The generation that changed the way Americans think about rock-n-roll, free love, and the Volkswagen Beetle will soon turn its energies in new directions. Just as popular culture received a major overhaul at the hands of the youthful baby boomers, medical care in this country is poised to get a thorough once-over in the coming decade, as members of the post-war generation reach their golden years.

The first boomers will turn 65 in 2010, and experts estimate some 78 million people, born between 1945 and 1960, will reach retirement age in the next 20 years. This means there will be significantly more senior citizens in this country than ever before — and thanks to advances in medical care, those seniors will eventually boost the average age considerably. According to the U.S. Census Bureau, the number of people over age 85 will double, to 7 million, between 1994 and 2020.

Inevitably, this glut of gray-haired individuals will arrive at physicians' offices with the usual varieties of age-related ailments: diabetes, arthritis, hypertension, and chronic heart disease. But they will bring something else, too. Call it consumer savvy. Call it high expectations. Call it "attitude," if you will. With money, smarts, and high-speed Internet connections, a few tens of millions of geriatric baby boomers are about to take the healthcare profession on a wild, magic carpet ride.

But where is it going? And what will it all mean to physicians and the way they practice medicine? Physicians Practice Digest talked to numerous analysts, experts, academicians, and other such soothsayers to put together this speculative view of what healthcare in 2010 may look like.

'Empowered' flower childeren

First and foremost, aging baby boomers by and large will be "empowered consumers," according to a report by the Institute for the Future, a think tank in Menlo Park, Calif. Such consumers "have considerable discretionary income, are well educated, and use technology (including the Internet) to get information about their health. These new consumers increasingly will engage in shared decision making with their physicians," states the institute's "Health and Health Care 2010: The Forecast, The Challenge," which was released in 1997 and describes the critical factors that will influence health and healthcare in the first decade of the 21st century. Among the topics addressed in the report are demographic trends, consumers, health insurance, the healthcare workforce, medical and information technologies, and public health.

Others put it less delicately.

"We have [with the baby boomers] one of the most self-centered, self-important generations in human history, people who expect to live forever and to remain eternally youthful," says Tom Miller, director of health policy studies at the Cato Institute in Washington, D.C.

The implications for medical providers may be staggering. At PriceWaterhouseCoopers in Dallas, Associate Director of Research Sandy Lutz compares the future of healthcare to current financial markets.

"Today we have very empowered investors - who manage their own portfolios online, who pick their own stocks, who trade their own stocks very frequently, who are not loyal to stocks, and who constantly are trying to figure out where the value is," she says. "What we have seen in the financial markets could happen in healthcare."

It is not exactly clear how this kind of enhanced self-determination is going to play out in the medical arena. Although boomers likely will not swap docs as readily as they drop their losing stocks, the analogy does suggest that the coming generation of seniors will put unprecedented new demands on physicians' performance, in terms of both the services they provide and the results they produce.

Moreover, the ready availability of electronic information, as it has done in the financial realm, will feed this newly empowered consumer of medical care. Physicians are beginning to see signs of this trend already, as a growing number of patients are arriving in their offices with reams of downloaded documents in their arms.

Boomers are among those already using this information, but they are interested in it for more than just sparking conversation. These are by and large highly educated individuals, and their easy access to medical information is going to have profound effects on the doctor-patient relationship.

Historically distrustful of authority, successful in their careers (and therefore comfortable with taking charge), boomers will likely have no qualms about self-diagnosing and —perhaps more significantly —second-guessing their physicians. If they've read about a new form of treatment, or have visited online discussion groups where the efficacy of a procedure is called into question, they will likely raise those concerns with their practitioners.

Is technology self-serving?