In 2000, Netflix CEO Reed Hastings presented the CEO of Blockbuster Video John Antioco with a proposal to sell Netflix to him for $50 million. Antioco passed on the offer, citing Netflix as a niche DVD-by-mail business that did not have much potential to grow. Netflix as of 2015 had a market valuation of $32.9 billion. This example of a missed opportunity is just one of many in the modern tech world.

Leadership and vision are 2 completely different things. Effective leadership requires decisive and ardent decision making in the face of uncertainty, a culture of collaboration, and a willingness to make bold and courageous moves. Effective vision determines your reason for existence or purpose, your core values, your value proposition, or in other words what makes you unique and good at what you do and defines your strategic intent. If your vision is not in sync with the demands of the future, no matter how dynamic your leadership might be, you are open to large blind spots and will certainly miss strategic opportunities. The same thing happens when great vision is matched with poor leadership.

What happens when you’re mired in the tyranny of a glorified past and obsessed with the extension of the present? A vision is thus created that focuses more on maintaining the “successes” of the present and tries to make a future that is built on the social and economic parameters that governed the past. In simple terms, looking too much at the way it was and the way it ought to be can stop an industry in its tracks and have dire consequences for its professionals.

A good example of this is the airline industry. Air travel used to be a product and a service. It was highly regulated, required an intermediary to purchase a ticket (travel agent), had well-demarcated differences in class seating and amenities that were identical across all competitors, and was an “experience.” Consumers were expected to act in a certain way even though they were the customers (remember dressing for travel?). Then came deregulation of fares and rate transparency combined with instant communication via the Internet. It took a while, but travel agents became irrelevant even though they railed against the dangers of “do it yourself travel.” The claims the American Society of Travel Agents made about the risks of not using a travel professional were not enough to overcome a shift in consumer preferences, direct access to purchase, and low fares.

Consumers can now search many Web sites that show them the best possible fares, schedules, amenities (or not), and service levels in real time. Consumers are the decision makers when it comes to what they want and what they believe is best for them, even though they may have been advised by others to elect a different course of action. Airlines understand this. In health care, we should understand this too because it is similar to the principle of respect for patient autonomy. Air travel for the majority of consumers today is just a service that will take them from point A to point B and is not the inaccessible luxury that it once was. Consumers want low-cost, on-time, direct flights. That’s it. They’re not looking for meals, snacks, beverages, and thick blankets. They don’t mind pay-to-play for anything other than a seat on the plane. Here’s the interesting part though. When consumers are forced to choose among direct flights, on-time flights, amenities, or low cost, which factor do you think influences their decision most? The International Air Transport Association studied this in 2015 and released a global survey that indicated 43% of all travelers based their purchase on price followed by 21% on convenience of flight times: https://www.iata.org/publications/Documents/Highlights%202015-Global-Passenger-Survey-Final.pdf . The survey concluded that the passenger of today and tomorrow is independent, has a self-service attitude, likes continuous movement without delay, wants 24/7 connectivity, and has higher expectations of products and services.

The current attitude and operational model in orthodontics does not mesh with the way it is and the way it will be with regard to the market for our services. It is mission critical that we create a sustainable market position for the 10,000-odd orthodontists in the United States and the hundreds of residents who graduate annually. We can’t be successful in achieving this by colluding with regulatory bodies against purveyors of doctor-directed at-home aligner treatment or by trying to convince the consumer of the perils of do-it-yourself orthodontics or by broadcasting the message that only orthodontists can provide “good” orthodontics to the public. The days of policing all things orthodontic in the free market are over. We need to create a vision that honestly portrays orthodontics for what it is and what we have to offer vs what we think it ought to be. This is the crux of the problem. Do we carry on believing that malocclusion is a disease process and continue trying to convince insurers that it is medically necessary? Or do we finally cast aside the dogma, admit that 100 years of research “evidence” does not support many of our warmly held beliefs, and create a vision that moves beyond the present and looks to the future?

Vision and leadership both require 1 important element: courage. Courage to ask the hard questions. Courage to consider that our current belief system may be inaccurate. Courage to directly relate our results with our actions. Courage to know that we individually and collectively, are responsible for where we are today. Courage to admit that no outside factor controls what happens in our practices. Courage to change and improve in spite of our fears, traditions, and tendencies.

If we are truly interested in creating a new vision for orthodontics, we need to appreciate and to a large degree accept what the American consumer wants and expects from us. The sky’s the limit!