The future of medicine

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What will the world of medicine look like in 2123?

Although we can’t know for sure, it’s obvious that the pace of change — mainly driven by technological advances — is accelerating and patients have increasingly high expectations for health care, especially when it comes to convenience.

An iPrescribe survey asked more than 1,000 individuals what health care might look like in 2053, and many of their answers focused on remote care. A majority (64%) predicted that routine care will be provided by remote and mobile technology, and 41% thought surgery would be able to be performed remotely anywhere in the world via robotics. Sensors implanted in the body that send real-time data to doctors (37%) and 24-hour turnaround of test results (53%) were other popular predictions, along with at-home physician visits (47%).

Technology is reshaping patients’ experiences today as well as their expectations for tomorrow. How will these technologies advance? What will being a doctor look like in the future? How will health care evolve?

Medical Economics spoke with experts who study trends in health care to predict what the coming decades might look like. Join us on this journey into the future, where technology and how we think about health and health care will pave the way for massive industry changes.

Shifting from reactive to proactive medicine

Experts predict a fundamental shift in medicine, with the industry moving from a reactionary system to one where technology helps flag problems before they become major issues, allowing physicians to be more proactive.

In fact, Deloitte US predicts that by 2040 health care as we know it will no longer exist and the focus will be on “health,” not “health care.”

“It’s a recognition that the end state here is not medicine, where I’m unwell; the end state is to never get unwell to begin with,” says Neal Batra, MBA, a principal in Deloitte’s life science and health care practice. “Health care is about recovery from when something has gone wrong; it’s a break-fix orientation. Our perspective is that there is a handful of mechanisms that are available in the market that allow us to now move from a reactive sick-care model to one that can be much more proactive with faster reaction, that will let us either anticipate illness or address it much earlier and allow us to get back to health faster.”

This future will be powered by sensors monitored by artificial intelligence (AI)-enhanced machines that will change how diseases are managed, says Jagmeet P. Singh, M.D., Ph.D., a professor of medicine at Harvard Medical School and author of “Future Care: Sensors, Artificial Intelligence, and the Reinvention
of Medicine.”

Today, patients can have sensors implanted that measure the pressure in the heart, with the information wirelessly transmitted to the physician’s office through a bedside device or smart phone. This type of data monitoring will only become more prevalent in the future.

“I think that there will be an evolution of disease management models,” Singh says.

For example, patients with heart failure can require extensive care and extended hospital stays. Remote monitoring can provide data to help identify which patients require attention, but a cardiologist might have hundreds of patients to keep track of.

“Do these heart-failure physicians have the bandwidth, the time, and the job description to manage all the data?” Singh asks. “This is where I think there will be disease management models where you’ll have third-party vendors who will look at a patient with heart failure and have the entire infrastructure to look after the patient and (treat) them and be plugged into academic medical centers. When a patient triggers a certain threshold, they get ushered into a subspecialty center for monitoring or admission. I think there is going to be some change in the way complex patients are managed in the future.”

David W. Bates, M.D., MS, chief of the division of general internal medicine and primary care at Brigham & Women’s Hospital and a health informatics expert, says he expects social media to be more helpful to patients, connecting them with patients with similar conditions and finding the right support. He also predicts technology will be better integrated, allowing patients to take more control of their care. “Many of the medical tools today on mobile devices are standalone, but it’ll be possible going forward to get into your electronic health record and do many of the things you need to do from your device,” Bates says. “Big data will be used to help AI make suggestions to us about tailoring things for individual patients, and most health data in the future are going to be stored in the cloud, which will make (the data) accessible from any location.”

The explosion of data is what Batra says will be one of the biggest drivers of change in health care. “It’s not just simply more data, but it’s the nature of it; it’s much more granular, it’s much more real time, and much of it is novel,” he says. “When you connect it to other data sources, that connection of novel, real-time data gives me even deeper insights in terms of what’s going on.”

Data generated from patients combined with AI to help manage it can provide the raw materials to fundamentally change health care, but in an industry notoriously slow to change, Batra says it will take someone from the outside to move things forward.

“Industries change only from outside pressure,” Batra says. “You never have a set of incumbents, who are entrenched, all of a sudden say, ‘Hey, we’re making a lot of money, let’s blow this thing up and make it better.’ It doesn’t happen. Physicians are not the ones who will drive it, hospitals will not be the ones that drive it, health plans will not be the ones that drive it — it’s going to be the disruptive entrants coming in from the outside, looking to go after this problem in novel ways that are actually disruptive to the incumbents.”

And if those new disruptive entrants add value for the patient, the incumbents have to respond or they will lose their patients, who are the real engine of change in health care. “You still don’t get the transformation we’re suggesting without the other side of the coin, and from my perspective, that’s around consumers and
consumerism,” Batra says.

In the future, the patient is in charge

Experts agree that patients will continue to be a driving force in health care in the future. Patients will move from having some printouts from search-
engine driven research to having real-time data, having professional-level resources, and taking the lead in their care.

“You will finally have consumers at a level where they’re competent enough to actually exert an opinion in the conversation,” Batra says. “Consumers have activated from their respective seats in much the same way that consumers are activated in other industries.”

When individuals buy a house, they are fully engaged, doing research, choosing locations, deciding what they want and don’t want in a home, and choosing which professionals they want to work with. “I think that level of activation has now shown up in health, and I don’t think it’s going away,” Batra says. “I don’t think it’s just technology that’s driving the change, I think it’s the attitudes around consumerism, and the fact that I now know enough to manage this problem for myself, as opposed to deferring to a physician or clinician to hold my hand and guide me.”

Patients younger than 30 years have had cell phones to help them for most of their lives, and they will continue to turn to those devices for help. “All of us are kind of dependent on these platforms as a mechanism for interacting with the universe, and we expect the same thing for health care,” says Ian Morrison, a health care futurist and consultant. “There’s that side of consumerism that I think it’s very important that the industry has now finally got its head around and they’ve got to be mindful of that.”

Putting all this health data in patient-friendly formats that are easy to access will help boost patient engagement in the future, at least for some.

“There is a cadre of patients who are very engaged and want to be in control and often feel that their clinicians are not responsive enough,” Singh says. “They want some sort of interaction and are really obsessive about their help. For them, I can see self-management strategies just becoming very easy. I think there will be a cultural change, in which patients will drive the change themselves, as they get more empowered by understanding their disease state and want care at their behest, when they want it, where they want it.”

But there are also potential problems with these advancements. Just like with technology and educational advancements, some people are likely to be left behind.

“The dark side of this is the medical literacy and health literacy problem, where you’ve got probably a majority of Americans who cannot process the information that they’re being fed,” Morrison says. “Health care is, as we were all taught in graduate school, a unique industry where you have asymmetry of information between physicians having control over that in terms of what they know and what we don’t, and that asymmetry is pretty profound. And even with AI and all the other tools, it’s tough to overcome it completely.”

Batra says the assumption that health care is so complicated that the average person cannot navigate it on their own is slowing innovation in health care, but that technology will make it more manageable for the
average person.

“You don’t have to be a mechanic to buy a car, and I don’t think you have to be a physician to make decisions about your own health,” Batra says. “As the digital tools get better, you should be able to get enough guidance and translation of information to make you a very thoughtful and very responsible consumer and let you navigate your
own decisions.”

Regardless of the obstacles, experts say there is likely no stopping this future of more patient-driven care.

“Continuous-care strategies are eventually going to be the only way that we can provide care and make it sustainable,” Singh says. “Part of this shift will occur because it’ll be patient motivated, and part of it is going to occur clearly because the health care system otherwise is nonsustainable in its current form without shifting costs or shifting the onus for care to the patients themselves and engaging them.”

How will doctors be paid?

In a future where the patient is in charge and managing more of their own care, how will doctors get paid? Experts have slightly different opinions on how it will shake out, but one thing is for certain: Fee-for-service will disappear, and so will the independent physician.

“I think we’re likely to move to value-based care in which providers will be paid a set amount (to care) for an individual over a period of time or for a population of patients over a period of time,” Bates says. “That will take payers out of the micromanagement role, and providers will have more latitude in terms of deciding what to do. But they’ll have to make their decisions wisely, because it’s easy to just to spend more, and if you run up too big a bill then the physician will be liable for that.”

Singh also sees the demise of fee-for-service because it doesn’t fit with population-based strategies required to improve outcomes. “The only way for that to happen is having a shared savings approach or a capitated approach, which is value based, that will allow for these changes,” Singh says, pointing out that hospitals and health plans are already moving in that direction.

Batra sees a slightly different future shaped by the advancements in technology and the information sensors can provide for early detection. That technology will be inexpensive enough that the patient can pay for it out of pocket, allowing most people to help monitor their health for signs of trouble.

“Our perspective is that there will be plenty of money to go around on complex cases because a lot of the money around sick care will come out of the system, in part because they’ll be intervening sooner and maybe even delaying the onset of disease or avoiding it altogether,” Batra says.

Results of a Deloitte study predict that if this happens, it could save the health system $4 trillion annually. “But it does require a system that has really been entrenched on being reactive to (become) one that is much more proactive and engaged earlier, and that takes time to change that culture and that structure,” Batra adds.

This structural and cultural shift will likely mean the demise of the independent physician. The number of employed doctors continues to grow, and Morrison says that trend will continue, whether it’s through hospitals, retailers, private equity ventures, or some other major employer.

“Going forward, I do not see independent solo practice making a late-breaking comeback in the fourth quarter,” Morrison says. “It does not strike me as a
plausible scenario.”

The same technology that is enabling patients and helping improve outcomes will overwhelm independent practices, which most likely will not have the resources to process the data or track patients.

“I don’t think a single doctor or a small practice can certainly keep up with all of this,” Singh says. “There’s this overwhelming desire for a system that’s meeting all these connected-care strategies in between different hospitals, that can enhance efficiency and at the same time improve the value of care. And I can only see that smaller practices will probably have to find a way of becoming affiliates or engaging with these system-wide approaches.”

Future doctors will need different training — and attitudes

If health care fundamentally shifts toward the patient and technology drives data to them, translates it and helps them take action on it, what does that mean for doctors? They can’t keep practicing the way they have been for decades, experts say. They’ll need to take on new roles, which will change how they are trained and how they
see themselves.

“For patients who are less complicated, I think we’ll have nurse practitioners and physician assistants being much more involved in care than they are today,” Bates says. “I think we’ll also come up with approaches to having much of the administrative work that is being done by clinicians now done by other people. I think that we’ll also have techniques, for example, to make generating notes much
less onerous.”

Even today, AI is being integrated into electronic health records (EHRs) to do exactly that —transcribe patient encounters in much the way a scribe would and integrate it into the medical record. All the physician has to do is review it for accuracy, and as machine learning continues to improve, this will become less of a burden.

The ease with which medical information is accessed and the rate at which knowledge is being expanded will force doctors into a new way of thinking. “I think the fundamental change will be the switch from an emphasis on knowing everything about a content area, to teaching people about techniques about how to access information when you need it,” Bates says. “The information that you need about specific areas is essentially available now all the time on the web. If you don’t know something, it’s relatively easy to look it up.”

Doctors will need to learn when the right time is to look something up, because it can take time away from the patient and time is already in short supply, Bates says.

“Learning this skill of how to very rapidly access key information will be critical,” he says. “… If you’re thinking about some rare syndrome, you can look it up and see what the findings associated with it are.”

Physicians will need to shift from feeling the need to always have the answer in their heads right when a patient asks to being comfortable looking up the information either with the patient in the room or later.

These more specialized inquiries may become the norm for the primary care physician as they search for answers to uncommon diagnoses. With more midlevel clinicians handling routine care, this means the average patient will probably see their doctor less frequently, and when they do see them, it is more likely to be virtual.

“I think there will be an evolution of the job description of clinicians,” Singh says. “As care becomes more remote — and a lot of care will — it’s going to require the repurposing of a lot of clinicians and redeploying a lot of clinicians.”

Singh sees doctors falling into two categories: On one side will be traditionalists who practice medicine in person, whereas the other side will have “virtualists,” who practice virtual care and follow their patients through remote monitoring platforms and data coming in from sensors.

“I think hospitals will morph to have remote monitoring centers that will be staffed by clinicians, (which is) different from the way we’re currently practicing medicine,” Singh says. “I think large hospitals and academic medical centers will largely become big (intensive care units), where the sickest of patients stay and get cared for. The intermediate-care patients now will either be treated in the outpatient arena or at home, and this would require a change in the skill sets. I’m presuming there’ll be specialists who spend all their time only doing procedures in these large hospitals and looking after really sick patients. Those are the intensivists, but as you move out of that realm, you’ll have specialists. But their training and practice of medicine will be quite different from the way it is today.”

To prepare doctors for this new future, medical schools will have to adapt how they train physicians. Some of the changes will have to focus on the technology aspect, but other changes will have to address how doctors think, and these shifts are already happening to some degree.

“There are already changes within the medical school curriculum to teach medical students about virtual care advocates and how to really do a clinical exam virtually and make it as objective as possible,” Singh says. “I think there are already strategies for educating newer classes and medical students with statistics and informatics and understanding the basic principles of artificial intelligence.”

Why force students to retain every bit of information and be able to recite it when that same information is now available with a few taps on a smart phone?

“It is almost the smartest student is the one who can get the information the fastest, who has the fastest thumb to click away on their iPhone,” Singh says.

Adds Batra, “So many physicians were educated with an assumption that they were the conduit through which all knowledge was delivered, and they also were trained in a world where the structures and systems are oriented around the provider’s convenience. You come to my building on my schedule, you work in my environment, and I will guide you based on my ability to run tests and interpret them, and then you act off of my advice. It’s very much a notion that the physician is in control and is the holder of all information.”

That way of thinking will not work in the future. The patient now has access to the same information and the same data and demands the convenience provided by other patient-friendly industries.

“Going forward, I think being a physician is a very different job,” Batra says. “I think you’re going to have enormous amounts of care being provided in the home and on the go through technology devices that support insight and consumers. Patients are able to act on their own with maybe some mild or light assistance.”

Physicians will have to master many more technology devices and also have a command of data, even from devices they may not have been trained on.

“They’re going to have to be able to absorb and engage with data that they may not have sourced out of their labs or out of their own facilities,” Batra says. “But I think technology can help them do that.”

In the future, the data will be integrated into the EHR, and AI will flag data the physician needs to review. Patients aren’t going to accept a rejection of their data by physicians just because they are not familiar with the device or are unsure of the quality of the data.

“You sort of have the classic physician saying, ‘I’m not going to really gauge and accept those sources because they’ve not been part of the protocols I’ve been trained on,’ ” Batra says. “From the consumer perspective, that’s a terribly bad experience, because you’re like, ‘No, this is real data, the signal is in here and I need your help interpreting it, because I think it might help me intervene on an illness that’s emerging.’ ”

The AI will see you now

AI is projected to be the tool that helps physicians maximize their abilities and serve as a sort of second opinion source. “We’ll be using AI to go through what’s going on with patients and it will make suggestions to us,” Bates says. “Physicians will still be making the choices, but we’ll have a lot more decision support than we do today.” He adds that although AI may not make a diagnosis, it may suggest specific treatments or medications for patients who have not responded to standard options.

Morrison says that AI, despite all the hype, is not a determinant of medicine’s future; it’s just an amplifier of what direction humans choose to go. “AI has big impacts because it amplifies directions that we are currently on or opens up opportunities to go in different directions, but those decisions are made by people and not predetermined by technology,” Morrison says. “I think it will open up new opportunities in productivity improvement, because that really is one of the central challenges for the industry.”

But even with all the promise of AI, Singh warns that there are potential drawbacks. “…AI-based strategies can help you see a patient faster, provide a strategy faster, spend less time with the patient,” Singh says. “You would think that would translate into a reduced administrative burden. I can see that the time you save will be put into seeing more patients, so it may not be a time gain; you are still working hard, but harder in a different way.”

Experts predict the future will bring many changes to the medical profession, and patients and outside influences will force physicians to change how they think, where they practice, and what they learn. But in the end, being a doctor is still projected to be a highly sought-after position.

Morrison says there’s an old saying that it’s better to be a doctor than anyone else, and he believes that saying will continue to be true. “There’s sort of nonsense out there with people saying that we’re never going to get good people into medicine,” Morrison says. “I couldn’t get into the universities that I went to now, and I suspect a lot of current practicing physicians couldn’t get into their medical school programs where they went to school, because they are now so competitive. I don’t think we’re short of smart people.

“It’s going to be just as rewarding in the future if you like to look after patients and help people and get paid a really decent salary,” he adds. “If you can expect to be in the top 1% of income, and you’re doing good work, that’s still a pretty good gig.”