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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:

E27: Bringing Complex Procedures Back to Rural Roots with Dr. Rebekah Wever Apr 10, 2025

Show notes

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 Apr 03, 2025

Show notes

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 Mar 13, 2025

Show notes

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 Mar 06, 2025

Show notes

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

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 Feb 27, 2025

Show notes

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 Feb 13, 2025

Show notes

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:

Rural American Surgeon Facebook page

Critical Access Hospital program

E21: Technology Disruptors in Rural Medicine with Dan Leman - Part 1 Feb 01, 2025

Show notes

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:

BMDMI
When Helping Hurts book

E20: Mohs Surgery and Skin Grafts with Dr. Konstantin Grigoryan Jan 23, 2025

Show notes

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:

E19: General Surgery in the Last Frontier with Dr. Shannon Gulley Jan 17, 2025

Show notes

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

E18: Evolution of the North American Rural Surgical Society Jan 10, 2025

Show notes

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)

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