When you think about the future, you can’t help but think of flying cars and space travel for all. These are concepts that represent an idealized future, a future that should be here. This is much like the future of medicine: one can't help but see an idealistic vision of individualized medicine, the ability to prevent heart disease, and possibly a cure for cancer.
For many of us, part of the appeal of becoming a part of a health care team included helping to drive innovation by improving existing therapeutic options. Our goal is to cure and innovate. Just like the flying car and the self-driving car, innovations in medicine will result in many changes in health care delivery in the U.S. and around the world. Some of the most interesting questions for me are: How will medicine be practiced in the future? Who will provide this care? Who will receive it? I think a lot of our health care will come from technology already part of our daily lives: wearables, health care data analysis, and telemedicine.
While writing this I casually glance at my smartwatch, and I do this without thinking; confirming that I have closed all my rings thus guaranteeing that I have stood for the recommended length of time, exercised for the recommended length of time, and moved for the recommended length of time. I can track personal improvements, monitor mindful moments, and set new goals. The guesswork of calculating calories burned during a workout, measuring my heart rate, and my blood oxygen levels has been lifted and I can concentrate on other things. I, like many people around the world (an estimated 230 million people by 2026), now depend on the wearable as a health monitoring device.
What is interesting about this is I have never taken the time to consider the accuracy of my smart watch, I have never inquired if the recommended health care metrics are appropriate for me as an individual, nor have I questioned if using this device is actually improving my health. On the other side of my watch glass, I try to remember that my data is being collected, correlated, and sold to the highest bidder. This information is being used to create a profit and while I have no question that someone will benefit from this data collection, such as the shareholders of smartwatch companies, I wonder if the growth of technology companies, coupled with the growth of wireless internet connections, will result in more people placing greater faith in wearable devices to monitor their health.
Health Care Data Analysis
Today, out of approximately 7.8 billion people worldwide, approximately 4 billion people have access to internet services. It is estimated that within 30 years, the world population will be almost 10 billion, with almost 100% access to internet.
As almost everything will be connected to the Internet, there is a greater potential for mass data collection. A sizable portion of the data collected will be medical. One would hope that this would result in early detection of disease and integrated communication tools to send urgent or emergent health care data directly to a health care team if necessary. However, as it stands today, there are 10 to 15 million doctors in the world. Currently there is a shortage of 4.3 million physicians, nurses, and APPs.
Interestingly enough, one of the future solutions for the shortage of physicians could include using artificial intelligence. There have been several advances in AI that stand to improve the delivery of medicine and have the potential to be applied in almost every field of medicine. Complex systems are being built for use by health care practitioners and will improve their performance.
The anticipated attrition rates of health care systems are high — 22% of physicians say they will cut back on their hours, and 12% say they will leave medicine in the next few years. While the workforce shrinks, we will likely find that more help will be needed for data analysis, as data collection continues to grow and will require advances in correlation and monitoring. Will a patient need a physician to contact them when they have an abnormal EKG or lab value? We already use AI to analyze patient data. If there are no health care practitioners available, will it become common to receive a diagnosis and treatment plan from your wearable devices?
Before the pandemic resulted in the mass and rapid adoption of telemedicine, the technology was being used to provide care in areas across the U.S. These areas represented a health care desert of sorts, in that they did not have access to a traditional health care team. There were ICUs and clinics being managed remotely by intensivists and subspecialists before COVID-19 because of the scarcity of clinicians.
For the last few years, telemedicine has replaced regular checkups. As patient access to the internet increases, teleconsultations may become the standard of care. While I have no question that a physical exam provides a wealth of information, I wonder — will patients using their household sensors, wearables, and in many cases, implantable devices upload their health care data to a member of a health care team? This could result in a response from an AI device followed with a telehealth visit follow-up. For those patients with significant barriers to health care — such as lack of health insurance, poor access to transportation, and limited resources — this technology could either improve or worsen access. It is clear that lack of health insurance coverage may have a negative effect on health. According to the NIH, uninsured adults are less likely to receive preventative services for chronic conditions such as diabetes, cancer, and cardiovascular disease. People without health insurance coverage are less likely to seek treatment for chronic conditions like diabetes or preventive services, and children are unlikely to receive dental care, immunizations, or well child visits without insurance.
I have no doubt that expanding health care technology can result in improving access to care, whether it’s through a wearable, telemedicine, or AI and health care data analysis. The question for all of us is: Does the future of medicine have equitable care for all?
What do you think the future of health care looks like?
Alexandria Lynch is a general urologist with a focus on robotic surgery practicing in New York. She believes that practicing medicine is a privilege that can build a well-educated, healthier society, and encourage a just culture. As a native New Yorker, she enjoys long walks along the Westside highway admiring the Manhattan waterfront, thin-crust pizza, writing, flying, and endless afternoons at the Strand. Dr. Lynch is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Diana Connolly