A Day in the Life of a Physician: Part 1

By Robin Dasilva and Therese Fitzgerald

This is the first in a series of four posts about a day in the life of Barry Izenstein, MD, an endocrinologist and internal medicine physician who practices in Springfield and Holyoke, Mass.

A Specialty in Crisis

Early Morning

Barry Izenstein, MD, FACP, begins his busy day at 8:00 a.m. the way he has for the past 20 plus years: caring for veterans at the Soldiers’ Home in Holyoke. After consulting with the nursing staff on duty, he performs rounds greeting and examining his patients. Today he is concerned not only with the well-being of his patients, but also with their future care as the threatened closing of the home and its outpatient clinics weighs heavily on his mind.

“These patients have fought for their country and deserve to have their health needs met, “he said. “I worry that they will have great difficulty finding new primary care physicians and the stress they will experience with the transition to a new health care system.”

Dr. Izenstein does more than advocate and care for patients. He served as Governor of the Massachusetts Chapter of the American College of Physicians. In that role, he encourages internists in Massachusetts to provide input and take action on national and local political issues affecting internal medicine. He also hosts local scientific meetings and continuing medical education events, and encourages medical student members and associates to participate in local and national college activities. In addition, Dr. Izenstein educates and mentors young physicians in his role as assistant clinical professor of medicine at Tufts University School of Medicine.

(Note: Thanks to the efforts of Dr. Izenstein and others like him, funding for veterans’ services was restored and care continue to be provided to the veterans at the Soldiers’ Home.)

As a founding partner of Endocrine Associates of Western Massachusetts in Springfield, Dr. Izenstein reports to his practice at 9:00 a.m. for his first of 24 appointments of the day. His first patient has already had his weight checked by the medical assistant and is now waiting in the examination room.

The patient is happy to see Dr. Izenstein and eager to share photos of his new dog. After a short conversation about dogs, Dr. Izenstein begins the visit by examining the patient’s chart and asking him a number of health-related questions, including any changes to his health, medications he is currently taking, and how he is feeling overall.

The patient examination begins with a check of the patient’s blood pressure and pulse, tasks often performed by a medical assistant, but Dr. Izenstein likes to do it himself. As he continues with the examination, Dr. Izenstein talks to the patient about his overall health and well-being and makes suggestions for preventive measures he believes can lead to further improvement.

At the end of the patient’s visit, it becomes apparent that the primary care shortages documented over the past four years in the MMS Physician Workforce Study are all too real. The patient asks Dr. Izenstein if his niece can make a primary care appointment with Dr. Izenstein, but he says his panel is currently closed to new primary care patients.

Later, Dr. Izenstein explains that his biggest challenge as a physician is primary care.

“Caring for the whole patient and responding to all of their needs is a monumental task,” he said. “Likewise, in today’s environment, with the imbalance in paperwork and compensation for time and work, selling primary care to students is a difficult task. Indeed, perhaps that should be health reform’s number one goal.

“A bigger issue is that primary care is undervalued, underpaid. Studies have shown that a system with primary care as its main driver has better outcomes, better quality, and lower costs. Thus, with primary care soon to be in crisis, shouldn’t primary care be the first and foremost concern for the new health overhaul?  With tens of millions of newly insured citizens and only a handful of new primary care physicians.

In Part 2: The Challenges of Practicing Medicine in Massachusetts