The Rural American Surgeon
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.
Listen on:
Episodes
Thursday Mar 13, 2025
Thursday Mar 13, 2025
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
Thursday Mar 06, 2025
Thursday Mar 06, 2025
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
Thursday Feb 27, 2025
Thursday Feb 27, 2025
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
Thursday Feb 13, 2025
Thursday Feb 13, 2025
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
Friday Jan 31, 2025
Friday Jan 31, 2025
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
Thursday Jan 23, 2025
Thursday Jan 23, 2025
Host Dr. Randy Lehman welcomes Dr. Konstantin Grigoryan, dermatologist and Mohs surgeon, to uncover his unique journey toward becoming a surgeon and explore the intricacies of skin cancer management. With skin cancer being a prevalent challenge in rural surgery settings, Dr. Grigoryan highlights the precision and benefits of the Mohs technique. Whether you're a surgeon seeking to refine your understanding of this specialized approach or simply interested in the art and science of dermatologic surgery, this episode offers valuable insights and practical takeaways.
0:00 Intro
1:37 Dr. Grigoryan’s Background
5:51 How I Do It: Mohs Surgery
17:09 How I Do It: Skin Grafts
34:12 Financial Corner
35:20 Classic Rural Surgery Stories
45:23 Resources for the Busy Rural Surgeon
45:58 How I Do It: Benign Skin Cyst
Resources mentioned:
DermNet NZ
Friday Jan 17, 2025
Friday Jan 17, 2025
Host Dr. Randy Lehman welcomes Dr. Shannon Gulley, a seasoned general surgeon with 20 years in practice, including the last decade operating in Alaska. She shares practical insights on personal finances as well as codes and modifiers, with an overall emphasis on maximizing your efforts and your income as a surgeon. With experience both as an employed surgeon and a practice owner, Dr. Gulley shares her thoughts on the two and dives into thyroidectomy and anterior spine exposure in a bonus “How I Do It” segment.
0:00 Intro
6:15 Dr. Gulley’s Background
21:31 How I Do It: FNA and Thyroidectomy
36:41 Financial Corner
38:18 Classic Rural Surgery Anecdotes
39:45 Resources for the Busy Rural Surgeon
40:30 How I Do It: Anterior Spine Exposure
Resources mentioned:
American College of Surgeons
American Society of Breast Surgeons
Mayo Clinic
QuickBooks
Thursday Jan 09, 2025
Thursday Jan 09, 2025
Looking ahead to the upcoming NARSS conference on January 17-18 in Denver, Dr. Randy Lehman explores the pivotal role of the North American Rural Surgical Society in supporting rural surgeons. He delves into the society's rich history and traces its evolution from the Northern Plains Vascular Society to its current form. He shares his personal experiences at the annual NARSS conference, highlighting its significance as a hub for practical learning and networking and how it has impacted his rural practice for the better.
0:00 Intro
0:51 North American Rural Surgical Society
6:01 Upcoming conference details
Resources Mentioned:
North American Rural Surgical Society (NARSS)
Thursday Jan 02, 2025
Thursday Jan 02, 2025
Host Dr. Randy Lehman welcomes Dr. Jeremy "Bud" Stoller, a distinguished rural surgeon from Van Wert, Ohio. Known for his expertise in hernia repair and his commitment to rural healthcare, Dr. Stoller shares his journey from training at The Ohio State University and the University of Toledo to practicing in his hometown. Dr. Stoller details his approach to ventral hernia repair and his excitement for utilizing robotics in his small-town hospital setting.
0:00 Intro
5:10 Dr. Stoller’s Background
12:29 How I Do It: Ventral Hernia Repair
37:02 Financial Corner
39:01 Classic Rural Surgery Anecdotes
43:06 Resources for the Busy Rural Surgeon
Resources Mentioned:
International Hernia Collaboration
SurgeOn app
General Surgery News
American College of Surgeons (ACS) forums
Thursday Dec 26, 2024
Thursday Dec 26, 2024
Host Dr. Randy Lehman and Dr. Tod Stillson have a heartwarming conversation about the importance of transparency and trust when it comes to small town healthcare–especially in family medicine when you have the opportunity to serve families through many stages of life. In addition to discussing the impact of closing obstetrics units in rural hospitals, Dr. Stillson shares insights on achieving financial independence and introduces his “Employment Lite” model, which combines the benefits of traditional employment with private practice. This episode might just save a rural surgeon a few hundreds of thousands of dollars over the years!
0:00 Intro
3:43 Dr. Stillson’s Background
7:51 Rural Maternity Unit Closures
9:12 Financial Corner
31:45 Resources for the Busy Rural Surgeon
36:17 Classic Rural Surgery Anecdotes
41:28 Resources for the Busy Rural Surgeon
Resources mentioned in this episode:
Doctor Incorporated book
Donor Advised Funds
SimpliMD