The Rural American Surgeon

E20: Mohs Surgery and Skin Grafts with Dr. Konstantin Grigoryan

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

E19: General Surgery in the Last Frontier with Dr. Shannon Gulley

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

E18: Evolution of the North American Rural Surgical Society

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)

E17: Robotic Ventral Hernia Repair with Dr. Jeremy Stoller

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

E16: Big Impact in Small Town Family Medicine with Dr. Tod Stillson

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
 

E15: Rural Surgery Research with Dr. Dorothy Hughes

As part of this new miniseries, "The Children of Rural Surgeons," host Dr. Randy Lehman welcomes Dr. Dorothy Hughes, daughter of esteemed rural surgeon, Dr. Tyler Hughes. Their conversation delves into her experiences growing up with a small-town surgeon for a father and how that impacted her upbringing. And ultimately, how Dr. Dorothy Hughes came full circle to rural surgery from an academic perspective, including some of the compelling research she's done in this field. 
 
0:00 Intro
1:10 Dr. Dorothy Hughes’ Background
5:55 Growing Up as the Child of a Rural Surgeon
15:37 How I Do It: Rural Surgery Research
19:43 Financial Corner
23:01 Classic Rural Surgery Anecdotes
25:01 Resources for the Busy Rural Surgeon
 
Resources Mentioned:
 
Trailblazing Rural Surgery with Dr. Tyler Hughes
North American Rural Surgical Society
Selected Readings in General Surgery
Dr. Dorothy Hughes’ Google Scholar account

E14: "My Dad's a Rural Surgeon!" with Charlotte Lehman

In this heartfelt episode, Dr. Randy Lehman is joined by two very special guests, his daughter Charlotte and a surprise appearance by his wife, Brittaney. Together they reflect on the demanding days of residency in Minnesota, and how the transition to rural practice in Indiana has impacted their family life and balance.
 
Charlotte describes her dad’s work as candidly and charmingly as only an 8-year-old can (“lots of gross surgeries!”) and reflects on how much more she gets to see her dad now compared to the days of residency. This fun and lighthearted episode not only provides insights into the professional life of a rural surgeon with small children, but also underscores the personal aspects of being present with family throughout a demanding career. 

E13: GI Bleeds in Rural Canada with Dr. Emily Mitic

Explore surgical care in rural Canada through the perspective of host Dr. Randy Lehman as he sits down with Canadian general surgeon, Dr. Emily Mitic. Dr. Mitic is dedicated to serving rural Alberta, practicing in a small city uniquely positioned between two major urban centers, which means her hospital serves a greater population of about 425,000 people. Tune in for a detailed walkthrough of Dr. Mitic’s approach to GI bleeds, a discussion of some distinctions between American and Canadian healthcare, and a lively rural surgery anecdote!
[00:00] Introduction
[00:55] Dr. Mitic’s Background
[07:42] How I Do It: GI Bleed 
[30:43] Financial Corner: Canadian Healthcare
[37:57] Classic Rural Surgery
[42:12] Resources for the Busy Rural Surgeon
Resources Mentioned:
Huber Ag Equipment
American College of Colorectal Surgeons Guidelines

E12: From Residency to Rural with Dr. Ben Mundell

Host Dr. Randy Lehman sits down with Dr. Ben Mundell, a newly minted general surgeon carving out his path in the Eastern Sierras of California. Together they discuss what it takes to thrive as a rural surgeon, especially in those crucial early months out of residency. Tune in for practical advice, invaluable insights, and must-know resources for making a successful transition from residency to rural practice.
 
0:00 - Introduction 4:16 - Challenges Facing Rural Hospitals09:00 - Dr. Lehman's Early Career Insights 13:00 - Handling Complex Cases in Rural Practice18:40 - Expanding Surgical Scope in Rural Hospitals26:30 - How I Do It: Laparoscopic Inguinal Hernia Repair44:00 - Resources for the Busy Rural Surgeon 
 
Resources Mentioned:
UpToDate
North American Rural Surgical Society

E11: The Value of Surgical Mentorship with Dr. Eugene Shively

Host Dr. Randy Lehman sits down with friend, mentor, and "godfather" of rural surgery, Dr. Eugene Shively to discuss his impressive 46-year career. From the comfort of Dr. Shively's 200-year-old cabin (listen for the full story!), the two discuss the evolution of surgical techniques, Dr. Shively's approach to common bile duct exploration, and invaluable advice for residents who plan to pursue a career in rural surgery.
 
[0:00] Introduction
[0:48] Dr. Shively’s Background
[10:25] How I Do It: Common Bile Duct Exploration
[25:50] Financial Corner
[31:51] Classic Rural Surgery
[39:13] Resources for the Busy Rural Surgeon
[45:45] How I Do It: Perianal Procedures
[59:08] Importance of Having a Mentor
Resources Mentioned:
Podcast: Single Payer Health Care