It's become a mantra of reformers that the quality of teachers is the single most important in-school factor in student performance. If so, is the quality of doctors the single most important in-office factor in patient health? This question passed my mind after I read a letter to the editor written by Richard Amerling, M.D., director of the Association of American Physicians and Surgeons, that was published in The Wall Street Journal ("Better Use of Medical Records Is Good as Far as It Goes," Sept. 26).

Although Amerling's remarks were about the practice of medicine in this country, they could just as easily have been about classroom teaching: "Assuming health outcomes can be accurately assessed (and this is a huge assumption), the greatest factor affecting them is the underlying health status of the patient. Outcome reporting, and ultimately 'payment for performance,' will inevitably lead to cherry-picking of healthier patients by doctors, hospitals and all the new Accountable Care Organizations created by the administration."

At last, a magisterial voice outside of teaching unwittingly weighs in on the inherent flaw in the educational accountability movement. To wit: Why is there a double standard in judging doctors and teachers? If even the best doctors are not expected to overcome the "underlying health status" of their patients, then why are teachers expected to overcome the underlying conditions in the lives of their students? To put the matter differently, doctors are not seen as miracle workers, but teachers somehow are. Why is that so?

Amerling also correctly predicts that paying doctors on the basis of the outcomes with their patients will inescapably lead to cherry-picking of healthier patients. If schools are privatized and allowed to compete, as reformers want, why won't they engage in the same selective admission of students? This is particularly likely to happen if teachers are paid on the basis of their performance. The only reason it is not happening now is that public schools by law must admit virtually all students who show up at their doors.

The good doctor urges restoration of the physician-patient relationship, which he rightly recognizes as the "cornerstone of high quality, affordable care." By the same token, I urge reformers to place far greater weight on the teacher-student relationship, which I maintain is the sine qua non of a quality education.