The Rural American Surgeon

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 too...

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 t...

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 combi...

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...

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....

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...

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 mo...

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 surge...

Introducing a new miniseries on money—starting with the question beneath the dollars: What’s the point?   Before we talk finance, we’re digging into foundations. In this episode, Dr. Randy Lehman shares an unexpected conversation with ChatGPT about evolution, intelligent design, and the meaning of existence—revealing why, for him, the evidence points to faith over chance.   But this isn’t just abo...

What happens when a rural hospital loses its only surgeon and faces closure?   Host Dr. Randy Lehman welcomes Dr. Manu Kaushik, who stepped in to save a dying critical access hospital in Greenville, Alabama. After 40 years of service, the hospital's longtime surgeon retired, COVID hit, and the OR shut down completely - threatening the entire community's access to care.    Dr. Kaushik shares his in...

How do you perform a carotid endarterectomy with confidence while ensuring patient safety in a rural setting?   Host Dr. Randy Lehman welcomes Dr. Michael Roskos, his former program director for the rural surgery track at Mayo Clinic, to dive deep into this critical procedure. They explore patient selection criteria, detailed surgical techniques, and the evolution of vascular surgery practice over...

What does it take to bring advanced foregut surgery to a rural hospital? Host Dr. Randy Lehman sits down with Dr. Greg Gerrish, a third-generation surgeon practicing in South Dakota, to talk shop on the real-world challenges and wins of rural surgical care. From Barrett’s esophagus to emergency thoracotomies, Dr. Gerrish brings both technical depth and day-to-day experience to the conversation. Th...

What happens when Mayo Clinic precision meets small-town grit? Dr. Randy Lehman sits down with Dr. Kabir Mehta, who never expected to land in Hazard, Kentucky–population 5,000–but now finds deep purpose in bringing advanced bariatric care to a region where patients used to drive hours for a specialist.  This honest doctor's lounge conversation covers the real stuff: Dr. Mehta’s surgical strategies...

What does it take to thrive as a rural surgeon for over four decades?  Host Dr. Randy Lehman welcomes Dr. P.J. Reddy, a most adaptable and resourceful rural surgeon who shares his journey from India to settling in Kansas, where he practiced for 41 years.  Dr. Reddy discusses his experience with colonoscopies, offers financial insight for medical students, and emphasizes the importance of a broad s...

What makes rural surgery uniquely rewarding and challenging?  Host Dr. Randy Lehman welcomes one of the greats–Dr. Gary Timmerman, a distinguished surgeon from South Dakota–to share his journey and insights into rural surgical practice.  Dr. Timmerman discusses his career path, the role his faith has played throughout his many years of surgery, and offers a detailed exploration of esophagectomy te...

How can rural surgeons navigate the complexities of modern surgical techniques while maintaining financial stability?  Host Dr. Randy Lehman welcomes back Dr. Eugene Shively, a retired general surgeon from Campbellsville, Kentucky, to explore this question. They discuss the critical role of rural surgery, delve into common bile duct exploration techniques, and examine the growing presence of robot...

A family emergency gave Dr. Randy Lehman an unexpected perspective—from the waiting room instead of the operating room. In this episode, he shares the story of his grandfather’s emergency gallbladder surgery and how that experience reshaped his approach to rural surgical care. From the weight of urgent decisions to the strain of limited resources, Dr. Lehman reflects on how these events transforme...

For Dr. Randy Lehman, “rushing to surgery” sometimes means taking to the skies. In this episode, he shares how aviation became an unexpected solution to some of rural healthcare’s biggest hurdles: time, distance, and access. From unforgettable landings to the real-world logistics of owning and flying a helicopter, Dr. Lehman gives us a front-row seat to how this unconventional approach is transfor...

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 d...

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...

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 f...

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...

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...

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 a...

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...