Ill-informed critics judging you. Meddling conspirators thwarting you. Faceless micromanagers and bureaucrats watching you.

Sound like a page out of Orwell?

Perhaps. But it’s also what your doctor wakes up to every morning, if you share the view of Minnesota attorney and health care policy author Kip Sullivan (“Physicians are burning out, and patients must rally around them,” Dec. 30).

Referencing studies suggesting that doctors have high rates of burnout and early retirement, Sullivan blames what he calls the “physician deprofessionalization movement.” Among the causes, he cites mounting paperwork and technology burdens on doctors while laying most of the blame on what he sees as an overall loss of physician autonomy.

And who’s taking autonomy away? Pretty much everyone who isn’t a doctor. Sullivan’s list includes wrongheaded insurers and big employers, number-crunching administrators, and arbitrary measurers of health care quality — all telling doctors what to do. His remedy? The “restoration of physician authority.”

We are doctors. We’ve practiced in Minnesota for decades. And we couldn’t disagree more.

To be sure, doctor burnout is an issue. But the answers to this and other health care challenges won’t be found by concentrating more power with doctors, or with insurers, employers, government, or any single group, for that matter. Answers will be found through new and deeper collaboration among all of these groups. And if there’s any shifted power, it should move squarely to where it belongs: with patients.

So the sooner we drop rhetoric pitting one health care interest against another, the better. The good news is that there’s ample evidence that reasonable, forward-looking collaboration between different parts of the health care system can save lives and money. We all have roles to play — and we all need to be better partners — in bringing more of it about.

Consider what we’ve found with patients with diabetes. Peer-reviewed research shows that, between 2004 and 2012, patients with diabetes cared for by doctors in one health plan showed a 30 percent decline in hospitalization for complications like stroke and heart failure. Death rates dropped about 18 percent. These results followed improvements in how patients controlled their risk factors. And they were possible because doctors partnered with the health plan and relied on its data to make refinements in patient care.

In our own physician group, we work to keep patient costs down because we know that every patient dollar we spend is one he or she could use elsewhere. Some therapies can now cost anywhere from two to six times what an average person makes in a year. When we recommend such a therapy, we’re sometimes asked by an insurer to make sure we’ve made the correct diagnosis or that we’ve considered expense along with effectiveness and the patient’s wishes. To call this “micromanagement” is hyperbole. We see it as smart stewardship of our patients’ resources.

Or, take something simpler. On a recent evening, one of our family members developed an infection that needed fast attention. Instead of going to an emergency room or an urgent-care clinic, she visited the online clinic virtuwell. After a few questions, a nurse diagnosed her and wrote a prescription. She picked up the prescription from a pharmacy down the street and was back to her routine in under an hour. When patients use virtuwell rather than an office-based doctor, the average savings is a little over $100. For families with high-deductible insurance, that’s real money. And it’s another innovation that came about through physician/insurer collaboration.

We believe that we’re better doctors than we were when we started out decades ago. Some of that improvement has come with wisdom gained over a career. But much of it has come from being open to the kinds of partnerships that have given us exactly what Sullivan wants every doctor to have: The knowledge of science, and of our patients’ values, to help us make decisions as a doctor/patient team.

The future of American health care, if it’s healthy, will be about collaboration. If there was ever a golden age of physician autonomy, it’s not one to which we’ll be returning. Nor should we want to, when we can choose instead to build enlightened approaches more befitting of the challenges we face and needs of those we serve.


Thomas Kottke is a cardiologist and Arthur Wineman is a family physician at HealthPartners, where both serve as medical directors.