In fact, a number of applications along these lines are already on the market. As the availability of higher-bandwidth transmission lines escalates over the next three to five years, it is likely these applications will proliferate rapidly.

In addition to thinking more about better methods of diagnosis, physicians also will have to do more to keep themselves on top of the relative pros and cons of treatment trends. For example, Fanale notes that, though pharmaceutical advances bring great promise, those advances often come with a heavy price.

"One of the biggest pressing issues is the cost of pharmaceuticals. It is clear these costs are rising at double-digit percentage rates, and physicians will have to deal with that," he says.

As increasing numbers of patients leave the workforce and find themselves on fixed incomes, doctors will need to become increasingly sensitive to cost concerns.

"We need to be much more aware of the newer drugs on the market and of the older ones that work, and we will need to think about the cost of the selections that we make when we prescribe a particular drug," says Fanale.

While gerontologists have long weighed such considerations, it is likely that all physicians will have to get into the habit in the coming years.

By the same token, all physicians will have to think about the role they will play in helping to support the medical needs of seniors in settings other than the office. Analysts say boomers will stay in their homes for as long as possible, rather than move into nursing homes, and that fact will fuel a demand for doctors who are willing to travel.

Does this suggest a return to the days of physicians making house calls? In fact, that may just be the case.

"There is a lot of care that can be delivered at home," and if Medicare will adequately compensate that care, increasing numbers of physicians may choose to incorporate home care into their practices, says Fanale.

Embrace the change

All this begs the question: What do physicians need to do in order to be ready to embrace the changes that are coming? The experts offer a few practical suggestions.

• Go back to school. Devote some continuing-education time to learning the basics of care for seniors, since they will likely come to represent a larger portion of your practice.
  
  
• Get computer savvy. Keep up with the literature regarding advancements in technology, such as the clinical use of e-mail, and start to think about how electronic information is going to factor into your work. How will you practice in a world where geography matters considerably less than it has in the past?
  
  
• Face the "alternative." Like it or not, physicians in a customer-service-driven healthcare environment are going to have to justify to their patients the rationale for choosing traditional remedies instead of — or at least in addition to — so-called alternative therapies.
  
  
• Take a customer-first attitude. Along those same lines, physicians will somehow have to address the amorphous issue of "customer service." This will reach into every aspect of one's practice: from where the office is located, to what the hours are, to who answers the phone, to how the waiting rooms are set up. No longer a mere appendage to a doctor's practice, the waiting room will become a marketing vehicle. If service is key, that means patients will want comfy chairs, reading material that does not date back to the previous year, perhaps even a hot cup of coffee while they wait.
  
  
• And don't make ,em wait. These choosy consumers will expect to be seen at their appointed time, and they will demand the freedom to make those appointments at their convenience. This may push docs toward evening or weekend hours, or even toward some system of limited open-door time at the beginning or the end of the day, during which patients with immediate needs can simply drop by.

All this speaks to the broader issue of marketing. As Price-WaterhouseCoopers notes, "[i]t used to be that the physician was the brand, and thus the consumer's dependency was to the physician. If a physician moved across town, the patient still went to him or her."