The Rural American Surgeon

Randy Lehman
  • 4.9 (23)
  • Science
  • Updated Weekly

Welcome to ”The Rural American Surgeon,” a podcast series dedicated to providing insights, resources, and a community for the surgeons of rural America. Your host, Randy Lehman, is an established authority on the multifaceted aspects of rural surgery—from the unique professional benefits and challenges, rural surgical training paradigms, current reimbursement landscape, and how to create triple win opportunities for sustainable rural surgery in partnerships with hospitals and rural communities. This podcast is designed for both rural general surgeons and rural surgical specialists who are seeking not just advice and guidance on practicing in rural areas, but also inspiration to foster valuable partnerships across our great land. Each episode is a deep dive into topics such as mastery of rural surgery, the rural lifestyle, fighting professional isolation, building a system to ensure surgical services are offered at a high level, using scarce resources wisely, achieving personal financial freedom, accessing a wealth of outside surgical resources, and inspiration at a high level of why what we do is important.

  1. 5d ago

    The Rural Surgeon’s Guide to Treating Pilonidal Disease

    Dr. Levi Smucker joins host Dr. Randy Lehman on The Rural American Surgeon to discuss his path to rural general surgery, from growing up in Pennsylvania and training at Bassett Healthcare in Cooperstown to building his practice in Goshen, Indiana. He shares how a close knit group of six surgeons has given him strong mentorship, broad operative experience, and the opportunity to develop his own areas of expertise while serving multiple hospitals. Dr. Smucker also takes a practical look at pilonidal disease, walking through patient presentation, conservative management, the Gips procedure, excision, wound healing, and the Bascom cleft lift. The conversation explores how he approaches recurrent and complex cases, technical considerations for different procedures, and the importance of choosing treatment based on the individual patient. They also discuss cost sharing within local Plain Church communities, an unusual rural surgery case involving an esophageal food bolus, preparing for challenging cases without letting anxiety take over, and why mentorship remains so important for the next generation of rural surgeons. Key Takeaways 00:38 Meet Rural General Surgeon Dr. Levi Smucker 01:20 From Pennsylvania to Rural Surgery in Indiana 02:18 Why Bassett Healthcare Was the Right Place to Train 02:52 Building a Career in a Supportive Rural Surgery Practice 04:21 Resources and Capabilities Across Three Hospitals 05:09 Finding a Surgical Niche in Rural Practice 05:52 Bringing Vascular Surgery Into General Surgery Practice 06:25 The Broad Spectrum of Rural General Surgery 08:30 Why Rural Surgery Still Matters 09:15 Understanding Pilonidal Disease 11:27 Evaluating Patients After a Pilonidal Abscess 12:09 Treatment Options for Pilonidal Disease 13:05 How the Gips Procedure Works 15:02 The Bascom Cleft Lift Procedure 16:43 Technical Approach to the Gips Procedure 18:13 Choosing the Right Treatment for Complex Cases 20:48 Performing the Bascom Cleft Lift 24:52 Creating an Off Midline Closure 26:03 Coding Considerations for Pilonidal Surgery 27:42 Lessons From Plain Church Communities and Cost Sharing 29:10 A Classic Rural Surgery Case 30:06 Preparing for Difficult Cases Without Burning Out 32:46 Why a Culture of Mentorship Must Be Passed On Resources Mentioned Bassett Healthcare https://www.bassett.org/ Gehrig Surgical Associates https://www.gerigsurgical.com/ Critical Access Hospitals https://www.cms.gov/medicare/health-safety-standards/certification-compliance/critical-access-hospitals

  2. Sep 24

    What Rural Surgeons Need That Most Residencies Don’t Teach

    Dr. Joon Shim, program director at Bassett Healthcare in Cooperstown, New York, joins host Dr. Randy Lehman and Jacob on The Rural American Surgeon to discuss how Bassett prepares residents for the realities of rural general surgery. Dr. Shim explains how residents begin gaining operating room experience from day one and train across a broad spectrum of surgical cases without competing with surgical fellows. The conversation explores what it takes to thrive in rural surgery, including adaptability, resilience, emotional intelligence, and the ability to provide excellent care when patients face challenges with transportation, insurance, and access to specialists. Dr. Shim also shares what she looks for in residency applicants, Bassett’s approach to leadership development, and why rural surgeons must be prepared to think independently, operate confidently, and care for the entire community. Key Takeaways 01:21 How Bassett’s Rural Surgery Residency Is Structured 01:54 Building Independence From the First Day in the OR 03:35 What Makes a Resident Thrive in Rural Surgery 04:25 Why Adaptability Is Essential for Rural Surgeons 05:30 How Rural Healthcare Can Improve Continuity of Care 06:26 Providing Excellent Care Despite Patient Resource Limitations 07:15 Adapting Treatment for a Patient With Limited Access to Care 08:22 The Extreme Cases Rural Surgeons Can Encounter 09:56 What Dr. Shim Looks for in Residency Applicants 11:25 Teaching Emotional Intelligence and Leadership 12:42 How Much Operative Experience Interns Can Get 14:27 Training Across Specialties Without Surgical Fellows 15:38 Where Bassett Surgery Graduates Go to Practice 16:46 How Medical Students Can Learn More About Bassett 17:28 Training Surgeons Who Are Technically Driven and Deeply Human 17:48 Thinking Independently and Leading Compassionately 18:54 Connecting With the Rural Surgery Community 19:59 How to Choose the Right Residency Program 20:35 Dr. Shim’s Journey From Major Trauma Centers to Rural Surgery Resources Mentioned AO Foundation https://www.aofoundation.org/ Bassett Healthcare Network https://www.bassett.org/ Bassett General Surgery Residency Program https://www.bassett.org/medical-education/residency-fellowship-programs/general-surgery-residency-program Bassett Surgery Residents on Instagram https://www.instagram.com/bassettsurgeryresidents/ North American Rural Surgical Society https://www.northamericanrss.org/

  3. Sep 17

    Why Rural Surgeons Can’t Afford to Be Too Specialized (Part 2)

    Stuart Ferguson returns for part two of his conversation on The Rural American Surgeon to explore the practical realities of providing urologic and general surgical care in the remote Shetland Islands. Stuart discusses the limitations that come with practicing in a small island hospital, including equipment decisions, limited critical care capacity, weather that can prevent patient transfers, and the need to know when a case should be referred. He then walks through his approach to transurethral resection of the prostate, including patient selection, equipment, safety landmarks, difficult catheter placement, and how elective urology experience helps when managing emergencies. The conversation expands beyond the operating room as Stuart shares his approach to charitable giving and how he and his wife make global health work in Zambia a regular part of their careers. He explains how rural surgery gave him the broad skill set needed to work in low resource environments and shares a case that demonstrates the value of being a generalist who can see the whole patient rather than a single problem. The episode concludes with practical resources for rural surgeons and an introduction to the Viking Surgeons Association. Key Takeaways 00:00 Returning for Part Two With Stuart Ferguson 00:48 Managing Kidney and Bladder Stones in Shetland 01:37 How Often Stuart Performs TURPs 01:48 Operating Rooms, Endoscopy, and Critical Care Capacity 02:26 Patient Transfers and Scotland’s Retrieval Service 02:54 When Weather Makes Transfer Impossible 03:32 Selecting the Right Patient for a TURP 05:14 Equipment and Safety Principles for TURP 06:15 Cystoscopy and Identifying Key Landmarks 07:33 Managing a Difficult Urethra 08:19 Difficult Foley Catheter Placement and Guidewire Techniques 09:23 Using Urology Skills to Manage Severe Hematuria 09:59 Stuart’s Approach to Tithing and Charitable Giving 10:50 Automating Giving Through a Separate Account 11:27 Supporting Global Health Work in Addition to Giving 13:05 Faith and Community in Shetland 14:31 The Viking Surgeons Association and Rural Surgery Community 16:09 Randy’s Path Into Rural Surgery 18:44 Training Specifically for a Rural Surgical Career 20:29 Creating Change Within a Small Rural Health System 21:31 Making Time for Global Health Work in Zambia 21:54 Stuart’s Connection to Rural Surgery in Zambia 23:30 How Global Health Work Maintains Surgical Skills 26:13 Why Rural Surgery Transfers Well to Low Resource Environments 28:20 The Value of Being a Holistic Generalist 29:30 Connecting Multiple Medical Problems Across Specialties 30:18 Recognizing When the Patient’s Greatest Need Is Something Else 32:45 Resources for the Busy Rural Surgeon 33:24 AO Surgery Reference for Unfamiliar Procedures 33:54 Primary Surgery for Low Resource Settings 34:54 The Viking Surgeons Association Resources Mentioned  AO Surgery Reference  Viking Surgeons Association  Royal College of Surgeons of Edinburgh  Faculty of Remote, Rural and Humanitarian Healthcare  NHS Shetland

  4. Sep 10

    Why Rural Surgeons Can’t Afford to Be Too Specialized (Part 1)

    Stuart Ferguson, a consultant general surgeon in Scotland’s remote Shetland Islands, joins The Rural American Surgeon to discuss what it takes to practice surgery 200 miles into the North Sea and why he deliberately built his career around becoming a broad surgical generalist. Stuart shares his training journey from Glasgow and Northern Ireland to colorectal surgery, global health work in Zambia, and Scotland’s Rural Surgical Fellowship. He explains how the fellowship allowed him to build additional skills in urology, orthopedics, trauma, and obstetrics specifically for the needs of Shetland. The conversation also explores what surgical practice looks like for a population of roughly 22,000 served by three consultant general surgeons. Stuart describes a practice divided between general surgery, urology, trauma, and orthopedics, along with endoscopy and emergency procedures that would typically be divided among several specialists in larger hospitals. The episode concludes with a look at how he developed the urology skills needed to practice independently in such an isolated setting. 00:00 Why Rural Surgery Creates a Broad Skill Set 00:45 Meeting Stuart Ferguson and the UK Tradition of Calling Surgeons “Mr.” 05:42 Stuart’s Surgical Training in Scotland and Northern Ireland 07:30 Going From Colorectal Training Back to Generalist Surgery 08:00 Scotland’s Rural Surgical Fellowship 08:38 Building Skills in Urology, Orthopedics, Trauma, and Obstetrics 09:21 How Many General Surgeons Serve the Shetland Islands 11:51 What “Rural” Means in an Extremely Isolated Community 17:01 Shetland’s Scandinavian History and Culture 18:33 Serving 22,000 People With One Hospital and Three Surgeons 19:32 Stuart’s Mix of General Surgery, Urology, and Orthopedics 20:45 The Bread and Butter Procedures of a Shetland Surgeon 21:17 Managing Complex Cases and Surgical Emergencies 22:33 Endoscopy Without a Gastroenterologist 31:09 How Stuart Built His Urology Skills After General Surgery Training 32:08 Using the Rural Surgical Fellowship to Prepare for Shetland 33:13 Training for Independent Urologic Practice 200 Miles Into the North Sea Resources Mentioned ●  NHS Shetland ●  Royal College of Surgeons ●  British Society of Gastroenterology

  5. Sep 3

    What Does a Rural Surgeon Actually Need to Know?

    Dr. Amiri, program director at Marshall University, and fourth year surgery resident David Kanarowski join The Rural American Surgeon to discuss Marshall’s dedicated rural general surgery residency and how it prepares surgeons for independent practice in rural communities. They explain how residents spend roughly two thirds of their training at rural hospitals, gaining early operative experience without competing with other residents for cases. The conversation covers the broad skills rural surgeons may need, including C-sections, endoscopy, orthopedics, and procedures shaped by the resources available in their future communities. Dr. Amiri and David also share what Marshall looks for in applicants and why a genuine commitment to rural life matters. The episode concludes with a practical discussion of Dr. Amiri’s approach to robotic right colectomy. 01:07 Why Marshall Created a Rural Surgery Residency 02:26 Spending Two Thirds of Training in Rural Hospitals 03:09 Preparing for a Career in a Small Town 05:27 Tailoring Training to Future Rural Practice 06:48 How Marshall’s Rural Residency Is Structured 07:49 What Marshall Looks for in Rural Surgery Applicants 09:03 Case Volume and Early Operative Experience 09:53 Taking Call in a Rural Hospital 10:43 Housing and Rural Rotation Sites 11:56 Training with OB/GYN, Orthopedics, and Other Specialties 13:59 Endoscopy and C-Sections in Rural Practice 16:14 Finding Residents with a Rural Mindset 17:02 Training General Surgeons Rather Than Specialists 18:29 Fellowships That Can Benefit Rural Surgeons 20:11 How Dr. Amiri Performs a Robotic Right Colectomy 22:33 Medial to Lateral Dissection and Pedicle Ligation 24:28 Using ICG to Identify the Middle Colic 26:55 Bowel Transection and Stapling Technique 29:05 Creating the Anastomosis 30:44 Postoperative Care and Early Discharge 31:26 Adapting the Technique Without a RobotResources Mentioned ●       Marshall University

  6. Aug 27

    Are You Really Ready to Be the Only Surgeon in the Room?

    Dr. Anne O’Rourke, program director at the University of Wisconsin, joins The Rural American Surgeon to discuss how UW’s rural surgery track prepares general surgery residents for independent rural practice. She explains how the five-year program combines training in Madison with recurring rural rotations, giving residents experience with the broad skill set rural surgeons need, including endoscopy, C-sections, trauma stabilization, and general surgery. Dr. O’Rourke also shares what the program looks for in applicants and why courage, confidence, resilience, and exposure to practicing rural surgeons are essential for preparing the next generation of rural surgeons. 00:45 Training the Next Generation of Rural Surgeons 01:56 Why Wisconsin Created a Rural Surgery Track 03:09 The Five-Year Rural Surgery Pathway 06:58 How Rural Rotations Are Structured 09:32 What UW Looks for in Rural Surgery Applicants 11:16 Courage, Confidence, and Resilience in Rural Practice 13:58 Training in C-Sections and Other Rural Surgical Skills 16:03 Endoscopy, C-Sections, and Trauma Stabilization 17:36 Preparing Residents for Independent Practice 19:09 Why Exposure to Rural Surgeons Matters 20:41 Why Surgeons Choose Rural Practice 24:34 The Importance of Providing Care Close to Home Resources Mentioned●  University of Wisconsin Rural Surgery Track ● Wisconsin Surgical Collaborative ● North American Rural Surgical Society ● University of Wisconsin Rural OB/GYN Track ● NRMP Match

  7. Jun 11

    Training Miniseries 3: Dr. Frank Wood and Dr. Barclay Stewart

    Our “Training the Rural Surgeon” miniseries continues as Dr. Randy Lehman and Jacob Steffen are joined by Dr. Frank Wood from the University of Oklahoma and Dr. Barclay Stewart from the University of Washington to examine how residency programs are building the next generation of rural surgeons. Dr. Wood explains why Oklahoma created a dedicated rural surgery track, how residents train in Lawton, and why broad clinical exposure, culture fit, and teamwork remain essential for long term success in rural practice. The discussion also explores the workforce challenges facing rural Oklahoma as experienced surgeons retire and communities work to maintain local surgical care. Dr. Stewart outlines the University of Washington's PROGRESS program and the WWAMI model, connecting rural and global surgery training across the Pacific Northwest. He discusses flexible training pathways, regional partnerships, and how residents gain experience in diverse care environments while preparing for broad scope surgical practice. For medical students and residents interested in rural surgery, this episode offers two distinct approaches to developing surgeons who can serve rural, remote, and frontier communities. 0:00 Intro 00:55 Oklahoma's Rural Surgery Track 08:08 What Programs Look for in Applicants 13:51 Teamwork and Culture Fit 18:53 Training Philosophy and Resident Development 24:51 Case Volume and Early Operative Experience 27:59 The WWAMI and PROGRESS Model 33:51 Broad Scope Training Across Rural Sites 38:35 Flexible Training Pathways 43:28 Learning Care Delivery in Different Environments 49:47 Matching and Program Structure University of Oklahoma General Surgery Residency Programs https://medicine.ouhsc.edu   University of Washington Department of Surgery https://uwsurgery.org/  🌐 Connect with The Rural American Surgeon: https://www.theruralamericansurgeon.com/  Join us on Facebook: https://facebook.com/profile.php?id=61564305936854

  8. Jun 4

    Training Miniseries 2: Dr. Mariela Rivera

    Our “Training the Rural Surgeon” miniseries continues as Dr. Randy Lehman and Jacob Steffen are joined by Dr. Mariela Rivera, Program Director at Mayo Clinic in Rochester, Minnesota. They discuss how Mayo Clinic’s rural general surgery track equips residents for the broad scope of rural surgical practice. The conversation explores the structure of the rural track, training across Mayo Clinic Health System sites, flexible rotations, endoscopy, OBGYN, subspecialty exposure, and the balance between tertiary care training and high-volume community surgery experience. Dr. Rivera also explains what she values in applicants, including adaptability, emotional intelligence, ownership, strong patient relationships, and a demonstrated commitment to rural practice. For medical students and residents interested in rural surgery, this episode offers an inside look at Mayo Clinic’s approach to training surgeons for the clinical breadth, autonomy, and responsibilities of independent rural practice. 0:00 Intro 06:53 Key Strengths and Structure of the Residency Program 10:51 Qualities of a Successful Rural Track Applicant 13:58 Intern Case Volumes and One-on-One Surgical Mentorship 17:23 Surgery Olympics: Simulation-Based Skill Assessments  Resources Mentioned: Mayo Clinic Residency Programs https://college.mayo.edu  🌐 Connect with The Rural American Surgeon: https://www.theruralamericansurgeon.com/  Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

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Welcome to ”The Rural American Surgeon,” a podcast series dedicated to providing insights, resources, and a community for the surgeons of rural America. Your host, Randy Lehman, is an established authority on the multifaceted aspects of rural surgery—from the unique professional benefits and challenges, rural surgical training paradigms, current reimbursement landscape, and how to create triple win opportunities for sustainable rural surgery in partnerships with hospitals and rural communities. This podcast is designed for both rural general surgeons and rural surgical specialists who are seeking not just advice and guidance on practicing in rural areas, but also inspiration to foster valuable partnerships across our great land. Each episode is a deep dive into topics such as mastery of rural surgery, the rural lifestyle, fighting professional isolation, building a system to ensure surgical services are offered at a high level, using scarce resources wisely, achieving personal financial freedom, accessing a wealth of outside surgical resources, and inspiration at a high level of why what we do is important.

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