The Rural American Surgeon

E30: Innovations in Rural Surgery with Dr. Eugene Shively

How can rural surgeons navigate the complexities of modern surgical techniques while maintaining financial stability? 
Host Dr. Randy Lehman welcomes back Dr. Eugene Shively, a retired general surgeon from Campbellsville, Kentucky, to explore this question. They discuss the critical role of rural surgery, delve into common bile duct exploration techniques, and examine the growing presence of robotic surgery in rural hospitals. Dr. Shively also brings up the debate about government-subsidized insurance and recounts a memorable case from his career. 
Tune in for a compelling episode packed with practical notes and inspiring stories for every medical professional.
0:00 Intro
5:18 Why Rural Surgery is Special to You
16:44 How I Do It: Laparoscopic common bile duct exploration
24:09 Volumes and equipment for common bile duct exploration
29:45 Open common bile duct exploration techniques
32:03 Dr. Shively's thoughts on robotic surgery in rural locations
38:11 Case discussion: Sigmoid colon polyp management
49:27 Financial Corner: Hospital employment for surgeons
51:17 Classic Rural Surgery Story: 1989 case
54:17 Resources for the Busy Rural Surgeon
56:12 Outro

E29: The Case That Changed Me

A family emergency gave Dr. Randy Lehman an unexpected perspective—from the waiting room instead of the operating room.
In this episode, he shares the story of his grandfather’s emergency gallbladder surgery and how that experience reshaped his approach to rural surgical care.
From the weight of urgent decisions to the strain of limited resources, Dr. Lehman reflects on how these events transformed his approach to pre-op communication and deepened his commitment to compassionate, patient-centered care.
0:00 Intro
5:28 Grandpa's emergency
11:26 Resource limitations in small hospitals
18:30 Unexpected turn of events post-surgery
24:38 Lessons learned
38:13 Importance of rural surgeons

E28: Flying My Helicopter to Surgery

For Dr. Randy Lehman, “rushing to surgery” sometimes means taking to the skies.
In this episode, he shares how aviation became an unexpected solution to some of rural healthcare’s biggest hurdles: time, distance, and access.
From unforgettable landings to the real-world logistics of owning and flying a helicopter, Dr. Lehman gives us a front-row seat to how this unconventional approach is transforming his surgical practice in Indiana.
...and let’s be honest, flying is just plain awesome!
0:00 Introduction
1:58 Family Aviation Roots and Grandpa's Flying Legacy
12:47 Trading Long Drives for Short Flights During Residency
19:51 The Real Economics of Maintaining Three Aircraft
25:31 Robinson R44 Operations and Beating the Air into Submission
29:23 Why a Helicopter Provides Crucial Direct Hospital Access
34:03 Getting a Helicopter License in Just 54 Days
38:17 Landing at Hospitals, Schools and Family Farms
41:53 Transforming Friends Through Rural Peace After City Chaos
47:03 Weather Limitations and Always Having a Safety Plan B
52:24 When $400 Per Hour Flying Actually Makes Financial Sense
54:08 Small Minds vs. Creative Rural Transportation Solutions
59:09 Designing an Intentional Rural Surgical Practice
Resources Mentioned:
Cleveland Helicoptershttps://clevelandhelicopters.com/
One Six Righthttps://www.onesixright.com/

E27: Bringing Complex Procedures Back to Rural Roots with Dr. Rebekah Wever

Join host Dr. Randy Lehman as he welcomes Dr. Rebekah Wever, a passionate young rural surgeon who returned to her Appalachia, Ohio roots after training in South Dakota. 
 
In this episode, Dr. Wever shares candid reflections on her first independent cases while delivering a masterclass on the innovative Transversus Abdominis Release (TAR) technique for complex hernia repairs. She reveals how her dedication to building healthcare resilience in her underserved Appalachian hometown means the difference between life-threatening transfers and keeping critical care local.
 
Whether you're a healthcare provider considering rural practice or simply curious about delivering exceptional surgical care in underserved communities, discover why Dr. Wever believes returning home might be the most rewarding decision a surgeon can make.
 
0:00 Introduction
1:26 Dr. Wever's Background
7:01 Why Rural Surgery is Special to You
8:49 How I Do It: Ventral Hernia Repair - Transversus Abdominis Release
37:55 Resources for the Busy Rural Surgeon
39:27 Financial Corner
42:01 Classic Rural Surgery Story
Resources Mentioned:
Book: Hernia Surgery: Current Principles by Yuri W. Novitsky

E26: Honduras Medical Missions & Gallbladder Cases with Dr. John Haeberlin

After a week of medical missions in rural Honduras, host Dr. Randy Lehman sits down with Dr. John Haeberlin to reflect on their experience and discuss laparoscopic cholecystectomy techniques.
Dr. Haeberlin shares insights on robotics and breaks down an excellent "How I Do It" segment on a gallbladder case. Dr. Lehman also recounts a compelling case from their time in Honduras, offering a firsthand look at the challenges and decisions they faced in the field.
 
0:00 Introduction
1:41 Dr. Haeberlin's Background
3:26 Why Rural Surgery Is Special To You
8:10 How I Do It: Laparoscopic Cholecystectomy
38:47 Classic Rural Surgery Story
45:26 Financial Corner
47:04 Resources for the Busy Rural Surgeon

E25: Rural Emergency C-Sections with Dr. Dave Kermode

Host Dr. Randy Lehman sits down with Iowa rural surgeon and former Navy doctor, Dr. Dave Kermode, for a gripping deep dive into an emergency C-section case. Together, they explore the key differences between elective and emergency C-sections in a rural setting, offering valuable insights for general surgery residents. Beyond medicine, they also discuss the intersections of finance, marriage, and faith, making this an episode packed with wisdom both in and out of the operating room.
 
0:00 Introduction
0:48 Dr. Kermode's background
4:08 Why Rural Surgery Is Special To You
7:55 C-Sections as a Rural Surgeon
16:59 OB Department Closures
29:01 How I Do It: Emergency C-Section
52:24 Technical Differences: Elective vs. Emergency C-Sections
1:03:02 Financial Corner
1:11:22 Classic Rural Surgery Stories
1:13:21 Resources for the Busy Rural Surgeon
 
Resources mentioned:
 
North American Rural Surgical Society
Really Rural Surgery Podcast
Rural Medical Training Collaborative

E24: Sentinel Node Biopsy with Dr. Mel Johnson - Part 2

Welcome back for this Part Two conversation with host Dr. Randy Lehman and distinguished breast surgeon, Dr. Mel Johnson. Listen for a technical walkthrough on sentinel lymph node biopsy, plus a very unique bonus “How I Do It” section involving surgery on a farm! Stay through the end for Dr. Johnson’s powerful encouragement for the new resident who might wonder what life looks like ahead.
 
00:00 Introduction
02:39 How I Do It: Sentinel Lymph Node Biopsy
05:43 Ongoing Trials in Breast Cancer Surgery
13:27 How I Do It: Patient Prep
20:54 Resources for the Busy Rural Surgeon
21:57 How I Do It: Piglet Hernia Repair
26:52 Financial Corner
28:43 Classic Rural Surgery Story
 
Resources Mentioned:
 
NCCN Guidelines
CoC Guidelines
New England Journal of Medicine article: "Sentinel Lymph Node Biopsy in Early Stage Breast Cancer: Is It Obsolete?" by Monica Morrow (December 2024)
INSEMA trial - Ongoing clinical trial on sentinel lymph node biopsy in breast cancer
SOUND trial - Ongoing clinical trial on sentinel lymph node biopsy in breast cancer

E23: Sentinel Node Biopsy with Dr. Mel Johnson - Part 1

Host Dr. Randy Lehman welcomes Dr. Mel Johnson, President of the North American Rural Surgical Society and Program Director at Gundersen Lutheran in La Crosse, Wisconsin. This Part One conversation highlights breast cancer treatment, focusing on sentinel lymph node biopsy and the decision-making process for prophylactic mastectomy. Tune in for Dr. Johnson’s insights into implementing comprehensive breast cancer care in rural settings, emphasizing the importance of multidisciplinary approaches and overcoming barriers.
 
0:00 Introduction
1:43 Dr. Johnson's Background
8:33 Residency Program Updates
14:54 How I Do It: Sentinel Lymph Node Biopsy (Patient Prep and Anecdotes)
25:40 How I Do It: Sentinel Lymph Node Biopsy (Technical Details)
34:33 Overcoming Obstacles in Rural

E22: Technology Disruptors in Rural Medicine with Dan Leman - Part 2

In this Part Two episode, host Dr. Randy Lehman returns with PA Dan Leman—who flips the script and takes on the role of interviewer! Together, they explore the balance between technological resources and human connection, the complexities of ethical decision-making, and the role of humility in a surgeon’s journey. Don’t miss this insightful conversation packed with thought-provoking perspectives and real-world experience.
 
0:00 Intro
5:03 Unexpected rectal cancer during surgery
11:19 Importance of humility in practice
17:41 Culture of humility among rural surgeons
22:37 Critical access dollars and healthcare policy
29:26 Investing in rural communities
 
Resources mentioned:
UpToDate
Rural American Surgeon Facebook page
Critical Access Hospital program 

E21: Technology Disruptors in Rural Medicine with Dan Leman - Part 1

Host Dr. Randy Lehman welcomes Dan Leman, a Physician Assistant with a notable background in telehealth innovation. Together, they explore the transformative role of telehealth technology in rural healthcare, highlighting Dan's pioneering work in developing remote medical solutions for underserved communities. The conversation also delves into the financial hurdles faced by healthcare startups and the profound experiences gained from international medical missions.
 
0:00 Intro
1:30 Dan Leman's Background
5:47 Telehealth Technology
12:25 Inventing Medical Technology
17:17 Surgical experience in Haiti
Resources mentioned:
PAACS
BMDMIWhen Helping Hurts book