Today, Dr. Randy Lehman sits down with a surgeon who traded stability for autonomy.

Dr. Amy Vertrees, an Army-trained general surgeon who built a thriving private practice covering three hospitals, breaks down the challenges and victories of modern rural surgery.

They explore what makes rural practice unique, why fellowship isn’t always necessary, and how to build a surgical team that lasts.

Plus, a candid conversation on hernia repair (when to go open vs. laparoscopic vs. robotic) and the complications that keep rural surgeons up at night.

Surgeons at any stage will find practical insights into training choices, private practice, and long-term sustainability in rural surgery.

0:00 Intro

0:13 Dr. Vertrees’ Background

2:12 Inside Private Practice

5:58 Building a Multi-Hospital Rural Surgery Group

9:26 Hub-and-Spoke Models & Surgeon Recruitment

16:10 Inguinal Hernia Volume

20:14 How I Do It: Inguinal Hernia Repair Philosophy

32:48 Confidence, Training, and Choosing the Right Operation

Resources Mentioned:

Connect with Dr. Vertrees:

https://www.bosssurgery.com/

🌐 Connect with The Rural American Surgeon:

https://www.youtube.com/@ruralAmericanSurgeon

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

Is it possible to build a surgical practice from scratch…on your terms…in the hometown you dreamed of serving?

Dr. Randy Lehman is proof that it is, and he’s an open book about his journey with the next generation of surgeons.

In this special Q&A episode, Dr. Lehman sits down with two med students from Baylor College of Medicine's Student Surgical Society to share the story of his path into rural surgery and how he’s built his practice.

They discuss training with intention, avoiding common early-career pitfalls, choosing high-value skillsets, and navigating the hidden politics of hospital privileges.

If you're a med student or resident eyeing rural surgery (or just want a brutally honest look at what it takes), tune in and join the community.

0:00 Intro

0:41 Baylor Student Surgical Society

5:06 Choosing Surgery vs. ER Medicine

11:35 Owning Your Training as a Future Rural Surgeon

17:55 What Rural Surgeons Actually Do Day-to-Day

25:59 Building a Multi-Hospital Rural Practice

31:47 Compensation, Value, and Why Rural Surgery Pays

42:37 High-Value Skills

1:01:21 Making High-Stakes Decisions in Isolation

1:04:34 Practical Surgical Insights and Risk Management

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 Intro
1:11 Pharmacy School Rejection & Pivot
5:49 Discovering Rural Surgery
13:36 The Town With Too Many Surgeons…
18:22 Buying My Childhood Clinic (And Meeting My Wife)
25:04 Liberty Clinic: Vision, Reality, and $30K Losses
28:58 The Surrender Prayer
36:41 Termination
44:44 A Lesson in Difficult Partnerships
48:39 Why Financial Margin Matters
54:53 Final Reflections on Resilience