This Could Be 2030

Here’s what’s remarkable: the infrastructure already exists.

Medical diagnostic devices designed for home use are available now. Think of them as medical tricorders — all-in-one tools that measure temperature, heart rate, and oxygen saturation, and perform otoscopic exams. Insurance companies could ship one to every household for less than a few percent of the cost of a single emergency room visit. They’re rugged, foolproof, and designed to be operated by patients, not clinicians.

Mobile phlebotomy services already operate in major cities. A van arrives at your home. You step inside for a blood draw. The samples go to the lab. You never leave your property. The economics work perfectly — especially when you optimize routes such as  Uber or Amazon deliveries. One phlebotomist visiting 15 patients in four hours costs less than maintaining a centralized draw station where 30 patients drive themselves, find parking, and wait in a queue.

Mobile imaging exists too. During COVID, some clinics offered radiological or ultrasound exams in your driveway. A specialized van parks outside. You step in, get scanned, step out. The images upload to the cloud. Your physician reviews them remotely. No hospital visit required. For imaging that requires larger equipment, a mobile van, e.g., for a CT scan, can park in a rural town’s city center a few times a month.

Virtual triage for urgent care and emergency departments is not only possible — it’s overdue. Unless you’ve put a screwdriver through your hand and it’s actively bleeding, your urgent care visit should start at home with a video assessment. A triage nurse determines whether you need in-person care or can be treated remotely. Emergency departments could operate call centers managing video triage across all 50 states. No staffing shortages. No regional bottlenecks. Just immediate access to assessment, 24/7.

Even if you do need in-person care, you might still be seen virtually. Imagine arriving at an ED where a pan-tilt-zoom camera on a robotic arm conducts your initial assessment while a physician examines you from a central monitoring station. During mass casualty events, natural disasters or flu season surges, this isn’t just efficient — it’s essential.

This isn’t healthcare in 2040. This is healthcare we could implement by 2030 if we wanted to.

The Physical Exam Is Theater

Now, I’m not a clinician, but after talking to hundreds of clinicians over the years, everybody more or less agrees that an actual physical exam that requires a touching of the patient is largely a relic of the past and only makes a difference in very few circumstances.

Many physicians have privately acknowledged that the physical exam rarely changes their diagnosis. Rather, the exam is used to confirm what they already know. Plus, they’re waiting for lab results. They’re waiting for imaging. The physical exam is oftentimes performed because it’s expected, because it’s tradition, because it’s what happens in a doctor’s office. It’s the medical equivalent of cutting the ends off the ham.

You know that story, right? A daughter asks her mother why she cuts the ends off the ham before putting it in the oven. The mother says, “I don’t know — my mother always did it that way.” So they call the grandmother, who explains: “We had a tiny oven in our old apartment. The ham never fit, so I had to cut the ends off.”

It is actually amazing what a “virtual physical exam” can do in lieu of touching the patient. With the right mindset, the right prompts, and fairly decent lighting and camera, many aspects can be assessed over video with similar efficacy.

With that, the physical exam is the ham ends of medicine. We do it because we’ve always done it. We pull out the reflex hammer and tap your knee. We listen to your heart and lungs with a stethoscope. We palpate your abdomen. These rituals provide comfort and familiarity, but they rarely provide the information that determines or changes the course of treatment.

What we actually need — the labs, the imaging, the patient history — can be gathered virtually. Range of motion can be assessed over video. “Does it hurt when you press here?” works just as well when the patient presses her own abdomen while you watch. Skin conditions are visible on high-resolution cameras. Gait abnormalities show up clearly on video.

For the few cases where hands-on examination matters, we have options. Local drop-in clinics with exam tools and telepresenters who facilitate the virtual physician’s assessment. Medical assistants who perform the physical components under remote guidance. Or, increasingly, patients who use home diagnostic devices to gather the needed data themselves.

The sacred cow of the physical exam needs to be questioned. Not eliminated — but questioned, put in its rightful place. Which elements actually inform clinical decisions? Which are security blankets we cling to out of habit (and to protect against malpractice claims or Board of Medicine investigations)?

The Paradox of Young Physicians

Here’s something unexpected: younger physicians often struggle more with telehealth than their older colleagues.

You’d think the generation raised on FaceTime and Zoom would excel at virtual care. But the opposite is often true. The reason is simple: they lack the pattern recognition that comes from thousands of in-person encounters. Experienced clinicians have seen so many presentations of strep throat, so many cases of congestive heart failure, that they can often diagnose from across the room. Their mental library of clinical patterns is vast.

Young physicians haven’t built that library yet. They’re still learning to recognize the subtle signs, the small deviations from normal. Taking away the in-person encounter feels like removing a crucial learning tool.

But here’s where AI becomes transformative.

Imagine an AI advisor that listens to every telehealth encounter. It has access to the patient’s complete history. It knows — “remembers” — the father had early-onset heart disease. It notices the patient mentioned fatigue during intake three months ago. While the physician conducts the video visit, the AI suggests: “Have you considered ordering a lipid panel? Family history indicates elevated risk.” Or: “The patient’s current symptoms align with hypothyroidism. Previous TSH was borderline. Recommend retest.”

The AI isn’t replacing clinical judgment — it’s augmenting pattern recognition. It’s giving young physicians access to the kind of deep, contextualized prompting that would normally come from a senior attending standing behind them during rounds.

This solves the training paradox. Young physicians can practice virtually while still developing the diagnostic intuition they need. The AI serves as a preceptor, mentor, and safety net.

What’s Really Blocking Us

Here’s the truth: technology isn’t the barrier. Patient reluctance isn’t the barrier. Clinical efficacy isn’t the barrier.

The barriers are reimbursement, clinician mindset, and leadership apathy.

What if we would consider paying more for a virtual visit because of the lower cost to society (lost work hours) and to the environment (transportation)? What if an admittedly arbitrary expectation is that every primary care clinician is conducting 20% of his visits virtually?

I have a dream that one day we will reach 100% telehealth. I don’t mean that 100% of (outpatient) care is delivered virtually. What I do mean is that if (1) it is clinically appropriate, (2) the patient wants it, and (3) the patient has the technical capabilities, we should be doing telehealth 100% of the time.

But we don’t offer it, because to the clinics and clinicians it makes no difference whether you come in or are virtual. Since they are familiar with in-person, let’s just stick with that.

We don’t offer it, because nobody ever sat down with the clinicians and systematically identified which symptoms or conditions or types of visits are indeed suitable for telehealth.

We don’t offer it, because we think that patients don’t want it (which is mostly more about the physicians’ than the patients’ preference) and we don’t offer them Telehealth TechChecks before the visit, so they are prepared.

Fee-for-service creates unnecessary visits. Consider urinary tract infections. If you have a history of UTIs and you feel one coming on with classic symptoms, why do you need an office visit? In a value-based system, your provider would simply send the prescription. But in fee-for-service, that visit generates revenue. The system is designed to require in-person encounters even when they add no clinical value.

Or consider follow-up visits to discuss lab results. Why am I driving two hours round-trip to have a physician tell me my cholesterol is high and here’s a prescription? That’s a phone call. It’s a secure message. It’s anything but a reason to burn half a day traveling.

Every system is perfectly designed to get the results it gets. Our system produces fragmentation, inefficiency, and unnecessary in-person visits because that’s what it’s designed to produce.

Equity Is Solvable

Before anyone claims virtual care will deepen health disparities, let’s address the obvious solutions.

Broadband access: Between terrestrial infrastructure and satellite coverage (Starlink and competitors), we can achieve 100% broadband availability in the U.S. This is a political choice, not a technical limitation. For those still limited, cellular is a viable option — even if it means handing out 5G Smartphones for $80 each to those who cannot make it to the clinic.

Devices: Insurance companies could provide every patient with a rugged, 10-inch healthcare tablet. These are single-purpose devices — they work for virtual visits and health management only. Production cost is $30-60 at scale. When one breaks, it’s replaced. The cost is trivial compared to the savings from preventing a single ED visit.

Language barriers: Real-time translation is here. You speak Spanish, I respond in German, and we both hear each other in our native languages with natural tone and inflection. Within five years, this won’t even be remarkable — it’ll just be how multilingual communication works.

Digital literacy: The smartphone adoption rate among all demographics — including elderly and low-income populations — proves that when technology solves real problems, people learn to use it. The 75-year-old who “can’t do computers” somehow figured out how to FaceTime with grandchildren during COVID. Technology adoption follows utility.

The equity concerns are real, but they’re not insurmountable. They require intentional design and investment. They don’t require waiting for some future breakthrough.

Healthcare Comes Home

By 2040, here’s what a typical healthcare experience looks like:

You wake up feeling ill. You open the health app on your insurance-provided tablet. The AI triage asks questions, reviews your history, and schedules a video visit within the hour. You connect with a physician who guides you through a self-exam using your home diagnostic device. Based on the findings, she orders labs. Within two hours, a mobile phlebotomist arrives. By that afternoon, results are back. The physician sends a prescription to your local pharmacy — or more likely, a drone delivers it to your doorstep.

You never left home. You never sat in a waiting room. You never exposed yourself to other sick patients or wasted half a day traveling.

For primary care, this is already the norm — somewhere. Annual wellness visits, chronic disease management, medication adjustments, minor acute conditions — all handled virtually. The occasional in-person visit for procedures that genuinely require hands-on care happens at convenient local clinics, not distant medical centers.

Specialty care operates the same way. Your cardiologist reviews your at-home EKG. Your dermatologist examines the rash via high-resolution photos. Your surgeon conducts pre-operative assessments over video and schedules post-operative wound checks at a local clinic with a telepresenter.

Behavioral health led the way here. Teletherapy normalized virtual mental health care years before the rest of medicine caught up. It demonstrated that therapeutic relationships form just as effectively over video as in person — sometimes more effectively, because patients feel safer in their own environments.

The shift from “virtual first” (every episode starts remotely) to “virtual mostly” (most care stays remote) isn’t radical. It’s the natural evolution of bringing healthcare back to where it started: close to the patient, integrated into daily life, accessible without heroic effort.

What Happens Next

The technology exists. The clinical models work. The patient acceptance is there — COVID proved people will embrace virtual care when given the option.

What’s missing is systems change.

Young physicians entering practice today will spend their careers navigating this transition.

They’ll practice in a world where some health systems cling to the old model — waiting rooms, in-person defaults, fee-for-service incentives — while others sprint toward virtual-first care. You’ll need to be fluent in both.

But they also have the power to accelerate the shift. Pushing for reimbursement models that reward outcomes over encounters. Demanding training in virtual care that’s as rigorous as traditional clinical rotations. Questioning every assumption about what “must” happen in person. Building their practices around patient convenience instead of institutional inertia.

The village healer walked to your home because that’s where you were. Dr. Mayo drove his buggy to your kitchen table because that made sense. Then we built hospitals and forgot why we did things that way in the first place.

Now we remember. Healthcare is coming home. Not because it’s nostalgic or romantic, but because it’s better. More efficient. More accessible. More humane.

The waiting room is dying. By 2040, it might finally be dead.

The question isn’t whether virtual care will dominate healthcare delivery. The question is whether you’ll help build that future or spend your career defending a system designed for a world that no longer exists.