Boom Time for Docs

After World War II ended in 1945, the United States experienced a population explosion that rippled through the country for decades and is still being felt today.

That new generation of babies, born between 1945 and 1960 - known collectively as the "baby boomers" - has proved to be a breed of Americans unlike any other in recent memory. Famed for an extroverted style of living, and getting what they want, most boomers today are well educated and financially stable. And, as the largest segment of the country's population, they are rapidly approaching retirement age and Medicare eligibility, begging the question: How will the large influx of senior citizens affect healthcare in America?

John Rother, director of legislation and public policy for the American Association of Retired Persons (AARP) thinks he may have some answers. Rother, who has been monitoring the advance of the baby boom for nearly two decades, has become the AARP's authority on the future healthcare needs of the post-war generation.

Recently he spoke with Physicians Practice Digest about what physicians (and the healthcare industry as a whole) are going to have to do to keep this demanding population of patients happy and healthy.

PPD: In 2010, the first of the baby boomers will begin to reach retirement age; by the end of that decade, the healthcare industry will be facing some 78 million people who will make medical care a priority. How is this new generation of senior citizens going to change the way physicians practice?

ROTHER: I think there are going to be several major changes. First, baby boomers are going to come into a doctor's office with a different attitude towards medical care. They'll want to be better informed and educated about their health. Baby boomers generally have a higher degree of education than previous generations and are going to put more pressure and expectations on doctors. Doctors are going to have to change from their role as experts into becoming partners in healthcare with patients.

Boomers also have shown to be interested in non-traditional, alterative medicine. A lot of patients are going to come in requesting alternative treatments. So, even if doctors don't believe in them, they should at least be educated about these treatments.

Another change for physicians is that they're going to have to move from acute care for older patients to dealing with more chronic diseases.

PPD: How is that going to change the way most physicians run their practices?

ROTHER: Moving from acute care to chronic means that patient care isn't just about the 15-minute exam anymore. Providing healthcare isn't just going to be the job of the individual doctor. Rather, medicine is going to be a team effort. Teams will include nurses, physical therapists, physician extenders, etc., and doctors are going to need to put the teams together and lead them.

PPD: What about the resentment some physicians have for physician extenders? Some doctors feel as though their profession is infringed upon by such people.

ROTHER: I think physicians need to think of their practices as providing a service. Physician extenders support the doctor and help him optimize his time.

PPD: What must physicians do to prepare their practices for the aging of the baby boomers?

ROTHER: Practices are going to have to keep ongoing communication with the patient, outside of the 15-minute, face-to-face encounter. That means that either the doctor or an employee will need to be calling patients the day after an appointment to ask if they're feeling better or if they're taking their medication. Patients are also going to be looking for practices that offer convenience: for instance, ease of getting appointments and short wait times. First of all, if people continue to make strides in the health stratum meaning that more people survive into older ages than ever before - the physician's practice will in effect be concentrating in geriatric medicine. It'll be essential for physicians to take CME courses on geriatric medicine.

Many baby boomers are (and will be in the future) very involved in taking care of elderly parents and usually make the decisions about their parents' healthcare. They are going to want a physician on their team to help them make intelligent decisions not only for themselves, but for their parents as well. It doesn't take long at a dinner party before someone will bring up their parents and the healthcare decisions they have to make and the problems they're having making them. Physicians should let patients know they're available to council them on such issues.

PPD: What specialties in particular are really going to feel the impact of the aging baby boomers?

ROTHER: This is hard to judge because technology plays a major role and can change so quickly. Ten years ago, who would have thought that Lasik eye surgery would have become as popular as it is, but it's very appealing to baby boomers because it enhances their ability to see and their self-esteem. That's why it's attractive to them. Specialties that improve functionality are going to become very much in demand.

I'd say probably there will be a growing need for rehabilitation services, orthopedics, physical therapy, etc. And I hate to say it, because I'm not necessarily in favor of it, but plastic surgery is probably going to be in demand. I think that baby boomers have money [more so than past elderly populations] and it will go towards maintaining function and appearance - it's inevitable.

PPD: Are there any specialties that you think will not fair well as baby boomers age and begin to dominate and influence the healthcare market?

ROTHER: Again, because of technology, this is hard to predict. Generally, I think traditional surgeries will begin to decline because of the increase in minimally invasive procedures. The focus is going to be toward techniques that allow a faster recuperation time.

PPD: How will the boomer generation handle managed care in the future?

ROTHER: It's one of the boomers' major sources of tension right now. They want their physicians' time and attention, but managed-care companies are pushing in the other direction: shorter visits, etc. There will continue to be tension between managed-care providers and baby boomers. Those who can afford it may very well gravitate toward practices that offer more time. This will mean either paying out of pocket or paying higher premiums.

PPD: What portion of the population do you see shelling out more money for better service?

ROTHER: Well, I really think it is going to depend on managed care. If it continues to have a bad public image, then the answer is most people are going to pay more to avoid managed care's hassles. In the current strong economy, the baby boom generation has more money, and healthcare is a high priority for them. They are willing to pay more for what they feel is better care. On the other hand, if managed care can reform itself to be more consumer friendly and offer a more positive environment that allows doctors to feel more comfortable within it, there will be no reason to leave a managed-care plan. It really depends on the way the managed-care industry goes; but right now, it's not doing very well.

PPD: What changes do you see being implemented within the Medicare program as a result of the aging of the baby boomers?

ROTHER: I think that Medicare will continue to have real value and may adopt some of the practices that have worked in the insurance sector. I think Medicare will become a leader in monitoring and improving healthcare quality and be in a great position to measure it by way of case management. I also think Medicare will offer more choices, despite the failure of Medicare+ Choice. I see more options, like a prescription drug plan or the opportunity to enroll in Medicare-associated PPOs. I think Medicare is currently tracking what is working in the private sector and will make positive changes.

PPD: How do you think the issue of Medicare prescription benefits will play out? Ultimately, when do you think a comprehensive plan will be passed?

ROTHER: Our hope is that Congress, under a new administration, will be able to develop a comprehensive pre-scription drug plan for Medicare beneficiaries. There seems to be a consensus among congressional leaders that this is needed, but now they need to figure out how to structure and pay for it. I think we'll be seeing some type of coverage early next year, and I hope we do because this is an urgent situation for many seniors who simply can't afford their prescriptions.

PPD: Is there anything physicians can do to help their Medicare patients who are short on cash?

ROTHER: One way is to help them get enrolled in reduced-cost prescription plans. Almost 20 states now have prescription plans, but many people who are eligible have not enrolled because there are few ways to find out about the plans. Doctors need to tell their patients about the plans and help them get enrolled. That is by far the most important thing that physicians can do: Help them fill out the forms and cut through any red tape.

PPD: How will technological improvements impact healthcare in the near future?

ROTHER: Utilizing the newest and best technology is going to be very expensive, yet Americans are very taken with anything "new." Baby boomers are going to demand the latest and greatest technology available. This is going to put a lot of pressure on the healthcare system and will put doctors in an awkward position between the patient, who wants all of the latest stuff, and the various payers, who are going to be resistant because of cost. We've already seen this play out over issues like Viagra coverage and we're going to see a lot more of it in the future.

PPD: As a result of the changes you mentioned, how will the doctor's role in society be modified in the next decade?

ROTHER: There is going to be a major shift toward preventive medicine, and prevention is going to require a lot more from the physician. It is important that doctors advocate the fact that our country is spending a lot of money to treat conditions that could be more easily (and cheaply) prevented.

I think it's going to be very important for doctors to get involved in social issues: violence, guns, seat belts - things that are sending people to the hospital daily. It doesn't take very long to understand where the real problems are and what to concentrate on.

Americans generally - and baby boomers especially - are increasingly health conscious. In this strong economy, we're going to need to put more money into the areas of healthcare where we're lacking now. I'm optimistic that, in the future, as a society, we will support the healthcare we need.

This artcile originally appeared in the November/December 2000 issue of Physicians Practice.