The Rural American Surgeon

Randy Lehman
  • 4.9 (24)
  • 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. 1D AGO

    Building a High Quality Rural Breast Surgery Program with Dr. Jill Ties

    Rural patients shouldn’t receive lesser care simply because of geography. Delivering that standard takes intentional systems, good data, and the right team around you. Dr. Randy Lehman sits down with rural surgeon and ACS Governor Dr. Jill Ties to talk about how she built a breast surgery program inside a critical access hospital in Wisconsin. They walk through the real work behind it: aligning with administration, earning the trust of referring physicians, shortening the time from abnormal mammogram to biopsy, and building a reliable process around a dedicated nurse navigator. For rural surgeons trying to strengthen cancer care close to home, this conversation offers practical ideas on building systems, relationships, and teams that make high quality care possible. 0:00 Intro 00:14 Dr. Ties' Background 03:37 Why Rural Surgery Is Special to Dr. Ties7:30 How I Do It: Building a Rural Breast Surgery Program 32:58 How I Do It: Breast Surgery Technique and Workflow 55:54 Financial Corner 57:36 Classic Rural Surgery Stories 1:00:16 Resources for the Busy Rural Surgeon Resources Mentioned: UpToDate: https://www.uptodate.com North American Rural Surgical Society:https://www.northamericanrss.org/  🌐 Connect with The Rural American Surgeon: https://www.theruralamericansurgeon.com/  Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

    1h 6m

  2. MAR 5

    Keeping Up Without Wasting Resources in Rural Surgery with Dr. Steven Bodney

    Rural practice can feel isolating, especially when you’re the only surgeon in the building… Dr. Randy Lehman sits down with Dr. Steven Bodney, former ACS Governor and longtime Indiana surgeon, to talk about what it really takes to build a durable career in that environment. Dr. Bodney reflects on his Army training, transitioning into solo rural practice, and helping build a new county hospital from the ground up. He shares how he developed a breast practice locally by owning the abnormal mammogram workup and learning the technical skills required to support it. You’ll also hear gold nuggets from Dr. Bodney on resisting procedural trends, knowing when not to operate, and learning the hospital business model before asking for more equipment. 0:00 Intro 01:35 Dr. Bodney’s Background 7:27 Why Rural Surgery Is Special to Dr. Bodney 15:50 How I Do It: Building a Rural Breast Practice 48:50 Financial Corner 52:16 Classic Rural Surgery Stories 1:01:02 Resources for the Busy Rural Surgeon Resources Mentioned: American College of Surgeons: https://www.facs.org UpToDate: https://www.uptodate.com 🌐 Connect with The Rural American Surgeon: https://www.theruralamericansurgeon.com/ Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

    1h 6m

  3. FEB 26

    Setting Goals as a Surgeon: Building Direction, Discipline, and Financial Freedom

    Today Dr. Randy Lehman reflects on the practices he employs to live a life of intention, including conferences, family rhythms, financial tracking, and the systems he’s built to avoid simply bouncing around through life.  From residency to rural practice, from debt payoff to financial independence, he shares the exact goal-setting framework he uses annually.  If you’re a surgeon trying to build a life of impact, margin, and intentional growth, this one’s for you.  0:00 Intro0:45 Conferences, Community, and Rural Surgical Connections3:16 Why Goal Setting Matters6:57 Consistency and the 1% Better Philosophy8:24 The 5-Year Perspective on Growth11:05 Out-Earning vs Frugality Early in Career13:14 What Gets Measured Gets Managed15:15 Applying Business Principles to Personal Life16:02 The Gap and The Gain Mindset19:23 Vision Documents and Annual Goal Structure23:15 The Daily To-Do List System26:09 Building and Tracking Net Worth28:58 Comparing Yourself to Your Former Self31:33 The One SheetResources Mentioned: 📚 The Gap and The Gain by Dan Sullivan & Dr. Benjamin Hardy 📚 The One Thing by Gary Keller Dave Ramsey’s Debt Snowball Method 🌐 North American Rural Surgical Society  https://www.northamericanrss.org/

    37 min

  4. JAN 29

    The Real Tradeoffs Between Robotic & Laparoscopic Surgery | Dr. Amy Vertrees Pt. 2

    Which is better, robotic or laparoscopic inguinal hernia repair? In this Part Two episode, Dr. Randy Lehman is joined again by Dr. Amy Vertrees, founder of the BOSS Business of Surgery Series and a career coach for surgeons, for an in-depth technical breakdown of both approaches. They compare every step of the operation, from port placement and mesh selection to managing seromas and preventing recurrence. You’ll hear practical pearls on landmark-based dissection, handling intraoperative bleeding, and the subtle but meaningful advantages of robotic tools. This episode zeroes in on the practical decision making behind robotic and laparoscopic hernia repair, highlighting how small technical choices can have outsized effects on outcomes. 0:00 Intro 0:40 Laparoscopic vs. Robotic TAPP 3:37 Port Placement Strategies & Access Tips 5:34 Mesh Types, Fixation Methods & Cost Considerations 9:38 Landmark-Based Dissection Tips 16:06 Managing Bleeding Near Cooper's & Iliac Vessels 21:38 Mesh Orientation & Securing Techniques 24:08 Peritoneal Closure & Tack Pitfalls 27:09 Post-op Seroma Management 28:05 Managing Massive Hernias 37:13 Financial Corner 39:58 Classic Rural Surgery Stories 47:11 Resources for the Busy Rural Surgeon Resources Mentioned: Connect with Dr. Vertrees: https://www.bosssurgery.com/ 🎙️ BOSS Business of Surgery Podcast: https://www.bosssurgery.com/podcasts/boss-business-of-surgery-series 🌐 Connect with The Rural American Surgeon: https://www.youtube.com/@ruralAmericanSurgeon Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

    1 hr

  5. JAN 22

    Why Confidence & Judgment Matter More Than Fellowships in Rural Surgery | Dr. Amy Vertrees Pt. 1

    Today, Dr. Randy Lehman sits down with a surgeon who traded stability for autonomy. Dr. Amy Vertrees, an Army-trained general surgeon who built a thriving private practice covering three hospitals, breaks down the challenges and victories of modern rural surgery. They explore what makes rural practice unique, why fellowship isn’t always necessary, and how to build a surgical team that lasts. Plus, a candid conversation on hernia repair (when to go open vs. laparoscopic vs. robotic) and the complications that keep rural surgeons up at night. Surgeons at any stage will find practical insights into training choices, private practice, and long-term sustainability in rural surgery. 0:00 Intro 0:13 Dr. Vertrees’ Background 2:12 Inside Private Practice 5:58 Building a Multi-Hospital Rural Surgery Group 9:26 Hub-and-Spoke Models & Surgeon Recruitment 16:10 Inguinal Hernia Volume 20:14 How I Do It: Inguinal Hernia Repair Philosophy 32:48 Confidence, Training, and Choosing the Right Operation Resources Mentioned: Connect with Dr. Vertrees: https://www.bosssurgery.com/ 🌐 Connect with The Rural American Surgeon: https://www.youtube.com/@ruralAmericanSurgeon Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

    35 min

  6. 12/18/2025

    What I Wish I Knew in Med School: A Conversation with Baylor’s Student Surgical Society

    Is it possible to build a surgical practice from scratch…on your terms…in the hometown you dreamed of serving? Dr. Randy Lehman is proof that it is, and he’s an open book about his journey with the next generation of surgeons. In this special Q&A episode, Dr. Lehman sits down with two med students from Baylor College of Medicine's Student Surgical Society to share the story of his path into rural surgery and how he’s built his practice. They discuss training with intention, avoiding common early-career pitfalls, choosing high-value skillsets, and navigating the hidden politics of hospital privileges. If you're a med student or resident eyeing rural surgery (or just want a brutally honest look at what it takes), tune in and join the community. 0:00 Intro 0:41 Baylor Student Surgical Society 5:06 Choosing Surgery vs. ER Medicine 11:35 Owning Your Training as a Future Rural Surgeon 17:55 What Rural Surgeons Actually Do Day-to-Day 25:59 Building a Multi-Hospital Rural Practice 31:47 Compensation, Value, and Why Rural Surgery Pays 42:37 High-Value Skills 1:01:21 Making High-Stakes Decisions in Isolation 1:04:34 Practical Surgical Insights and Risk Management

    1h 15m
  7. Money Miniseries 8: When The Dream Doesn’t Go As Planned…

    12/04/2025

    Money Miniseries 8: When The Dream Doesn’t Go As Planned…

    What happens when the plan…doesn’t pan out? In the final episode of the Money Miniseries, Dr. Randy Lehman shares a behind-the-scenes look at launching Liberty Clinic, the independent rural practice he built from the ground up (and nearly had to shut down).  The episode covers the financial, emotional, and leadership challenges that come with going first in a rural environment. It’s about the limits of planning, the gift of margin, and the kind of resilience that only develops after setbacks. 0:00 Intro 1:11 Pharmacy School Rejection & Pivot 5:49 Discovering Rural Surgery 13:36 The Town With Too Many Surgeons… 18:22 Buying My Childhood Clinic (And Meeting My Wife) 25:04 Liberty Clinic: Vision, Reality, and $30K Losses 28:58 The Surrender Prayer 36:41 Termination 44:44 A Lesson in Difficult Partnerships 48:39 Why Financial Margin Matters 54:53 Final Reflections on Resilience

    57 min
  8. Early Detection, Better Outcomes: Lung and Esophageal Cancer with Dr. Shanda Blackmon

    11/20/2025

    Early Detection, Better Outcomes: Lung and Esophageal Cancer with Dr. Shanda Blackmon

    In this episode of The Rural American Surgeon, host Dr. Randy Lehman is joined by renowned thoracic surgeon Dr. Shanda Blackmon. With a career spanning MD Anderson, Mayo Clinic, and now Baylor College of Medicine, Dr. Blackmon brings a wealth of knowledge on lung and esophageal cancer screening, staging, and treatment.  They walk through practical approaches to lung cancer screening, esophageal reflux evaluation, staging workups, and the impact of new therapies. There’s also an honest conversation about what palliative care really means in a rural setting, and how to know when “doing more” might not be better. Whether you’re doing EGDs, managing smoking histories, or counseling patients on cancer risk, this conversation is full of insight for everyday decision-making in rural surgery. 0:00 Intro 1:16 Dr. Blackmon’s Background 5:15 Why Thoracic Surgery Is Special to You 9:17 Palliative Care & End-of-Life in Rural Practice 17:19 Lung Cancer Screening & Workup 27:54 Esophageal Cancer & Upper Endoscopy 49:36 Lung Cancer Treatment Strategies 58:13 Surgery After Immunotherapy 1:00:32 Financial Corner 1:10:41 Classic Surgery Story 1:13:07 Resources for the Busy Rural Surgeon Resources Mentioned: AJCC Staging Manual:  https://www.facs.org/quality-programs/cancer/ajcc/ NCCN Guidelines:  https://www.nccn.org/guidelines/ USPSTF Screening Guidelines:  https://www.uspreventiveservicestaskforce.org

    1h 17m
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4.9
out of 5
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About

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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