Dr. Josh Rosen (known online as D-O-G-T-O-R Josh) joins host Dr. Andy Roark to debate a provocative question: should veterinary operations leaders who come from outside medicine be required to complete a clinic-based onboarding before leading teams? They explore the tension between “medicine people” focused on individual patients and “operations people” focused on scale, and how lack of day-to-day context can lead to decisions (like shorter appointments, pricing changes, wellness plans, or staffing shifts) that fuel burnout, harm client relationships, and hurt retention. Rosen argues leaders do not need technical skills like drawing blood, but they do need repeated, ongoing clinic exposure (such as weekly doctor shadowing) to understand real workflow and build sustainable, collaborative relationships between medical and operational leadership.

Dr. Josh Rosen is a relief veterinarian and veterinary content creator based in the New York metro area, practicing across NYC, Long Island, and Northern New Jersey. A graduate of the Virginia-Maryland College of Veterinary Medicine, his clinical interests span preventative care, urgent care, soft tissue surgery, dentistry, dermatology, and internal medicine. Working across many practices has given Dr. Rosen a rare, unfiltered view of what's actually happening on the ground in veterinary medicine today, including the growing gap between how organized medicine operates and what the people doing the work know it needs. He channels that perspective into his platform, @dogtorjosh on Instagram, where he covers clinical empathy, effective communication, team culture, and all the relatable laughs we share in this amazing profession. Today, he's advocating for a profession led by those with real, lived veterinary experience, rather than metrics alone.

Mentioned in this episode:

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Office Hours w/ Dr. Andy Roark

Inside the Uncharted Veterinary Community, Dr. Andy Roark hosts Office Hours where veterinary leaders can bring real-world challenges and get practical guidance from someone who understands the realities of practice life. These sessions give veterinarians, practice managers, and team leaders a chance to ask questions, workshop difficult situations, and gain perspective on issues like team dynamics, communication, burnout, and clinic operations. Instead of navigating leadership challenges alone, members get direct access to Andy’s insight along with the support of a community of veterinary professionals working through many of the same challenges.

Register for Office Hours here!

Welcome everybody to the Kun

Shame Veterinary Podcast.

2

I am your host, Dr.

3

Randy Rourke.

4

Hey, should, operations train people

who have not worked in practice

5

before, should they be required

to do like a medical onboarding

6

before they become a regional

director or an operational

7

leader, should that be a thing?

8

What would that even look like?

9

Guys, I have a guest on today, Dr.

10

Josh Rosen, , or dog tour.

11

Josh as he is known online.

12

, but he had some interesting thoughts

on this and I kind of brought him on.

13

Because I thought that's a fun idea

I would like to play with, and he's

14

clearly thought a lot about it.

15

And honestly, I, I really

like this episode a lot.

16

I think that there's, , I think

that there's some real opportunity

17

and potential for people who are

trained in outside of medicine,

18

in operations, and people who are

trained in medicine and outside of

19

operations to spend more time together.

20

And to get to see each other more clearly.

21

And I think that's, I think

that that's really important for

22

the future of our profession.

23

I think it's gonna decide which

practices are great and which

24

pre practices, , really struggle.

25

And so anyway, I just, I really

took a lot away from this talk.

26

It's a really cool idea.

27

Talk.

28

I hope you guys will enjoy it.

29

Let's get into.

30

Kelsey Beth Carpenter: This is your show.

31

We're glad you're here.

32

We want to help you in

your veterinary career.

33

Welcome to the Cone of Shame with Dr.

34

Andy Roark.

35

dr--andy-roark-_1_02-06-2026_132324:

Welcome to the podcast, Dr.

36

Josh Rosen.

37

How are you my friend?

38

squadcaster-319f_1_02-06-2026_132324:

I'm doing great.

39

Doing great.

40

dr--andy-roark-_1_02-06-2026_132324:

Josh, for people who don't know

41

you, you are a vet influencer

of social media, , presence.

42

I really enjoy your stuff.

43

I think you're funny.

44

I think you're very positive, , when

you talk about vet medicine and,

45

, you're a very optimistic person.

46

And so those are the things

that I look for on social media.

47

I just, I really enjoy

the work that you do.

48

you were also.

49

The veterinarian behind Doctor Josh,

D-O-G-T-O-R, doctor Josh, , vet

50

Relief and Consulting Services.

51

, You have an interesting, you've got a

really interesting perspective, which

52

is why I wanted to invite you on here.

53

It's sort of a combination of

who you are, meaning you, you

54

do a lot in the profession.

55

Yeah.

56

I think you have a, sort of a

high level view of the industry.

57

You do relief work, so you

are going into practices.

58

You have.

59

Been a medical director at multiple,

for multiple hospital groups.

60

And so you have been in, in medical

leadership inside of a couple of

61

different types of organizations , and

then you do consulting services as well.

62

And so I think you've got

a really cool perspective.

63

And you had a social media

post I saw on Instagram.

64

It's been a little while now.

65

but, but a while ago you had this

post and I thought it was fun.

66

And you said that you believed that

people who were coming into vet medicine.

67

From outside the industry in like

a leadership or operations role

68

should be required to do, to have

like an externship, , learning,

69

like, like doing the medicine side

before they were allowed to lead

70

other people inside of vet medicine.

71

I thought that was a fun idea

and I want you to, I want you

72

to state your case for me.

73

, squadcaster-319f_1_02-06-2026_132324:

that's definitely, a fun topic to discuss.

74

I really appreciate being here.

75

I'm excited to talk about this.

76

So, when we talk about, , organizational

medicine and we talk about the idea

77

of being able to, , make decisions

and, and make adjustments to the way

78

that we want to be able to help as

many pets as we can and, and be able

79

to make our team as happy as possible.

80

. There's definitely situations

where we aren't always bringing in

81

people at, , say, regional levels

or, , operational leadership levels

82

that have been throughout the process

of, veterinary medicine before.

83

And maybe they're coming from outside of

the industry from, . I typically refer

84

to say like Target or, I've seen seven

11 or, there's different companies out

85

there where there's a different way of

looking at, , the financial perspective

86

and, and being able to be as productive

and, and perform as well as possible.

87

Keep your business as healthy as possible.

88

, I think that it's really important too.

89

Keep those ideas and, and not,

leave those types , of individuals

90

out of the conversation.

91

However, when we know that they are

coming in with the weakness that they

92

have not been in this field before.

93

It is our duty in this field to make

sure that those individuals understand

94

what it is that they're managing at

the level that they're coming into.

95

Because if they are making decisions

that are, say, changing the pricing,

96

model that exists at a clinic, or maybe

they're adding, wellness plan, or maybe

97

they are taking people off the floor

for a certain day of the week, whatever

98

the case is, that they understand what

those impacts actually are, aside from.

99

The financial benefit and the reason

why that's important is because.

100

if we are only looking at the short

term gain of making these decisions

101

and we haven't had the benefit of

being in the clinic and seeing what

102

those impacts are, we, we don't truly

know what we're comparing against,

103

when we do a risk benefit analysis

to say that in the long term, is

104

this going to harm our relationships

with clients in the long term?

105

Is this going to harm our

relationships with our staff?

106

, What is our retention rate currently?

107

And things along those lines that are

really important when we talk about.

108

Financial health, not just the idea of

being able to perform as well as possible.

109

dr--andy-roark-_1_02-06-2026_132324:

I have this idea, I wanna

110

see if you buy into it.

111

So I have this idea that

there's two kinds of people.

112

In the industry, there's medicine

people and there's operations people.

113

And it's not just like

what your job title is.

114

, it's a worldview, I think.

115

I think that medicine, people want

to do medicine and operations.

116

People want to get medicine

done, and those sounds similar,

117

but they're really not.

118

And so my take on this is medicine.

119

People see the world through

the lens of The goal is to do

120

the medicine and the operations.

121

People see the world through a

whole different lens of we want to

122

accomplish this outcome and, and.

123

I, I, I think that it's more

than just like priority.

124

I think it's more than your priorities.

125

I think it's more than idea.

126

I think they're really

different worldviews.

127

But as I'm listening to you talk

about this, you're setting this up.

128

It seems like you might disagree

and sort of say it's really about

129

the experiences But I'm not sure.

130

So, Josh, let me ask you that.

131

Do you buy my idea?

132

That medicine people and operations

people have fundamentally different

133

worldviews in, in a lot of cases?

134

Or do you think that they're more similar

really than I do, and it's really a matter

135

of just, , what experiences have you had?

136

squadcaster-319f_1_02-06-2026_132324:

Are you saying that like those are

137

the individuals that tend to practice

at the clinic level versus those

138

that are, are not practicing at the

clinic level, are more in the mindset

139

of, of getting the medicine done?

140

dr--andy-roark-_1_02-06-2026_132324:

It's not even at the clinic.

141

It's not even at the,

clinic level necessarily.

142

I, I think that, my thought is if you've

been trained in medicine and, , I think

143

if you've been trained in medicine

and you, talk to the pet owners.

144

I think that you look at medicine a

certain way, which is actually the

145

individual patient is the focal point.

146

And what the top priority is.

147

And I think if you're in operations,

by definition, you tend to think

148

less about the individual patient and

more about moving patients at scale.

149

And those two things are just different.

150

You know what I mean?

151

It's hard to explain.

152

How often do you get conflict, because

I'm talking about when you say we need to.

153

We need to shorten appointment links.

154

I am thinking about the specific pet

owner that has lots of questions,

155

you know, and really needs her time

, and what that's gonna do to her.

156

And you are thinking

about the, you know, 125.

157

Clients that we see in a day and how

we move those people through there.

158

And I feel like there's a lot of

inherent tension because those two just

159

worldviews just ways of looking at things.

160

They're, they're just,

they're naturally different.

161

Do you, do you kind of buy into that?

162

squadcaster-319f_1_02-06-2026_132324:

I definitely buy into that I, and

163

I honestly think that it works

in conjunction with what I'm

164

dr--andy-roark-_1_02-06-2026_132324:

I think so, yeah.

165

squadcaster-319f_1_02-06-2026_132324:

If you have individuals that or

166

just have a tendency, this isn't

about this is almost like a, a

167

subconscious bias of some sort, right?

168

This isn't about like right

or wrong or good or bad.

169

This is just plainly about what that

individual is really good at doing, right?

170

And so if you take that idea and you

put them in a situation, whether it

171

be, headquarters, where you have all

of the operational leaders, all of

172

the medical leaders, all the financial

people working in one setting, that.

173

They've never been in the clinic

before to be able to say, no.

174

These are individuals, these

are individual patients.

175

These are individual teammates.

176

These are individual clients.

177

it's not as simple as like reading

it off of study card or a flashcard,

178

dr--andy-roark-_1_02-06-2026_132324: Yeah.

179

squadcaster-319f_1_02-06-2026_132324:

is, this is more of a soft skill and

180

understanding how we communicate and

how we have relationships with each

181

other is that if we aren't understanding

just at a very basic level, that we are

182

individuals, all of us in this process,

even if you're managing hundreds of

183

people at once, that when you lose that

people piece or you never strive to

184

get it in in the first place because

where you were previously working

185

really didn't require it because you

were working in a retail setting where.

186

, You're moving products that are, things

that people are buying on a regular

187

basis that aren't necessarily always

transferable to a medicine setting.

188

, Especially when we talk about

things like, sick cases and,

189

and things along those lines.

190

We still have to collect that data.

191

We still have to make sure that

we're comparing it appropriately

192

and seeing that we're growing

in the scale that we want to.

193

The idea that's the only thing that we're

focusing on and we're not, and we're not

194

keeping the individual in mind is, is the

direction that I don't want to see us go.

195

And, and I do feel that part of the

reason why I feel we're going in that

196

direction is because I have seen a lot

of individuals coming from outside of the

197

industry in those roles that, that just

haven't had the pleasure of being able

198

to see what's done on a day-to-day basis.

199

They're told and they

understand maybe at a, at a.

200

Higher level and they come

and visit here or there.

201

But to understand like what

happens when have a okay, we want

202

to go to 15 minute appointments.

203

. Are we gonna have that conversation and,

and not, and not have , the team support

204

that's needed to accommodate that?

205

Right.

206

Like you're talking about the idea

of, well, what happens when a client

207

comes in that wants to talk to me

for 20, 30 minutes about a really,

208

complicated case and they have the

right to do so because their pet

209

does have a lot of things going on.

210

Do you have a team that's supporting

you that, that allows that 15 minute,

211

booking area , to match what you're

looking for productivity wise?

212

Because if you're not paying attention

to that, you're thinking about , that

213

performance which is important.

214

, But you're not thinking about the

individual which, which takes away

215

from sustainability in the long term,

whether it's because of your team burning

216

out or because your clientele lose

their relationship with your clinic.

217

dr--andy-roark-_1_02-06-2026_132324:

I like this idea the

218

sustainability and the burnout.

219

I think That's really interesting.

220

When I was thinking about having you

on and sort of talking about this,

221

I was really just kind of enjoying

playing with the idea of some

222

sort of an onboarding for people.

223

People who are not from

within vet medicine and kind

224

of what does that look like?

225

, And the question I had that I think

is really important is, what are we

226

actually wanting people to learn?

227

What are we onboarding 'em to?

228

I don't think that it makes any

sense for the regional director

229

to know how to draw blood.

230

You know what I mean?

231

I don't think it makes any sense

for them to know how to clean cages.

232

I don't think it's that, and I don't think

when we talk about those sorts of things

233

that's not what we're talking about.

234

And so I, I think it's becoming, I

think the answer's becoming much more

235

clear here, which I think is good, but.

236

What would be if you were

actually gonna do this?

237

And I said to you, all right, Josh,

we're gonna make this onboarding

238

program for regional directors that

have not, you know, worked in practice

239

before, and they're, coming over , from

Target or Amazon or Google, and I

240

want you to onboard this person.

241

What do you see as the objectives

for the onboarding specifically?

242

Because it can't be just to spend time.

243

And , it can't be just to spend time,

you know, in the clinic, and it can't be.

244

They should learn effective, safe

animal patient restraint like that.

245

I like that.

246

Doesn't make sense.

247

I don't need the guy from Google who's,

you know, who's gonna work at the regional

248

level to be able to restrain pets.

249

But I do, I'm buying a lot of what

you're saying about the benefits

250

of sort of spending that time.

251

And so, yeah.

252

When I put it to you like that, and if I

said to you, what would be the objectives

253

of your training, tell me about, like,

how would you I don't, I don't mean again.

254

I don't know how deep you can go into the

weeds of just talking off the cuff like

255

this, but like what does that look like?

256

How do you put that together?

257

What are the goals?

258

squadcaster-319f_1_02-06-2026_132324: from

a big lens first I will argue that part of

259

this can be them just being in the clinic.

260

And the reason

261

dr--andy-roark-_1_02-06-2026_132324: Okay.

262

squadcaster-319f_1_02-06-2026_132324:

that is because if they, if the work

263

that they're doing require a location.

264

and they're not, say, working from afar.

265

Like if you're a remote

employee and you're

266

dr--andy-roark-_1_02-06-2026_132324:

Mm-hmm.

267

squadcaster-319f_1_02-06-2026_132324:

and miles away , from where the clinic

268

locations are, you know, there's

obviously going to be, situations

269

where that's not going to work.

270

But

271

dr--andy-roark-_1_02-06-2026_132324:

Right.

272

squadcaster-319f_1_02-06-2026_132324:

when it works out.

273

have the opportunity to do the same

things that you would do onboarding

274

in a setting where there's a clinic

and there's an office space where

275

you can spend the time there.

276

So I will just start off by saying

it is a very easy pivot, just from

277

the point of view of, being able to

see what it is that you're managing.

278

And I, and I believe that from a,

a managerial, you know, standpoint

279

is that, if you want to truly lead.

280

can't lead something that

you've never lived, you

281

dr--andy-roark-_1_02-06-2026_132324: Hmm.

282

squadcaster-319f_1_02-06-2026_132324:

I don't mean that you have

283

to know how to pull blood.

284

I don't mean that you have to

learn how to restrain an animal.

285

What I'm talking about is just simply

context, understanding that maybe, you

286

don't need to know how to draw blood,

but you maybe you want to know how long

287

it takes to get through an appointment

that has a full workup when you have

288

one team member with the veterinarian

versus two members versus three members.

289

I personally think that it's really,

really important to, . Have at least

290

like a half hour a week where you're

half hour to an hour a week where they

291

are actually shadowing a doctor, not

so that they understand medicine, not

292

so that they understand why or or what

it is that they're planning on doing,

293

but so that they understand the context

of what it is that they are managing.

294

Just like any other leadership

role, you don't have to know.

295

The skills of what you're managing, but

you absolutely have to know the context.

296

Otherwise you're not going to create

the relationships that allow , for

297

coaching to, to adjust , to a greater

performance and, to create the

298

relationships that, have a, positive

impact on, things like, the employees

299

that, are doing really good work for

you, working for you for a long time.

300

dr--andy-roark-_1_02-06-2026_132324: Yeah.

301

Okay.

302

I think I can get into this bit of

bite-size exposure therapy as well.

303

I think that makes sense to me.

304

I think I was originally imagining

like a mandatory Hallmark movie where

305

they were just put into the, that

clinic and they had to stay there

306

until they had a change of heart.

307

You know what I mean?

308

Until, until they met the.

309

squadcaster-319f_1_02-06-2026_132324:

stethoscope.

310

dr--andy-roark-_1_02-06-2026_132324: Yeah.

311

Yeah.

312

Until they met the pet owner

that changed it all for them.

313

And I was like, boy, that

sounds like a long way to go.

314

But I do, I, I like the idea of if

you're going to run this, you should be

315

exposed and re-exposed to the context.

316

, and I actually kinda like the idea of,

of some sort of ongoing exposure to

317

what's happening in the practice because.

318

I do believe that people forget, if

you're a veterinarian and you don't

319

go into the clinic for five years, you

don't really remember what it's like.

320

You do, but you don't really

remember how the chaos feels.

321

You don't remember the stress.

322

On the shoulders of the people around

you and just seeing it on them.

323

Like those are, they're subtle things

that, you actually feel when you're there.

324

It's like practice has a feel to

it , and that's the first thing to go.

325

You can remember the stories from when

you were there, but it's not the same

326

as getting in there and feeling it.

327

squadcaster-319f_1_02-06-2026_132324: Or

maybe you do remember, and you're going

328

through, you know, you're climbing the

ladder as like a, veterinarian that's five

329

to 10 years out, and you finally get to

the point where you're in leadership , and

330

you're maybe ready to make change, but

everyone you wants to make an adjustment

331

because they see the opportunity for.

332

Improvement , for

performance, productivity.

333

You're sitting there and you're like, do

I want to be the bad guy that wants to

334

tell everyone that this is never going

to work because like of X, Y, and Z?

335

and I think it's, it is definitely funny,

but at the same time, I know it happens.

336

dr--andy-roark-_1_02-06-2026_132324: yeah.

337

Oh, it definitely does.

338

squadcaster-319f_1_02-06-2026_132324:

happens and.

339

That's also why it's so important

that these organizations allow for

340

an equal amount , of leadership that

is coming from the veterinary world

341

as well as focusing on the finances.

342

Because I will never argue

that veterinarians are the

343

strongest, , financial wizards

344

dr--andy-roark-_1_02-06-2026_132324:

Oh yeah.

345

squadcaster-319f_1_02-06-2026_132324:

that's not what I'm here to say.

346

Right?

347

Like I, I think that , it's just important

that we understand that if we're going

348

to take in the skills that come from

outside of this industry, that we

349

also understand that there are still.

350

Skills that, that come from this industry

when it comes to leadership and management

351

and, and context is a huge part of that.

352

dr--andy-roark-_1_02-06-2026_132324:

Well, I was gonna ask you that question.

353

I had the, I had, the idea of, is

the flip side also a good thing?

354

Should we have everyone who works

with the animals on the floor, make

355

payroll one time and like set the

clinic schedule and make sure the

356

inventory is there because, , yeah,

it's no shade on the operations people.

357

They've got real skills and

like, honestly, , I think

358

the best thing would be.

359

If the medicine people had to do like an

operations onboarding of like, look guys,

360

this is how the sausage is actually made

and this is how we, this is how we pay

361

the bills and this is what it means when

you want to have, you know, X, Y, and z

362

, in the inventory and not run out of it.

363

And this is how we set

the employee schedule.

364

And so I do think that that's fun.

365

I've also got, I got this idea

that you sort of hit on that I

366

think is really very interesting.

367

Like, I think that to some degree,

to some level medicine people.

368

Kind of think the

operations people are evil.

369

Operations people to some

degree at some level, kind of

370

think medicine people are dumb.

371

, Like they're super book

smart, but they, yeah.

372

I mean, again, I didn't say

that with love, but to both.

373

But it's like you're

going back to the meeting.

374

People are like, guys, we're, we're

gonna increase revenue by 20%.

375

And the medicine people are like, Ew.

376

And then the medicine people are

like, yeah, nobody, everyone's

377

gonna hate this and they're gonna.

378

If they're, we're gonna have

massive retention problems.

379

And I think the operations

people are like, God, those

380

medicine people don't get it.

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Like, why don't they see that this is

required to, to pay everyone's salary?

382

And again, I, I think that there's, I

think it, that's why it came with that

383

worldview idea is I think that there's

a fundamental disconnect of kind of.

384

Medicine people kind of think ops

people are evil and ops people kind

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of think medicine people are dumb

and they just don't get it, you know?

386

And, and so anyway, I, I, but I I think

what initially excited me about your

387

idea is just at a theoretical level,

I think it's fun to think about how do

388

we get these people to see each other?

389

And I really think that effective

collaborations between operations

390

and medicine is the biggest

opportunity in vet medicine now.

391

And I think it's what separates,

, whether it's an individual clinic

392

or a big organization, I think it

separates the winners from the losers

393

and the ones that are sustainable is.

394

Do your medicine people have a voice in

operations and do the operations people

395

have a voice that gets heard in medicine?

396

I, I, I, I don't think that's ever

been more important than right now,

397

and I don't think the balance has ever

shifted more than it has recently.

398

To your point, there's a lot of people

coming into the industry, especially

399

coming into the industry at higher levels

that have pure operations backgrounds

400

and no medicine backgrounds, and it's.

401

Maintaining that connection and,

getting the two groups to see each

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other much less work together.

403

I think that that's really vital and I, I

don't think that it's happening naturally,

404

organically in a lot, in a lot of groups.

405

squadcaster-319f_1_02-06-2026_132324:

Right, because The idea of like,

406

separating the two and keeping distance

between the two is the same idea, right?

407

You lose context, you lose the idea

of why the other is so important and.

408

If you are feeling like the other is

the enemy, you're going to be less

409

likely to work together because of it.

410

whether you're thinking about it or

not, , you're not going to collaborate.

411

And, and that's the real shame is that the

two groups do exist so that they, there

412

is the most potential for success, right.

413

dr--andy-roark-_1_02-06-2026_132324:

Yeah, I love it.

414

Dr.

415

Josh Rosen, where can

people find you online?

416

squadcaster-319f_1_02-06-2026_132324:

Thank you so much for having me,

417

Andy, and, , find me on Instagram.

418

Um, there most often.

419

Also on, , TikTok, , Dr.

420

Josh, that's D-O-G-T-O-R-J-O-S-H.

421

You can also email me, , josh@drjosh.com,

422

whether it's to talk about this

topic, talk about clinical empathy and

423

communication and veterinary medicine,

if you have, you know, clinic needs

424

from relief standards, whatever.

425

Whatever you wanna reach

out about, I'm here for it.

426

Thank you so much again for having me.

427

dr--andy-roark-_1_02-06-2026_132324: No.

428

Thanks so much for being here, guys.

429

I'll link all that stuff up

in the show notes as well.

430

Josh, thanks for being here, gang.

431

Thanks for listening to everybody.

432

We'll talk to you soon.

433

squadcaster-319f_1_02-06-2026_132324:

Have a good one.

434

That's what I got guys.

435

Thanks, , to, to Dr.

436

Josh for being here.

437

Thanks to you guys for being here.

438

Guys.

439

If you liked this episode, , like share,

subscribe, send it to all of your friends.

440

Tell everybody , that

they should listen to it.

441

, Make your kids listen to it.

442

If you're in charge of like a youth

sports team, Maybe that went too far.

443

Look, just, be nice to us and tell

your friends that you like the

444

podcast and that's how the show grows.

445

Anyway, guys, that's all I got today.

446

Take care of yourselves, gang.

447

I'll talk to you later on.

448

Bye.