The Rural American Surgeon

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 Intro1:11 Pharmacy School Rejection & Pivot5:49 Discovering Rural Surgery13:36 The Town With Too Many Surgeons…18:22 Buying My Childhood Clinic (And Meeting My Wife)25:04 Liberty Clinic: Vision, Reality, and $30K Losses28:58 The Surrender Prayer36:41 Termination44:44 A Lesson in Difficult Partnerships48:39 Why Financial Margin Matters54:53 Final Reflections on Resilience

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 Intro1:16 Dr. Blackmon’s Background5:15 Why Thoracic Surgery Is Special to You9:17 Palliative Care & End-of-Life in Rural Practice17:19 Lung Cancer Screening & Workup27:54 Esophageal Cancer & Upper Endoscopy49:36 Lung Cancer Treatment Strategies58:13 Surgery After Immunotherapy1:00:32 Financial Corner1:10:41 Classic Surgery Story1:13:07 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

Money Miniseries 7: How I Talk to My Kids About Money

We all want to set our kids up for success, but that doesn't just mean tossing them a pile of money.
In this episode, Dr. Randy Lehman shares how he talks to his kids about money, work, value, and responsibility—and why teaching them to earn and invest is more important than handing them a big inheritance. 
From selling eggs to reading Laura Ingalls Wilder, he shares stories and ideas that shape how he's raising capable, kind, financially wise adults.
It's part money, part parenting, and all about what it really means to pass something on.
0:00 Intro 0:23 Why money lessons start early 1:21 What the culture gets wrong about getting rich 3:18 Rights vs. goods and services6:10 Why we don’t do allowance 9:31 A story from Farmer Boy that says it all 16:45 Inheritance, legacy, and what actually matters 20:55 Why we talk about money, faith, politics, and more with our kids23:42 What's next in the series
Resources Mentioned:Farmer Boy by Laura Ingalls WilderThe FFA Creed: "Less need for charity and more of it when needed"Tuttle Twins book series
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The Truth About Surgical Responsibility with Dr. Adrian Sava

What happens when a seasoned Swedish surgeon shares his global perspective on bariatrics, rural surgery, and the personal cost of a life in the OR?
In this episode, Dr. Randy Lehman welcomes Dr. Adrian Sava, a bariatric and general surgeon based in southern Sweden. With nearly 30 years in surgery, Dr. Sava reflects on his journey through academic training, private practice, and cross-border rural surgery in Norway.
They dig into technical details of the Roux-en-Y gastric bypass, debate the role of robotic surgery, and compare healthcare systems between Europe and the U.S. 
But this episode isn’t just about operations…it’s about finding balance, maintaining humility, and preserving purpose in a high-stakes profession.
Dr. Sava opens up about family sacrifice, burnout, and faith—sharing how a CT-negative fishbone reaffirmed his trust in clinical instinct, and how a difficult colostomy case helped him regain perspective on the balance between professional duty and personal identity.
0:00 Intro1:11 Dr. Sava’s Background and Surgical Training6:57 Practicing Bariatrics in Sweden13:42 Swedish vs. American Rural Surgery17:04 Private Practice, Public Insurance, and the Economics of Care26:56 Why Surgery Is Special to Dr. Sava30:55 How I Do It: Roux-en-Y Gastric Bypass55:45 Financial Corner: Surviving Surgery with Discipline59:13 Classic Surgery Stories from Sweden1:07:06 Resources for the Busy Rural Surgeon1:13:12 Finding Balance Through Faith
Resources Mentioned:
IFSO Congress (International Federation for the Surgery of Obesity and Metabolic Disorders): https://www.ifso.com/
Swedish College of Surgeons🌐 Connect with The Rural American Surgeon:
https://www.theruralamericansurgeon.com/
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Money Miniseries 6: Legacy

In today’s installment of the Money Miniseries, Dr. Randy Lehman takes a personal turn into the topic of legacy and what it means to give well.
This isn’t just about donating money. It’s about stewarding what you have—finances, time, talent—with the belief that it was never yours to begin with.
From reflections on attending the memorial of Charlie Kirk, to the contrasting worldviews of justice vs. mercy, to practical insights on donor advised funds, we explore what it means to give while you’re living.
The hope at the end of this episode is that you’ll be asking: What will I be remembered for?
0:00 Intro1:25 Legacy and the Charlie Kirk Memorial3:59 What Will You Be Remembered For?7:14 Justice vs. Mercy15:32 Tithing and the Posture of Giving19:18 Donor Advised Funds and Tax-Advantaged Generosity24:40 Giving Beyond Money28:21 Model, Document, and Pass It On
🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ 
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Why This Family Doctor Does C-Sections with Dr. Brogan Bahler

A family doc taking on surgery in rural America?
That’s what Dr. Brogan Bahler is doing as a rural family physician who has carved out a full-scope OBGYN practice, including C-sections, D&Cs, hysteroscopies, and more.
In today’s conversation, Dr. Bahler and Dr. Randy Lehman discuss:
How residency moonlighting helped prepare him for surgical OB
Why rural hospitals shut down OB—and what that means for local care
What general surgeons need to know to safely assist or perform C-sections
How to credential yourself for surgical OB privileges
Details on how he performs a C-section
Whether you're a rural general surgeon, FMOB, or still in training, this episode is a powerful look at what it means to step up when your community needs you most.
0:00 Introduction0:41 Dr. Bahler’s Background & Training Path2:59 Surgical OB Without an FMOB Fellowship5:21 How Many C-Sections Are Enough?12:06 C-Section Skills Every Rural Surgeon Should Know14:55 Emergency C-Sections & Locums Work18:15 Building OB Volume in a Rural Practice23:57 From Family Med to Full-Time OB-GYN25:23 Why Rural OB-GYN Is Special26:18 How I Do It: C-Section29:06 Resources for the Busy Rural Surgeon31:48 Financial Corner38:51 Classic Rural Surgery Stories
Resources Mentioned:
https://www.acog.org/
🌐 Connect with The Rural American Surgeon:
https://www.theruralamericansurgeon.com/
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Money Miniseries 5: Efficiency

What does it really mean to be efficient?
In this fifth installment of the Money Miniseries, Dr. Randy Lehman takes us deep into the philosophy and practical tactics of operating with maximum efficiency–whether you’re in the OR, clinic, or managing investments.
From streamlining surgical workflows to understanding your personal dollar-per-hour, this episode covers it all. Dr. Lehman shares his real-world methods for doing laparoscopic cholecystectomy in 18 minutes, maximizing passive income from real estate, and building a practice that works for you (not the other way around).
He also issues a challenge: what are you doing that doesn’t even need to be done?
This episode is for rural surgeons, high-performers, and anyone who wants to reclaim their time, energy, and money by focusing on what really matters.
0:00 Introduction0:35 One Year of the Show2:02 Defining Efficiency4:01 Efficiency in Surgery11:36 What’s the Point of Efficiency?12:34 The Dollar Per Hour Framework15:26 Efficiency in the Clinic vs. the OR20:34 Replacing Yourself22:24 How I Tracked Every Surgical Case I’ve Ever Done26:17 Real Estate29:35 Passive Income as the Ultimate ROI32:02 The Rock Over the Hill: Levels of Financial Freedom34:45 Stop Doing the Wrong Things36:37 Final Reflections and Next Steps
Connect: 
https://www.theruralamericansurgeon.com/ 

E45: Nasty Gallbladders and Negotiating Contracts | Dr. Seung Gwon (Part 2)

What do you do when the gallbladder just won’t behave—and the duct isn't clear?
 
In Part 2 of our conversation, Dr. Randy Lehman and Dr. Seung Gwon get deep into advanced gallbladder surgery, rural surgical reality, and the wisdom behind bailout decisions. From fenestrated cholecystectomies to lost stones, lost nights of sleep, and lost support staff, Dr. Gwon outlines the tactical and mental tools rural surgeons need to stay sharp and stay sane.
 
Then they head into the financial corner, discussing disability insurance, budgeting philosophies, and how new surgeons can avoid lifestyle creep. Dr. Gwon closes with a memorable hernia case and two essential resources every rural surgeon should know about.
 
If Part 1 was about building a career, Part 2 is about protecting it.
0:00 Introduction0:41 How I Do It: Acute Gallbladder Surgery (Continued)25:21 Financial Corner30:40 Classic Rural Surgery Story36:05 Can You Reinforce an Open Repair with Laparoscopy?37:02 Resources for the Busy Rural Surgeon
Resources Mentioned:
International Hernia Collaboration (Facebook Group)
Women in Rural Surgery (Facebook Group)
American Hernia Society
ACS Video LibrarySAGES Video Library

E44: Nasty Gallbladders and Negotiating Contracts | Dr. Seung Gwon (Part 1)

What if you could design your own job out of residency…and make it stick for 20 years?
 
In Part 1 of this two-part episode, Dr. Randy Lehman sits down with Dr. Seung Gwon, a general surgeon from El Centro, California, to explore what it takes to build—and keep—a solo rural practice. They dive deep into income guarantees, sign-on bonuses, practice models, and the realities of mentorship (or lack thereof) when you go independent.
 
Dr. Gwon walks through her early contract, how she avoided debt, and why she still prefers solo practice even after years of cross-coverage and evolving hospital partnerships. Then they jump into technique: gallbladders in rural America, why these cases are tougher than in residency, and how Dr. Gwon has refined her approach over hundreds of challenging cases.
 
If you’ve ever considered going solo or wondered how to safely handle a gallbladder that’s “nothing like you saw in training,” this episode is for you.
 
0:00 Intro
1:07 Dr. Gwon’s Background
2:28 Why I Stayed in Rural Surgery
5:51 Income Guarantee & Starting Solo
9:25 Practice Model Evolution
11:15 Call Coverage & Compensation
13:11 Dr. Lehman’s Practice Journey
21:45 Four Models of Surgical Employment
22:11 You Have Negotiating Power
27:21 How I Do It: Acute Gallbladder Surgery
52:47 Three Memorable Open Cases

E43: Money Miniseries 4: Our “Secret Weapon” Tax Strategy (My Wife)

In this episode of the Money Miniseries, Dr. Randy Lehman sits down with a very special guest—his wife, Brittaney—to share the tax strategy that’s become a cornerstone of their financial plan: Real Estate Professional Status (REPS).
They walk through what REPS is, why it’s so powerful for high-income households, and how Brittaney’s role as a full-time real estate professional allows them to combine active and passive income for significant tax advantages. From tracking hours and managing properties to navigating cost segregation and bonus depreciation, this episode is packed with practical, real-world insights.
Along the way, they share personal stories of fear, learning, teamwork, and even a few landlord-tenant adventures that reveal how relationships, integrity, and persistence create opportunities.
Whether you’re a surgeon looking to optimize your tax strategy, a spouse considering REPS, or just curious about how to leverage real estate for long-term wealth and freedom, we hope this conversation will provide both inspiration and actionable takeaways!0:00 Introduction2:19 What REPS is and who it benefits6:10 IRS rules and meeting the requirements8:02 Why commercial real estate works for us9:27 Finding the right CPA and legal team11:20 Brittaney’s daily role and family flexibility14:32 From fear to confidence in real estate18:22 Active vs passive income and depreciation23:31 Cost segregation and bonus depreciation29:48 Four ways real estate pays you36:58 COVID tenant challenge and negotiation44:35 Parking dispute and preserving relationships48:57 Integrity snowball and off-market deals54:16 Other income levers and closing thoughts
 
Resources Mentioned:
Real Estate CPA Podcast: https://www.therealestatecpa.com/podcast 
BiggerPockets: https://www.biggerpockets.com/ 
IRS Guidelines on Real Estate Professional Status: https://www.irs.gov/taxtopics/tc42