I’ve taken a little writing break as I turned off news to preserve my mental health after the election. As 2024 limps to a close, I look forward to a fresh start in 2025 with a few of my own crystal ball predictions of what’s to come in American health care.

Accessing primary care will continue to be a challenge, not just in rural communities but in big cities too. Telehealth and nurse practitioners will take up some of the slack, and urgent care and emergency departments will be packed with patients that shouldn’t be there. More doctors will opt for concierge (prepaid) models, creating further access problems for patients who can’t afford more expensive care.

There will be more bifurcation of care with for-profit clinics springing up to treat specific conditions (menopause, men’s health, weight loss, frail seniors, cosmetic dermatology, hyperactive disorders, psychedelic treatment, millennial anxiety). These will be 100 percent virtual and without clinic walls. Qualifications of the providers will be unknown.

Telemedicine companies that are not integrated with overall health will become the norm as computer-savvy Gen X and Millennials need more health services. Patients prefer a physician who has in-person and tele-visits, but if they aren’t able to find a primary care doctor, they will be happy with episodic contact and getting quick prescriptions.

The FDA (under Robert Kennedy Jr.) will be split into Food and Drug. Regulations will be diminished for medical devices and tests, speeding up the entry for new companies with unproven devices, tests, and treatments. Internet advertising and influencer hype will make patients think they must have the newest innovation (even if it does not add value), driving up cost.

At-home testing (point of care) will come into the marketplace with home tests for pap smears, HIV and STIs, urinary tract infections, influenza, RSV, COVID, colon cancer, continuous glucose monitors, blood tests, Lyme disease, infertility, allergies, and DNA cancer screening, to name a few. Customized test kits will come on the market, and patient adoption will increase as payment mechanisms are worked out.

At-home health testing kits will gather various biomarkers for personalized nutrition plans. Despite this focus, nothing will change with our industrial food chain and the corn and sugar subsidies that poison our health and our environment. Make America Healthy Again will fail to counteract the subsidies and industrialized production of both crops and animals. (But it will get a lot of air time and attention.)

The prior consumer protections under the FDA, CMS, and the Department of Commerce (Kennedy, Oz, and Lutnick) will relax restrictions and science testing even more for unproven treatments and supplements. Snake oil salesmen will be the norm and get huge VC funding to peddle quack treatments that have no science or rigor. The internet will be filled with influencers hawking these treatments. There will be few protections, and it will be every person for themselves.

AI will enhance personalized medicine by its ability to process and interpret complex datasets that inform personalized treatment strategies. A genetic profile can inform cancer treatment and other medication responses. As AI is incorporated into radiology platforms, there will be fewer errors and quicker turnaround times. Similarly for pathology readings. This may not fully occur in 2025, but it will begin at the enterprise level for health systems that can afford it.

Medical offices will adopt AI chatbots that are empathetic and provide instant answers to medical questions. This will be terribly frustrating if there is not a human to intervene at some point. Doctors will have a low tolerance for AI platforms that increase their workload or don’t work to enhance patient care and diminish their time spent doing mundane tasks. AI scribes and assistants are on the horizon for 2025, but there will be a lot of trial and error that will frustrate physicians. Physicians will push for augmented intelligence to protect their patients.

GLP-1 drugs will continue to revolutionize medical conditions that are associated with weight and addiction.

Home health care will explode and become more necessary as more and more patients are discharged and cared for in their own homes. Two-thirds of baby boomers have now reached Medicare age. Robotics will ultimately help with this problem, but it won’t be here for 2025, so it will still be left to home health aides (underpaid, overworked) and family members (not paid at all and overworked) to care for the elderly and infirm.

Frankly, I could go on and on, but that’s enough. Please comment and let me know what you think or add to this list.

Toni Brayer is an internal medicine physician.