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. 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

  2. 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

  3. May 28

    Training Miniseries 1: Dr. Mel Johnson and Dr. Lauren Dudas

    Our “Training the Rural Surgeon” miniseries begins with Dr. Randy Lehman joined by medical student Jacob Steffen, Dr. Mel Johnson from Gundersen, and Dr. Lauren Dudas from WVU to examine how residency programs prepare surgeons for broad scope rural practice. The discussion covers operative volume, subspecialty exposure, rural rotations, and why some programs intentionally train residents in urology, ENT, OBGYN, and critical access environments where specialist backup may not exist.They also discuss signaling, mentorship, interview strategy, and the qualities program directors consistently look for in future rural surgeons.For students considering rural surgery, this episode offers a practical look at how different programs approach autonomy, breadth, and long term preparation for rural practice.0:00 Intro05:01 Broad Scope Rural Surgery with Dr. Mel Johnson11:14 Applicant Fit and Program Mission17:11 Research and Rural Surgery Mentorship23:50 Surgical Case Volume29:05 Finding Rural Surgery Programs32:17 Rural Surgery Training at WVU with Dr. Lauren Dudas41:40 Grit and Independent Learning46:39 Resident Case Mix49:21 Program Resources Resources Mentioned:Gundersen Foundation General Surgery Residency Program:https://gundersenhealth.orgWVU General Surgery Residency Program:https://medicine.hsc.wvu.edu/surgeryWVU Surgery Instagram:https://instagram.com/wvusurgeryNorth American Rural Surgical Society:https://ruralsurgery.orgAmerican College of Surgeons Rural Surgery Advisory Council: https://facs.org🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ Join us on Facebook:https://www.facebook.com/profile.php?id=61564305936854

  4. May 21

    Why Great Surgical Residents Prepare Before They Feel Ready | Jacob Steffen Pt. 2

    The operating room rewards preparation long before it rewards confidence. In Part Two of this conversation, Dr. Randy Lehman continues mentoring medical student Jacob Steffen through the realities of surgical training: knot tying, OR etiquette, retraction, camera driving, tube placement, handling responsibility, and earning trust inside a surgical team. Dr. Lehman explains why great surgical residents often separate themselves early by mastering small technical details before anyone asks them to. The conversation also explores entitlement, situational awareness, humility, preparation, reputation, and the compounding effect of discipline over time. They discuss why some residents continue getting more opportunities while others remain stuck at the same level, and why surgery ultimately favors the people willing to prepare before they feel ready. This episode is about learning before the pressure arrives. 0:00 Intro 00:34 Practical Skills Students Should Already Know 08:50 First Responsibilities Inside the OR 11:34 Knot Tying and Technical Repetition 21:55 OR Etiquette and Sterile Field Awareness 31:21 Biggest Mistakes Medical Students Make 43:09 Career Advice and Personal Growth in Surgery Resources Mentioned: 🌐 Mayo Clinic https://www.mayoclinic.org/ 🌐 Medscape https://www.medscape.com/ 🌐 Ethicon Knot Tying Manual / Surgical Education https://www.jnjmedtech.com/en-US/companies/ethicon 🌐 Connect with The Rural American Surgeon: https://www.theruralamericansurgeon.com/  Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

  5. May 14

    How Responsibility Turns Students Into Surgeons | Jacob Steffen Pt. 1

    In surgery, responsibility comes before confidence.Medical students entering a Sub I are expected to manage patients, present clearly, stay organized, and earn trust before they feel fully comfortable doing it.In this Part One episode, Dr. Randy Lehman mentors medical student Jacob Steffen through rounds, presentations, list management, tube management, and operating room etiquette.Jacob explains why the students who stand out are not the ones pretending to know everything. They’re the ones who are reliable, honest, teachable, and willing to take ownership under pressure.They also discuss the Dunning-Kruger effect in surgical training, the danger of overconfidence, and why credibility matters more than performance.Confidence is built by carrying responsibility before you feel ready for it.0:00 Intro02:09 What a Sub I Actually Is10:13 How I Do It: Rounds, Lists, and Daily Workflow20:07 Managing Tasks and Running the List35:09 Physical Exam and Tube Management40:50 The Dunning-Kruger Effect50:04 Professionalism and Operating Room Etiquette Resources Mentioned:🌐 Mayo Clinic:https://www.mayoclinic.org/Epic:https://www.epic.com/🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ Join us on Facebook:https://www.facebook.com/profile.php?id=61564305936854

  6. May 7

    A Father-Daughter Conversation About Rural Surgery & Real Life

    Today Dr. Lehman sits down with the most special guest, his daughter Charlotte.  And this time, she’s in the host seat asking the hard-hitting questions! She covers everything from fear in the operating room to money, parenting, and of course, the grossest thing dad’s ever seen in surgery. 🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/  Join us on Facebook:https://www.facebook.com/profile.php?id=61564305936854

  7. Apr 23

    What It Actually Takes to Build a Sustainable Locums Career | Megan Hoot of CompHealth

    Locums surgery is often treated as temporary coverage, but many rural hospitals rely on it to maintain consistent access to care. Surgeons step in without relocating, often filling roles that cannot support full time hires. Megan Hoot, a physician recruiter at CompHealth, has spent over eight years placing surgeons into roles that often become long-term solutions. She has worked closely with Dr. Randy Lehman across multiple assignments and brings a clear view of how these arrangements develop. In this episode, Megan and Dr. Hoot break down how locums works in practice, including licensing, privileges, malpractice coverage, and how surgeons are selected and paid. They also address common misconceptions about ease and competition. For rural surgeons, locums becomes a way to maintain coverage while building flexibility without sacrificing continuity. 0:00 Intro 01:54 Megan Hoot’s Background 11:14 Why Rural Surgery? 16:31 How I Do It: Locums Setup and Entry 39:44 Financial Corner: Locums Rates 58:55 Resources for the Busy Rural Surgeon Resources Mentioned: Book a call with Megan: https://snshqsc.co/uVf0y3 CompHealth: https://www.comphealth.com/ 🌐 Connect with The Rural American Surgeon: https://www.theruralamericansurgeon.com/ Join us on Facebook: https://www.facebook.com/profile.php?id=61564305936854

  8. Apr 16

    The Reality of Practicing Alone | Dr. Scott Nelson

    In rural surgery, there’s no “waiting until you feel ready.” There’s only action, because sometimes you’re the only one. Dr. Scott Nelson, a colorectal surgeon in Grants Pass, Oregon, built a solo practice after losing his partner early in his career. What followed was years of figuring it out in real time, often without backup. In this episode, Dr. Randy Lehman and Dr. Nelson break down what it actually looks like to grow into responsibility: managing cases outside your training, making decisions without a safety net, and learning through repetition, not confidence. They also walk through practical approaches to common perianal disease, including hemorrhoids, fistulas, abscesses, and fissures in a rural setting. From handling GI bleeds without formal training to building a full colorectal practice in isolation, this conversation highlights a core reality of rural medicine: Competence often comes after you accept responsibility. If you’re early in your career (or stepping into situations where you feel unprepared) this episode will shift how you interpret that feeling. 0:00 Intro 01:54 Dr. Nelson’s Background 04:23 Why Rural Surgery Is Special to You 14:26 How I Do It: Managing Perianal Disease 48:03 Financial Corner 53:31 Resources for the Busy Rural Surgeon Resources Mentioned: 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

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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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