I’m doing something a little bit different this week.

Thing is, I’ve never wanted Leading Veterinary Teams to only be me. Since the day I dreamt up this idea, I’ve wanted to be the ‘brains’ behind the vision, but I’ve also always known that true leaders are always learning. And if I’m ever going to claim to be what I say I claim to be, I have to take a step back and showcase other people for the strengths they have. Let’s face it. None of us know everything. None of us have experienced everything. Everyone can learn a little something from someone else.

With that said, I’ve wanted to open this newsletter up to other voices. Not because I’ve run out of things to say (if you know me, even a little bit, you know that will never happen 🫣), but because there are people on the floor right now seeing things I’m not seeing, in hospitals I’m not standing in, and their perspective sharpens the conversation in ways mine alone simply…. can’t.

Shane Gambale is one of those people. He’s a hospital manager. And he recently watched something play out that stayed with him. So much so that he wrote about it and shared it with me. I read it twice, sent it to two people I respect, and then asked if I could share it here.

The piece below is his. So, I’m getting out of the way and giving him his space to share his story.

A note before you start: what he’s describing is happening across our profession right now and if you read this and think “we do this,” you’re not alone. The point isn’t to name and shame. It’s to look honestly at a pattern most of us have either implemented, inherited, or have been on the receiving end of.

Shane Gambale, Hospital Manager

There is a quiet shift happening in veterinary medicine.At first glance, it looks like nothing more than a change in language. Practice Manager becomes Clinical Coordinator. Leadership becomes support. Management becomes assistance.

It sounds harmless. Even collaborative.

It isn’t.

The titles are being softened. The expectations are not. The responsibility is still there. The accountability is still there. The weight of the role has not changed. What has changed is the authority to carry it, and the compensation that acknowledges it.

In general practice, that’s already enough to create strain.

In specialty and emergency medicine, it becomes something else.

It becomes dangerous.

ER and specialty hospitals are not neutral environments. They are not predictable. They are not forgiving. Patients arrive unstable. Decisions are made under pressure. Teams are required to function cohesively under emotional and cognitive strain for hours, sometimes days, at a time.

Every role inside that system matters. Every gap is felt. Every inefficiency compounds.Leadership in that environment is not a luxury. It is a stabilizing force.

A true practice manager in an emergency setting does not simply coordinate. They build and protect the systems that allow medicine to happen safely. They ensure staffing is appropriate, not just on paper, but in real time. They advocate for technicians who are stretched beyond capacity. They identify workflow breakdowns before they become patient safety issues. They hold standards in place when the pace of the environment tempts people to cut corners just to survive the shift.

They are not ornamental. They are operational.

When that role gets diluted, when it gets repackaged into something that sounds smaller, lighter, more supportive, what actually happens is not a reduction in responsibility.

It is a redistribution of pressure.

The hospital still needs leadership. The cases do not become less complex. The caseload does not decrease. The emotional weight does not lift.

So the responsibility doesn’t disappear. It just moves.

It moves onto technicians who are already running at capacity. Onto doctors already carrying immense cognitive load. Onto staff already navigating client emotions, workflow gaps, and operational inconsistencies.

And it lands, heavily, on the person in the in-between role. The one expected to coordinate, stabilize, support, and quietly manage without the title, authority, or compensation to do so effectively.

They are expected to hold the system together. They are not given the tools to repair it.This is where the conversation usually stops. At burnout.

Burnout is real. It is visible. It is measurable. We talk about it often.

But burnout is not the endpoint. It is a symptom. A signal that something upstream is misaligned.

What happens after burnout is where the real cost begins to show.

The system starts to fray. Not all at once. Not catastrophically. In small, cumulative ways.

A technician misses a detail they would have caught six months ago. A doctor hesitates a second longer than they should because they are mentally fatigued. A handoff between team members becomes less precise. A treatment is delayed, not out of negligence, but because there are simply too many competing demands and not enough support to meet them all seamlessly.

No one is careless. No one is incompetent.

They are operating inside a system that is asking more than it is structurally designed to support.

The team feels it.

We do not talk enough about how operational strain impacts medical quality. We talk about medicine as though it exists in isolation, driven purely by knowledge, skill, and intention.

Medicine is delivered through systems. Through workflows, communication, staffing structures, leadership. When those systems are strained, even the most skilled clinicians are forced to practice within those constraints.

The result is not dramatic failure.

It is erosion. Subtle, incremental, and often invisible until it is not.

The patient in front of you does not know your staffing ratio. They do not know your title. They do not know whether the person trying to hold the hospital together has the authority to make the changes that need to be made.

They only experience the outcome.

Repackaging leadership roles is often framed as efficiency. As restructuring. As adaptation.

When it results in management-level responsibility without management-level authority, it is not efficiency. It is misalignment. And misalignment, in a high-acuity medical environment, has consequences. Not just for the people working within it. For the patients who depend on it.

This is not about titles. It is not about ego. It is not about whether someone is called a manager or a coordinator.

It is about whether the structure of the role matches the reality of the work. If a position is responsible for overseeing workflow, supporting and directing staff, maintaining operational consistency, bridging communication across roles, and holding together a high-demand system, it is a leadership role.

It should be treated as one. With authority. With support. With compensation that reflects its impact.

When it isn’t, the burden does not disappear. It shifts. In veterinary medicine, especially in emergency and specialty care, there is a limit to how much shifting a system can absorb before something gives.

The question is not whether someone can step into these repackaged roles and handle it.

Many can. At least for a while.

The question is what it costs them, and what it costs the patients, when they are asked to.

If you have any authority over how roles are defined in your hospital or your portfolio, pull up the job description for every leadership-adjacent role you have.

Roles with the names: Coordinator. Lead. Supervisor….. Anything in that in-between space.Then check three things:

Structural problems are fixable. They just need someone with the authority to fix them to actually do it.

Thanks for being here. Special Thanks to Shane for trusting this space with his first piece of public writing.

If this one resonated, forward it to one leader who needs to read it. That’s how this work travels.

I may have one more QUICK newsletter in me later this week because this week HAPPENS to be a REALLY BIG week for me…..

🎓 ya girl’s getting her MBA diploma 🎉 and I have some thoughts… but I really didn’t want to make this one THAT long (it’s already pretty long)… so.. maybe I’ll see you again before Sunday for a quick Thoughts before I walk the Graduate Graduation Stage share

If you’ve got something you’re seeing on the floor, something you’ve been turning over in your head, something you want to write about, reach out. I want to make space here for more voices like Shane’s. Managers, Lead techs, anyone carrying the weight of this work and thinking hard about it. Hit reply and tell me what’s on your mind.

Suzanne

Suzanne Thomas is the founder of Leading Veterinary Teams, a platform built for veterinary managers and frontline leaders who were promoted without a playbook.