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The Rural American Surgeon — Science
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.

Copyright: © Copyright 2024 All rights reserved.

Latest Episodes:

Why This Family Doctor Does C-Sections with Dr. Brogan Bahler Sep 27, 2025

Show notes

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 Introduction
0:41 Dr. Bahler’s Background & Training Path
2:59 Surgical OB Without an FMOB Fellowship
5:21 How Many C-Sections Are Enough?
12:06 C-Section Skills Every Rural Surgeon Should Know
14:55 Emergency C-Sections & Locums Work
18:15 Building OB Volume in a Rural Practice
23:57 From Family Med to Full-Time OB-GYN
25:23 Why Rural OB-GYN Is Special
26:18 How I Do It: C-Section
29:06 Resources for the Busy Rural Surgeon
31:48 Financial Corner
38:51 Classic Rural Surgery Stories

Resources Mentioned:

https://www.acog.org/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:
https://www.facebook.com/profile.php?id=61564305936854

Money Miniseries 5: Efficiency Sep 18, 2025

Show notes

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 Introduction
0:35 One Year of the Show
2:02 Defining Efficiency
4:01 Efficiency in Surgery
11:36 What’s the Point of Efficiency?
12:34 The Dollar Per Hour Framework
15:26 Efficiency in the Clinic vs. the OR
20:34 Replacing Yourself
22:24 How I Tracked Every Surgical Case I’ve Ever Done
26:17 Real Estate
29:35 Passive Income as the Ultimate ROI
32:02 The Rock Over the Hill: Levels of Financial Freedom
34:45 Stop Doing the Wrong Things
36:37 Final Reflections and Next Steps

Connect:

https://www.theruralamericansurgeon.com/

E45: Nasty Gallbladders and Negotiating Contracts | Dr. Seung Gwon (Part 2) Aug 28, 2025

Show notes

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 Introduction
0:41 How I Do It: Acute Gallbladder Surgery (Continued)
25:21 Financial Corner
30:40 Classic Rural Surgery Story
36:05 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 Library
SAGES Video Library

E44: Nasty Gallbladders and Negotiating Contracts | Dr. Seung Gwon (Part 1) Aug 21, 2025

Show notes

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) Aug 14, 2025

Show notes

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 Introduction
2:19 What REPS is and who it benefits
6:10 IRS rules and meeting the requirements
8:02 Why commercial real estate works for us
9:27 Finding the right CPA and legal team
11:20 Brittaney’s daily role and family flexibility
14:32 From fear to confidence in real estate
18:22 Active vs passive income and depreciation
23:31 Cost segregation and bonus depreciation
29:48 Four ways real estate pays you
36:58 COVID tenant challenge and negotiation
44:35 Parking dispute and preserving relationships
48:57 Integrity snowball and off-market deals
54:16 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

E42: ERCP Up Close: A Fellow’s Guide to Advanced Endoscopy | Dr. Benji Smith Aug 07, 2025

Show notes

What happens when you're learning one of surgery's most technical procedures from a living legend?

Dr. Benji Smith, an advanced endoscopy fellow training under the renowned Dr. Vitale in Louisville, joins host Dr. Randy Lehman to share his journey from general surgery residency to mastering ERCP.

The two discover a surprising connection to the same medical mission in Guaimaca, Honduras before diving into the nitty-gritty of procedures most surgeons only hear about in referral notes.

From scope positioning and sphincterotomy techniques to stent placement and EUS biopsies, Dr. Smith breaks down what makes this specialty so challenging and so critical.

Plus, find out why he actually enjoys treating pancreatitis patients (yes, really!) and a perspective shift that might change the way you think about collaborating with advanced endoscopists.

0:00 Introduction

1:03 Dr. Smith's Background

7:09 What We Have In Common

9:33 How I Do It: ERCP

22:26 How I Do It: EUS

38:54 Financial Corner

43:21 Classic Surgery Stories

53:21 Resources for the Busy Rural Surgeon

Resources Mentioned

🌐 ERCP Fellowship Program, University of Louisville: https://louisville.edu/medicine/departments/surgery/fellowships

🌐 Guaimaca Medical Mission, Honduras: https://www.honduranmission.org/

🌐 PRISMA Health Upstate General Surgery Program: https://academics.prismahealth.org/graduate-medical-education/residencies/general-surgery-greenville

E41: Money Miniseries 3: Investing Jul 31, 2025

Show notes

What if the biggest ROI isn’t measured in dollars, but in freedom?

In this third installment of his finance miniseries, Dr. Randy Lehman unpacks what it really means to invest—beyond the usual “just put it in a 401(k)” advice.

From real estate and business ownership to tax liens and even cattle, Dr. Lehman pulls back the curtain on investment opportunities most professionals never hear about. This episode isn’t just about growing wealth—it’s about understanding risk, stewarding wisely, and building a life that money alone can’t buy.

With personal stories of loss, faith, and lessons from the parable of the talents, Dr. Lehman invites you to rethink what it means to truly invest—in assets, in people, and in yourself.

0:00 Introduction

3:45 Beyond Stocks and Bonds: The Full Investment Spectrum

8:20 Understanding Risk

15:30 Risk Tolerance Through Life Stages

22:15 Personal Stories of Loss and Faith in Investing

35:40 The Biblical Foundation of Investment Strategy

42:10 From Debt Elimination to Asset Building

48:25 Real Estate

55:30 Business Ownership and Alternative Investments

1:02:15 Cash Flow vs. Appreciation Strategies

1:08:45 The Freedom That True Wealth Provides

E40: Bringing Robotics to Rural Alabama with Dr. Quince Gibson Jul 24, 2025

Show notes

What happens when you bring cutting-edge robotic surgery to one of the poorest regions in America?

Host Dr. Randy Lehman welcomes Dr. Quince Gibson, a UAB-trained general surgeon serving rural Alabama's Black Belt region. Born in Jamaica and shaped by a life-changing encounter with poverty in inner-city Baltimore, Dr. Gibson made the bold decision to leave a successful business career to pursue medicine. His mission: bring quality surgical care to communities where 31% of residents live below the poverty line.

Dr. Gibson shares his remarkable journey of establishing trust in a community skeptical of healthcare, the challenges and triumphs of implementing robotic surgery in a critical access hospital, and why the robot ultimately couldn't be sustained with just one surgeon. From managing post-operative bleeding without call coverage to performing emergency surgery with limited resources, he reveals the stark realities of rural surgery in America's most underserved regions.

Discover the three A's of surgical success, learn the technical details of robotic ventral hernia repair, and understand why sometimes the most advanced technology isn't the answer to healthcare disparities.

0:00 Introduction

1:16 Dr. Gibson's Background

5:25 Why Rural Surgery Is Special to You

29:40 How I Do It: Robotic Ventral Hernia Repair

54:02 Financial Corner

1:00:32 Classic Rural Surgery Stories

1:17:28 Resources for the Busy Rural Surgeon

Resources Mentioned

📚 “Atomic Habits” by James Clear: https://a.co/d/dV7BWeH

📚 “The Talent Code” by Daniel Coyle: https://a.co/d/fxzAOVU

🌐 UAB Rural Surgery Program: https://www.uab.edu/medicine/home/education/md-program/rural-medicine/rural-medicine-program

E39: Money Miniseries 2: Freedom in Frugality Jul 17, 2025

Show notes

Beyond the 'why' of money lies the 'how'—and it starts with a practical paradox most doctors never hear: the less you need, the richer you become.

What if the secret to true wealth isn't earning more, but spending less? In episode two of his finance miniseries, host Dr. Randy Lehman reveals why frugality is the unsung hero of wealth building. This isn't about pinching pennies or living like a monk—it's about buying back your freedom.

Dr. Lehman shares his remarkable journey from a negative $150,000 net worth in residency to positive $400,000 by graduation, achieved through four strategic moves that most doctors never consider. From his $83,000 house two blocks from the hospital to the 12-unit apartment deal that taught him everything about real estate investing, Dr. Lehman demonstrates why your spending dictates your freedom more than your income ever will.

Discover the 4% rule, learn why minimalism is the upgrade to frugality, and understand how living below your means creates the margin needed for true financial independence.

0:00 Introduction

2:45 The FIRE Movement and 4% Rule

8:30 Frugality vs. Scarcity Mindset

12:15 The $83,000 House Story

18:20 Minimalism as an Upgrade

22:10 Four Ways to Build Net Worth in Residency

35:45 The 12-Unit Apartment Deal

42:30 Why Nothing is Permanent

44:15 From Saving Phase to Growth Phase

E38: The Colonoscopy Chronicles with Dr. Dan Margo Jul 10, 2025

Show notes

What happens when you're the only surgeon for hundreds of miles and every decision matters?

Host Dr. Randy Lehman welcomes Dr. Dan Margo, a seasoned rural surgeon from northern Minnesota, who has spent decades mastering the art of surgical practice in isolation. Dr. Margo shares hard-won insights from his years serving remote communities, including the unique challenges of being a visiting surgeon and the critical importance of collegiality in rural practice.

They dive deep into colonoscopy techniques–including abdominal pressure maneuvers and advanced lesion removal strategies–while exploring everything from Miralax prep protocols to pre-anesthesia evaluation timing. Dr. Margo demonstrates why rural surgeons must be master diagnosticians, skilled technicians, and compassionate caregivers all rolled into one.

Tune in for an inspiring episode filled with practical surgical wisdom from the frontlines of rural healthcare, where innovation is born from necessity and every patient interaction truly counts.

0:00 Introduction

2:58 Dr. Margo's Background

5:22 Why Rural Surgery Is Special to You

23:52 How I Do It: The Colonoscopy

1:35:40 Financial Corner

1:37:06 Resources for the Busy Rural Surgeon

Resources Mentioned:

🌐 Foregut Disease Foundation course: https://foregutdiseasefoundation.org/2025-course

🌐 North American Rural Surgical Society: https://www.northamericanrss.org/

🌐 American Society for Gastrointestinal Endoscopy (ASGE) Guidelines: https://www.asge.org/home/resources/publications/guidelines

🌐 Cologuard test (alternative screening method for colorectal cancer): https://www.cologuardtest.com/

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