<p>Oral and maxillofacial surgery is undergoing changes at the technical, structural, and human levels. Specialist and head physicians bear a particularly large responsibility. This article illuminates how their roles are expanding, which competencies will be important in the future, and the importance for the discipline of networking as well as of attracting young physicians and keeping them. At the same time, the growing demands on leadership, continuing education, and personal resilience are discussed, which arise in the tension existing between clinical routine and system changes. Technological innovations, new care models, and interdisciplinary cooperations open up new possibilities but also present new challenges.</p>