A Day in the Life of a Physician: Part 2

By Robin Dasilva and Therese Fitzgerald

This is the second 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 here.

The Challenges of Practicing Medicine in Massachusetts

Mid Morning

DSCN0688Dr. Izenstein’s next patient smiles warmly as he enters the examination room. He asks if Dr. Izenstein enjoyed the coffee he brought back for him from his homeland in Latin America. After asking the patient a number of health-related questions, they discuss the patient’s medications and a recent visit to a specialist. Although the patient has brought his medications with him, Dr. Izenstein does not have any information from the specialist’s office regarding his visit. Without this information, it is difficult for Dr. Izenstein to reconcile the patient’s chart and medications with those of the specialist’s office and has to obtain the necessary information verbally from the patient.

Dr. Izenstein is hoping that these types of issues no longer occur with the implementation of an electronic health record (EHR) system at the office, and his staff is cautiously optimistic about the transition. The staff hopes that the EHR system will make things easier for the practice in the long run. According to the practice manager, an EHR system would help cut out transcription costs to dictate charts. Transcription costs have increased with increased audits by insurance companies. However, the practice does have a system in place for prescribing electronically.

For now, Dr. Izenstein makes do with the information provided by the patient and continues his examination. Dr. Izenstein listens to the patient’s opposition to the surgery Dr. Izenstein has suggested. Together they discuss alternatives to the procedure and agree to continue postponing surgery until further discussion at the patient’s next appointment. The examination continues with Dr. Izenstein checking the diabetic patient’s blood pressure, listening to his heart and lungs, and examining his feet. Dr. Izenstein prescribes new medication for the patient based on their conversation and makes certain he is sending the electronic prescription to the correct pharmacy.

While Dr. Izenstein continues seeing patients, his practice manager discusses her thoughts about maintaining a practice in today’s environment.

“It is more difficult from a cost perspective to maintain a practice today than in past years,” he said. “This year, the practice’s revenue has been impacted largely by increases in premiums for our employees. The premium increases are much higher than in previous years. Also, insurance companies are placing more responsibility on the patient to pay up-front, i.e., increase in co-pays. Many patients cannot afford increased co-pays.

“Therefore, in many cases, the practice waives the co-pays for patients and the practice picks up the cost.  Patients are waiting longer to schedule appointments with physicians due to cost of co-pays.  Physicians have also seen an increase in patient calls. Patients would rather call than come in to see a physician and pay the co-pay.”

In Part 3: Why I Am a Physician

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