitals will have to adapt to changes that are expected to reduce errors and serve more patients.

“Health care is the largest industry that touches everyone,” said Gregory Forzley, chair of the MSMS board and a family physician in Grand Rapids.

At the forefront of health care is technology.

Hospitals and physicians plan to use stimulus dollars to advance information technology. The money could yield state and federal benefits for medical practices and their patients.

Technology such as electronic medical records will reduce errors while treating more patients at a faster pace. For example the American Medical Association says that electronic medical records have, “managed scheduling, patient data registration, health history and medication lists.”
Only 4 to 10 percent of hospitals in Michigan are using such electronic technology, and high–speed Internet access, which will be necessary for some technology, isn’t available throughout the state, Forzley said.

With a push for technology advancement, physicians will  have to adopt the technology to help their practice, while weighing the costs and maintenance of systems such as electronic records, he said.

Forzely said that putting in electronic medical records in one hospital could cost millions of dollars if starting from scratch. Learning how to use a new system, as well as training a staff, could add more expenses into the equation.

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Federal aid may not help schools with big deficits

By DANIEL OPSOMMER
Capital News Service

LANSING — Some school officials and teacher unions believe Michigan’s Race to the Top plan may not produce significant academic improvement if school districts’ immediate need for more money isn’t addressed.

Michigan’s Race to the Top plan has been signed by 756 districts. However, only 42 local unions have signed their district memorandums in support of the program.

“All the No Child Left Behinds or Race to the Tops in the world won’t help if we don’t have stable funding put in place for our school districts,” said Grand Ledge Public Schools chief financial officer Tom Goodwin. “Without adequate funding, more and more school districts will likely fail to meet the standards our legislators have put in place.”

Michigan Education Association President Iris Salters has cautioned locals against the plan. Salters said the statewide union will advise local presidents not to sign contracts that legally require them to implement a plan that doesn’t fix fundamental funding problems or pay for the new mandates the plan requires.

“MEA representatives spent countless hours working with the Department of Education to address our concerns about the draft state plan and to set reasonable deadlines that would allow people to see the final plan before making final commitments,” Salters said. “When we made such arguments, the department’s answer was simply to make local union presidents’ signatures optional, cutting us out of what was meant to be a collaborative process.”

Due to budget deficits, state aid to public schools was cut by 11 percent in October, resulting in $165 less per student for 2010.

While Detroit, Lansing and Grand Rapids public schools all signed off on the Race to the Top legislation, they are experiencing financial shortfalls. For example, Detroit lost $18 million in state aid while Lansing lost $3 million and Grand Rapids lost $9 million.

State officials project an additional $425 million cut in K-12 aid for 2011, which translates to $263 per student.

“If we keep cutting the way we are cutting, we’re going to have more and more districts that fail,” Goodwin said. “The question we need to ask ourselves is, what’s an acceptable failure rate for schools? I believe zero.”

Legislation passed late last year allows the Department of Education to establish a process for state takeover or closing of the bottom 5 percent of failing schools. It creates a state school reform and redesign officer in the department to oversee those schools.

However, Goodwin says the bottom 5 percent may not accurately address the number of failing districts because of the decrease in state aid.

“With all the lost revenue in funding, districts are forced to let teachers go, which ultimately increases class sizes considerably,” Goodwin said. “The problem is that with the Race to the Top, we continue to ask more of our teachers while failing to equip them with the proper resources.”

Legislators are divided on what approach to take to resolve the deficit without additional cuts to education aid. Senate Majority Leader Mike Bishop, R-Rochester, is proposing 5 percent pay cuts for teachers, professors and state and local government workers, while Reps. Tim Melton, D-Auburn Hills and Phil Pavlov, R-St. Clair say strengthening local businesses and put people back to work will help generate revenue through increased tax income.

Rep. Bert Johnson, D-Highland Park, said the Legislature needs to look at innovative ways to generate revenue to provide school districts with adequate funding. Johnson said the Legislature shouldn’t reduce school aid to resolve the deficit.

“We need to look at honest ways to increase revenue to provide school districts with the necessary tools to provide the quality education we are demanding,” said Johnson.

Michigan’s Race to the Top plan includes new laws that:

• Direct the Education Department to establish a process for state takeover or closing of the bottom 5 percent of failing schools.
• Create a state school reform and redesign officer in the department to oversee those failing schools.
• Raise the dropout age from 16 to 18.
• Allow alternative certification of teachers. 12 credit hour cert plan.
• Allow high-quality charter schools to become Schools of Excellence and authorize new charter schools.
• Require districts to assess teachers annually based on student progress and achievement.
Source: Michigan Department of Education

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Proposal for part-time Legislature lingers

By DANIELLE EMERSON
Capital News Service

LANSING – In a continuing effort to cut the state’s deficit, conservative members of both houses are suggesting one thing: a smaller government.

Although Senate Republicans recently unveiled a plan that they say would cut costs by up to $2 billion through reducing state employee salaries and cutting benefits, down-sizing proposals are by no means new to the Legislature.

However, much like a predecessor plan, an amendment to the state’s constitution would be necessary to convert the Legislature to a part-time entity.

Former Rep. Brian Palmer, R-Romeo, introduced a joint resolution to the House in 2007 advocating a part-time legislature, also known as a “citizen legislature.”

Palmer served in the House from 2002 to 2008 until he was term-limited.

His proposal would also have capped the legislative budget and eliminated all legislative reimbursements except for out-of-pocket costs, like gas money for trips between members’ districts and the Capitol.

The failed proposal also would have restricted the days the Legislature met to 60 a year, and lawmakers would have been paid on a per-day basis.

Citizen legislature proposals have not gone without criticism.

Among the concerns are who would be able to afford to serve as a part-time official, the impact of interest groups on the newcomers and their compressed calendar; and whether novice politicians would be able to handle the pressures of keeping the state running efficiently.

According to the National Conference of State Legislatures (NCSL), 17 states have a part-time legislature, 10 have a full-time legislature and the remaining 23 fall in between with a “hybrid” sort of government.

NCSL also noted that part-time legislatures are more prevalent in rural, small-population states. For instance, New Hampshire, Utah, Indiana, Georgia, West Virginia and Vermont are among states with part-time bodies. Conversely, California, Michigan, New York, Pennsylvania, Illinois and Florida are among states with full-time legislatures.

Brenda Erickson, a program principal in the NCSL Legislative Management Program in Dever, said there are three core differences between full-time and part-time legislatures: time on the job, compensation and staff per member. For example, while full-time lawmakers spend about 80 percent of their time on the job, part-timers spend only 54 percent.

Bill Ballenger, editor of Inside Michigan Politics and a former Republican state representative and senator, said that the actual conversion from full to part-time isn’t the reason the issue has lingered in Lansing for a decade or two. Lawmakers won’t, on their own, limit themselves, he said.

“The only way you can force them to meet the way they used to is to somehow pass a constitutional amendment or something that will force them to do what they’re supposed to do,“ Ballenger said. He cited Michigan’s non-full-time Legislature before changes in the state constitution in 1963.

But Ballenger – and other experts – argue that the change would be difficult with a Democratic House and Republican Senate.

To complicate the situation, a constitutional amendment would require not only the agreement of both houses, but perhaps most importantly, the green light from voters – a problem which California is grappling with as it considers switching to a part-time legislature.

Although there are no pending proposals to convert the Legislature, legislation to modify salaries or eliminate health care and retirement benefits have been introduced.

For example, Reps. Dian Slavens, D-Canton, Rick Jones, R-Grand Ledge, and Tom McMillin, R-Rochester proposed changes to retirement and health care benefits, and Rep. Paul Opsommer, R-DeWitt sponsored a resolution to modify salaries.

None have found their way out of the Committee on Government Operations since their introduction.

© 2010, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.

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Drop in solid waste brings mixed blessings

By JOSH GARVEY
Capital News Service

LANSING-Michigan landfills took in less solid waste in 2009 than in 2008.

That sounds like it should be good for the environment but the reality could be just the opposite.

That’s because the Department of Natural Resources and Environment (DNRE) collects a fee on trash to fund its waste disposal program, so less garbage means less money to monitor the landfills.

With 5 million cubic yards less coming in this year, that’s a large reduction in money.

“The funding for our solid waste program comes from a 21cents-per-ton fee that’s placed on every ton of garbage disposed of in Michigan landfills, regardless of where it comes from,” said Robert McCann, the DNRE press secretary.

“The Catch 22 that we’re faced with is that we’re seeing a sharp decrease in the amount of waste disposed of, but the effect is that we have a sharp drop in revenues coming into this department to run this program,” he said.

McCann attributes the reduction in waste to a combination of increased recycling and the recession. but Michigan Environmental Council (MEC) communications director Hugh McDiarmid blames the economy for the change.

“While we’re happy to see reduced waste going to landfills for a variety of reasons, it’s a double-edged sword,” he said. “We don’t like to see it because economic activity is down. We’d rather see it because we’re doing a better job of recycling, and I’m not sure that’s the case.”

The drop in waste has combined with a drop in the value of recycled materials to create a difficult time for the Michigan waste companies, according to Dave Rettell, the president of the Michigan Waste Industry Association.

“Like any Michigan company, we’re coping the best we can, whether by layoffs or hiring freezes or whatever,” said Rettell, of Veolia E.S. Solid Waste in Northville.

The missing money pays for programs that inspect landfills for environmental safety.

The fees are based on weight, but dumping is measured in cubic yards of waste. With the drop from 53 million cubic yards to 47 million cubic yards, the absent trash would fill 125,000 garbage trucks.

Without an additional source of funding within the year, McCann said there won’t be enough money to properly inspect the 81 landfills in Michigan, including 10 in the Detroit area, and one near Three Rivers.

He said the risk is that “we won’t be able to give communities the assurance that landfills are being operated properly, that there are not materials leaking out of the landfill and potentially getting into the groundwater supply and things like that.”

Michigan’s fee per ton is the lowest in the Great Lakes States, with Ohio charging $4.75 per ton and Wisconsin charging $12.98.  That low charge spurred Canada to send 9 million cubic yards over the state line last year, which was still a drop of more than 1 million cubic yards from 2008.

To compensate for that loss, the DNRE wants legislation to increase the per ton rate.

“What we’re proposing is raising it moderately, up to around 35 cents a ton, which is far lower than any other Great Lakes state,” McCann said. “We need to make sure that we have stable funding for our program. Otherwise, we aren’t going to be able to do our work anymore.”

The MWIA  has suggested  funding come from other sources.

“As we reduce what comes into our landfills, whether it’s because of economic reasons or because we’re recycling more, the agency will be consistently unable to meet their funding with the current system,” said Rettell.  “What we’re saying is that, to make it a more stable program, maybe the DNRE, instead of just hitting landfills with a fee, also hit the alternate options, like recycling and alternate use.”

McDiarmid said the MEC suggested an alternate plan, raising the dumping fee to $5.

“The problem from our perspective isn’t that there’s less waste going to the landfill, it’s that Michigan’s tipping fees are extraordinary low, virtually nonexistent,” McDiarmid said. “For a long time we’ve advocated an increase in the tipping fee, not only to fund environmental safeguards that we need, but to establish a real recycling program in Michigan.”

McCann said that although efforts to improve recycling are understandable current budget problems must be addressed first.

“There have been proposals in the past that would seek to raise our tipping fee up to $5, $6 or $7 dollars a ton,” he said. “And the purpose would be to discourage out-of-state waste from coming here. We can certainly understand that push and don’t have an issue with it, but we need to make sure that we have stable funding for our program.”

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Southwest Michigan responds to Haiti disaster

Haiti relief

Dr. David Collins treats a child in Haiti. Photo courtesy of Salvation Army

By BRANDON HOWELL
Capital News Service

LANSING – Southwest Michigan has responded strongly to the disastrous earthquake that has imperiled Haiti, even while some of the means remain unclear.

“The local people have been wonderful,” said Angie Laskarides, executive director of the Berrien County chapter of the American Red Cross.  “They’re very aware of what’s going on and they really want to support this effort.

“It’s similar to the response after Katrina,” Laskarides said.  “We don’t have as many local people who have loved ones in Haiti as we did with Katrina.  But for this one, there’s been an outpouring of money and people saying, ‘How can I help?’”

Laskarides said the Berrien County chapter had raised more than $7,800 in donations as of Jan. 20 by mail and walk-ins since the disaster occurred.  “I’m sure there’s much more being done online,” she added.  “About 60 percent of donations are generally online through national headquarters.”

Laskarides added that the American Red Cross can most benefit Haiti at this point by raising money and awareness.

“We can’t do anything else,” she said.  “It’s not our show, so to speak.  It’s the Haitian government, the United Nations and the International Federation of the Red Cross and Red Crescent Societies response, and we’re just one member of that team as an American Red Cross.”

Lakeland HealthCare, Southwest Michigan’s largest hospital system, is also contributing to the relief effort and has put together a medical team of doctors and other health professionals that is working in Haiti.

Sandi Lemley, practice administrator for Rappha Medical Center in St. Joseph, said the team flew to the capital, Port-au-Prince, and set up a base hospital with help from the Salvation Army and Missionary Flights International.

Led by Dr. Sherry O’Donnell, the Lakeland team includes four from Berrien County, two from the Grand Rapids area, one from Van Buren County and one from the Detroit area.

The team includes: Drs. David Collins of Intercare Community Health in Eau Claire and Michael Mayle of Coloma; Lakeland nurse Nancy Redman from; Vicki Shembarger of the Berrien Regional Educational Service Agency; Cherisse Tornga, a physician’s assistant from the Grand Rapids area; support staffers Kevin Tornga of the Grand Rapids area and Rod Mayo of Hartford; and Dr. Karl Bandlien, a surgeon from Westland.

“The physicians are all very experienced,” Lemley said.  “They work hand in hand with the Salvation Army in disaster relief efforts, especially as it pertains to medical intervention for treatment of injuries people have sustained in the earthquake.”

Lemley said the project came together “just hours” after the earthquake struck.  Several key contributors made the effort possible.

“Lakeland HealthCare gave us boxes of medications, IVs, things that they could take for the Haitian people,” she said.  “The Whirlpool Corp. made a very generous donation for the transportation of the team.

“We maintain a mission warehouse here at Rappha Medical Center, so we were able to pack 1,000 pounds of medical supplies out of our warehouse in a very short period of time,” she said.

While donations of food and clothing might seem like a good idea, Laskarides cited the hectic conditions on the ground in Haiti to explain why no such donations are currently being accepted in Southwest Michigan.

“It’s a logistical nightmare on the ground,” she said, “and agencies are already overwhelmed with coordinating that because of the limitations at the airport and the port itself being closed.”

Laskarides added that many people have informed her that they want to go to Haiti to help, but effective relief work in the country requires technical training and the ability to speak French Creole.

There will continue to be much work ahead, said Laskarides.  “This will be an ongoing relief effort, and after the national media is done covering it the people from the Red Cross societies, the U.N. and the various governments will still be there providing relief.”

“Right now, we’re just doing food, shelter, clothing, medicines and surgery, but things are going to have to be rebuilt.  In order for Haiti to survive, we’re going to have to be in it for the long haul,” she said.

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Restaurant owners fume over smoking ban

By LAURA FOSMIRE
Capital News Service

LANSING — The reactions are pouring in: Some restaurant owners are fuming about Michigan’s new smoke-free law that takes effect May 1.

“The state has stepped in and said, ‘We know more about the hospitality business than you do.’ Many of them are very upset,” said Andy Deloney, the Michigan Restaurant Association public affairs director.

Gov. Jennifer Granholm signed the bill in December that prohibits smoking in public places such as bars, restaurants, hotels and other businesses. The only establishments exempted are the gaming floors in Detroit casinos.

Tribal casinos aren’t covered since state laws don’t apply to Native American land.

Ron Dufina, owner of the Village Inn on Mackinac Island and in St. Ignace, said that his businesses will suffer greatly because of the law.

“I think it’s horrible,” he said. “You already can’t smoke in the dining room or on the patio. The only place you can smoke is in the bar, and I’ve spent a lot of money making it that way. Now customers can’t even do that.”

But the Michigan State Medical Society (MSMS) is welcoming the change. Gregory Forzley, who chairs the MSMS board, said that physicians have been advocating a smoking ban for five years.

“The Legislature has finally chosen to act on it,” said Forzley, a Grand Rapids family practitioner. “That’s tremendous. It’s an important public health issue as well as a personal health issue.”

Dufina said that he’ll “end up closing” the Village Inn in St. Ignace because of the law. He predicts he’ll lose most of his customers to the nearby tribal casino, where they can still smoke.

“The whole Upper Peninsula is going to be hurt,” he said. “I can tell you I won’t gain customers through this law.”
Deloney said two major factors contribute to the anger and unrest among many restaurant owners.

One is the power of choice and control that the new law takes away from them. By forcing all restaurants to provide a smoke-free environment, Deloney said, the state indicates that it knows how to run their businesses better than they do.
“Eleven years ago, there were 2,200 smoke-free restaurants in the state,” Deloney said. “Now there are more than 6,000. That’s a 174 percent increase.

“They know exactly what their customers want,” he said. “It’s not rocket science. To believe that because there is no state law there are no choices for smoke-free dining is ignorant.”

Dufina said he is extremely upset with the Legislature and will take action.

“I’m a member of the Michigan Restaurant Association, and we have worked tirelessly for 15 years to make sure this didn’t happen,” he said. “I’m going to make sure our representatives don’t get voted back into office.”

According to Deloney, uncertainty is the other factor because the exact regulations and how the new law will be enforced have yet to be determined.

“There’s a lot of confusion,” Deloney said. “We have 45 local health departments. There are some places with overzealous enforcement, others with virtually no enforcement. They’re already understaffed and underfunded.”

James McCurtis, a communications officer for the Department of Community Health, said the state is trying to figure out the answers to those questions.

“We’re right now working out plans on how the enforcement procedure is going to take place,” McCurtis said. “We’re working with the Legislature and local health departments in terms of how we’re going to enforce it, and whether it will be local health departments going in there and doing inspections when there is a complaint or if it will be police officers.”
Michael Rogers, the vice president of communications at the Small Business Association of Michigan, agreed that restaurant and bar owners will have the greatest hurdle to jump when it comes to complying.

“The biggest challenges are going to be for restaurants,” Rogers said. “A large number of their clientèle are smokers. They have to look at their business model and, first of all, communicate to the customers what the law is and that they’re required to comply.”

Rogers said that the best way for restaurants to adjust is with extra effort in public relations and communication.
“Small businesses, by and large, do a pretty good job on customer service,” he said. “They’ll have to work extra-hard in talking to customers, making sure they understand when the change arrives and when the deadline is for becoming completely smoke-free.”

Rogers said that owners could find alternatives to lure customers, such as specials for happy hour, and that it will be important to give customers other reasons to come besides smoking.

Deloney said that the ramifications of the new law will even affect owners who already run smoke-free establishments.
“Say I’m a restaurant that already prohibits smoking,” he said. “I have a way of dealing with it, I have my own policy. Now if someone comes in and smokes, my own policy doesn’t count anymore. I’m now subject to state sanction.”
Restaurants that voluntarily have been smoke-free will lose that marketing advantage, Deloney said.

McCurtis said that the roughly five months the department has to sort out the details is plenty of time and he isn’t concerned.

“It’s plenty of time to prepare for it,” he said. “It’s a state law now, so it’s something that we’re going to have to impose and implement.”

In the meantime, it’s a waiting game for Michigan business owners.

“We are going to continue to provide answers,” Deloney said. “We’re talking with the Department of Agriculture, the Department of Community Health and local health departments. We’re having conversations and answering and asking questions. Some of it is going to take time.”

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Race to the Top benefits, flaws debated

By CHRISTINE HOMAN
Capital News Service

LANSING–Schools have submitted their application for federal aid, and the race to the bank has officially begun.
In Michigan, 756 districts hope to receive part of the $526 million the state want from the federal Race to the Top proposal.

According to Louise Somalski, a lobbyist for the Michigan branch of the American Federation of Teachers, Michigan probably won’t know if it will receive the money until April.  She said that the state would like to begin implementing the new initiatives in the 2010-2011 school year.

Sen. Wayne Kuipers, chair of the Senate Education Committee said  “I’m not sure that we can quantify the impact this is going to have on the state of education in the future, but I think it’s going to be very positive.”

“I think it’s going to move education in a direction very different from the direction it’s headed in today,” he said.
Kuipers said the program is one of the most significant changes that the state has seen in education in a long time.

With Race to the Top funds, Michigan plans to focus on turning around the lowest-achieving schools, closing the performance gap between minorities and whites and using standardized tests and evaluations to assess student and teacher performance.

Somalski said it’s hard to tell what the long term impact of the plan would be, but that some benefits would come from legislation in place since last fall.

The legislation is intended to make Michigan more competitive for the federal money.  It includes a requirement that students stay in school until they are 18, plans to turn around the lowest-performing schools and enhancement of cyber schools for high school drop outs.

Although Race to the Top emphasizes schools with low achievement levels, many districts want the money for other purposes.

For example, Blissfield Community Schools applied for grant money to help its schools stay competitive Superintendent Scott Moellenberndt said.

“Obviously we’re trying to stay abreast of these changes as they occur, and trying to, based on the information we have, make the most informed and accurate decisions for the long term well- being of the students in our community,” Moellenberndt said.
The superintendant said that although district officials felt there were some details missing from the states Race to the Top plan, the plan contained enough flexibility to deal with any problems that might arise.

“In theory, we support the concepts.  When actually we begin the implementation, many of those things will have to be negotiated,” Moellenberndt said.

Moellenberndt said that of the  756 schools that applied for grant money, only 42 districts that applied made that decision with support from their local unions.

The Michigan Education Association (MEA) advised schools against applying for the money.

Doug Pratt, director of communications for the MEA, said important details were missing and that benefits to students are unclear.

“It’s way too early to figure out how this is going to play out in the long run, but the research points us to say there’s really not a whole lot there that’s really going to help student achievement,” Pratt said

Pratt also questioned the benefits of the alternative teacher certification allowed by the legislation, saying that Michigan already has a surplus of qualified teachers, who are either unemployed or graduating from college.

The MEA also had concerns over the emphasis Race to the Top competition puts on standardized testing, according to Pratt.  He said there are unintended consequences from reliance on standardized tests, such as “teaching to the test”.  He also said there is little evidence they actually improved student performance.

The state Department of Education says the Race to the Top plan is essential to reforming education in Michigan, according to Jan Ellis, of the department’s communications office.

“Students learn in a variety of different ways,” Ellis said.  “Teachers are finding it more and more important to be able to change the way they’re instructing to meet the needs of their students.”

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