Where Is the Puck Going (Think Four Dimensions)?

Rahul K. Shah, MD, MBA
AAO-HNS/F Executive Vice President and CEOI love hockey. As a child, I vividly recall listening to the Washington Capitals late-evening games on a radio tucked under my covers so I would not get in trouble. In college, you would find me in the front row cheering on Boston University; we even taught ourselves to play ice hockey as true enthusiasts. A highlight was a recreational league game against the Boston City Police. It should surprise no one that they beat the medical student team decisively.

My favorite thing in hockey was always predicting where the puck was going. This is a learned skill that demands alignment among every player on the ice, and that doesn't even account for externalities like opponents or the condition of the surface. Knowing where the puck is going is the difference between winning and losing. 

As a leader, I spend considerable time thinking about where the proverbial puck is going. At our novice recreational level, the puck moved in two dimensions (predictable, flat, manageable). At higher levels of play, the puck catches air, bounces off boards, and suddenly demands three-dimensional thinking. Strategy works the same way. What begins as a seemingly straightforward plan must evolve as the "game" accelerates and externalities multiply.

Looking back at 18 months as your EVP/CEO, I believe our specialty and the Academy have been making exactly that transition. We have been evolving from two-dimensional to three-dimensional thinking. Our Strategic Plan is organized around two pillars: strengthening and unifying our Specialty and modernizing your Academy.

For the Specialty, that means being the authoritative voice for high-quality otolaryngology care, reducing administrative and financial burdens on our practices, and fostering a lifelong learning mindset across our workforce. For the Academy, it means deepening member engagement, increasing unity among our subspecialty societies, and deliberately positioning our organization for the future. You can read more about our Strategic Plan here. These pillars are not parallel tracks running independently, rather they reinforce one another, and together they constitute the flywheel I have expounded upon in prior articles. We continue to skate down the ice and put points on the board. 

Here is where it gets interesting. Just as we are developing the capacity to play a three-dimensional game, the externalities are shifting again. I would posit that we are entering times where we must predict where a four-dimensional puck is going. What is the fourth dimension? I am honestly not sure; but I know it is out there. It may be artificial intelligence, quantum technologies, or the metaverse. I recognize those sound like buzzwords, but they are not; they are technologies actively being deployed in medicine today, being piloted for tomorrow, and will be commonplace in a few years. The practices, organizations, and societies that will thrive are those willing to pause long enough to take my question seriously.

I implore all of us as doctors in our practices, our departments, and our organizations to stop and ask, “Where is the puck going?” Healthcare strategy is no longer two-dimensional. The future will be with those who can start imagining a four-dimensional puck, and who are already skating toward where it will be.