A Day in the Life of a Physician: Part 4

By Robin Dasilva and Therese Fitzgerald

This is the final 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.

Read Part 1, Part 2 and Part 3.

Devotion to Patients – From Physician and Staff

Mid Afternoon

DSCN0688Dr. Izenstein’s office staff manages the front office as he continues seeing patients. The office staff is very dedicated to the practice. It is readily apparent that they enjoy their jobs and love working with the physicians and patients in the practice. The atmosphere is more like a family than a workplace.

The office transcends its designation as a place for medical care to a place of caring, similar to a home for patients. For example, one of Dr. Izenstein’s patients, who is mentally challenged, came in for a scheduled appointment. The staff was very attentive to her needs and made sure she was comfortable during her stay. They also ensured that she had her medication and a ride home. The staff often arranges rides for her and takes the saying “give you the shirt off your back” to a new level, with one staff member giving the patient her own coat when the woman arrived in inclement weather without one. On her way home that night, the staffer stopped by to retrieve the coat and check on the patient.

The familial feelings of home fall away and we’re brought back to reality when we ask the office staff about their typical day’s activities. We discover that staff spends most of its time dealing with administrative procedures pertaining to insurance companies. Most of the issues involved prior authorizations, lack of reimbursement, and billing issues related to coding.

According to Dr. Izenstein, insurance companies are not adequately covering medications and turning down prior authorizations. Dr. Izenstein was frustrated that as a physician he was spending so much time getting a prior authorization for patient care. He noted that insurance companies continue to add many hours to both the physician and staff’s days due to administrative burdens.

According to the staff, prior authorizations, referrals, and billing issues take up much of their time. Prior authorizations seem to be needed for everything, especially for primary care. Staff spends numerous hours getting prior authorizations. Nine out of ten times they are approved after phone calls to the insurance companies and nearly 100 percent of the time they are approved after peer conferences. When billing, staff estimates receiving only 50 percent of reimbursements. Billing issues mainly are due to coding errors, adding additional time on the phone with insurance companies.

Even when he successfully navigates the system of administrative procedures to provide the prescribed care, Dr. Izenstein faces further barriers of an administrative nature. Specifically, due to the high costs of prescriptions, many of Dr. Izenstein’s patients can’t afford their prescribed medications.

Late Afternoon

As the afternoon wears on, Dr. Izenstein continues to tend to his patients and return phone calls. As he works, we learn from the staff that Dr. Izenstein was greatly influenced by his father, a man who is also seen as an inspiration to many people in Springfield.

The staff was excited to tell us about the upcoming annual grand rounds at the Bay State Medical Center dedicated to the elder Dr. Izenstein’s memory. The Dr. Louis A. Izenstein Visiting Professorship and Lectures in Diabetes, Obesity and Metabolism was started by Dr. Izenstein and his siblings upon the death of their father in 1996. The lectures were developed by the Division of Endocrinology, Diabetes and Metabolism to honor the memory of Dr. Izenstein “who is considered a pioneer and visionary in his native Springfield”.

Dr. Izenstein’s father returned to the Springfield area upon finishing his training to develop an Academic Department of Medicine with a special focus on the development of high-level faculty and to bring the “state of the art” to the management of diabetes. From all accounts, the younger Dr. Izenstein is following in his father’s well-regarded footsteps and is beloved by his patients and staff for his dedication to his patients.


It is 5:00 p.m. and Dr. Izenstein is still working, seeing patients. He’ll be there late into the evening catching up on the paperwork and phone calls that are necessary but time-consuming to his practice.

Anyone spending the day with Dr. Izenstein can see how dedicated he is to taking care of his patients. And although Dr. Izenstein’s practice may not fit all of the criteria for the “medical home” models being piloted across the state and the nation, this physician’s warmth and caring embodies the true spirit of that model by providing a place where patients are welcomed, supported, and cared for in a nurturing environment.

End of series.

  1. Hi I would like to know how to respond to this story. I am a resident physician in a psychiatry program out in LA. UCLA, and wanted to submit something in.

  2. g. corcoran says:

    Would love to see one of these on a family practitioner. You would find that even more time is spent on prior authorizations and paperwork to get diapers and commodes and seat cushions for our patients. The prior authorizations are a disgrace. When US Healthcare found that 97% of their referral authorizations were granted—they stopped doing them. It makes sense unless the PA is a means of making it more trouble for the physician to order exactly the correct medicine for their patient.

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