Just as the aging boomers will demand more from their physicians, they will likely demand more from their elected officials on healthcare issues. If they don't like the healthcare system — a system upon which they will come to rely ever more heavily in their retirement years — it's a safe bet they will lobby hard to change it.

At the Cato Institute, Miller says the demands of aging boomers will almost surely force a change in how the government reimburses physicians for the care they provide to seniors.

"You have more of the population shifting over to the side of the healthcare system that is the least modernized — that is, the traditional Medicare program. So all these folks who in their young age have enjoyed prescription drug coverage and some degree of managed care will find themselves suddenly operating in a very different system," he says. "As the population shifts, we cannot continue to have one set of standards for the working population and then have this very different system for people over 65." Without major changes in Medicare, he adds, "ultimately physicians may say that they cannot survive in a world where there are all these rules and rigidity with relatively limited compensation."

In one model, experts project that Medicare may come to reflect the best practices of commercial managed care — and that could be a plus for physicians.

"If physicians get into a changed environment, one in which they feel that they can serve individual patients more effectively, they will find their approach to medical practice is much more of what they originally envisioned," Miller says.

It is almost inevitable, for example, that some form of prescription drug coverage under Medicare will arise in the coming years, giving doctors greater latitude in their pursuit of treatment options. Also, as the Institute for the Future suggests in its report, tomorrow's senior will likely push for the availability of more diverse insurance products, including POSs and even PPOs. Fanale agrees that pressure from politically confident seniors could force changes that will benefit practitioners.

"I think it takes a lot more time and effort to care for a frail 90-year-old person than it does to take care of a healthy 65-year-old person," and reimbursement levels will need to start recognizing that disparity as a greater percentage of the population reaches advanced age, he says.

The shape they're in

Fanale's analysis raises an interesting question: What will be the actual physical condition of this vast gray generation? What are the medical issues at stake here?

On the plus side, in their early years, the aging boomers may be in fairly good shape. They have largely pared down their smoking. They work out a bit and live within some reasonable level of dietary moderation. This state of affairs, combined with tremendous medical advances, means that they will live longer.

They may in fact live to be very old: The Institute for the Future projects there will already be more than 100,000 people over the age 100 in this country as early as the year 2010. Thus, in the long run, doctors may have more chronic diseases to deal with — including heart disease, emphysema, diabetes, and high blood pressure.

This means that more specialists will need to familiarize themselves with the needs of seniors - and this applies to physicians in a surprisingly diverse range of fields. For example, in addition to orthopedists, who traditionally have treated a big portion of the senior population, professionals in fields such as physical therapy and cosmetic surgery also will increasingly be called upon by this generation that experts say will expect to retain the full mobility and allure of youth, long into its twilight years.

"The geriatricians cannot care for all older people," says Fanale. "They specialize in frail, older people, but the general elder population will need to be cared for by all, so we will need to make sure that specialists everywhere are trained and equipped to care for older people in their own specialties and disciplines."

Those who do care for this aging population also will need to have new weapons in their arsenals.

"We will have to have more tools where people can be monitored electronically - where they send data telephonically or through the Internet to their doctors' offices, and if a red flag goes up, the doctor is alerted," Lutz says. "There are a lot of Internet companies that are developing these models, and that makes sense. Ten years ago we heard a lot about disease management, and now the Internet will really allow that to happen."