Dr. Ronald Weigel returns for Part 2 of his conversation with host Dr. Randy Lehman on The Rural American Surgeon.

The discussion continues with a practical look at what cancer care rural hospitals can safely keep local, when patients should be referred, and how smaller hospitals can build sustainable surgical programs even without 24/7 general surgery coverage.

Dr. Weigel explains that common cancers such as breast cancer, colon cancer, melanoma, and some prostate cancers may be appropriate for rural treatment depending on the surgeon’s experience and the hospital’s capabilities.

The conversation then moves into patient-centered breast cancer care, including mastectomy, reconstruction, rural patient preferences, and why treatment decisions should reflect what individual patients actually want rather than assuming every community has the same priorities.

Dr. Weigel also discusses how Commission on Cancer accreditation, tumor boards, rural-specific quality metrics, and participation in the National Cancer Database can help improve care and generate better data about cancer treatment in rural communities.

Later, Dr. Lehman and Dr. Weigel get into the nuts and bolts of rural surgery, including recurrent breast abscesses, lumpectomy incision placement, margin techniques, thyroid and parathyroid surgery, and operative exposure.

The episode culminates in a direct discussion about whether rural surgeons should perform thyroid surgery without nerve monitoring.

Dr. Weigel shares why he has not routinely used nerve monitoring in his own thyroid practice, while emphasizing careful identification of the recurrent laryngeal nerve, surgeon judgment, appropriate patient selection, and knowing which procedures belong in each individual rural practice.

Key Takeaways

00:00 Welcome Back to Part 2

00:17 Cancer Care Without 24/7 Call

02:02 What Cancer Should Stay Local?

03:22 Investing in Rural Surgical Capability

04:14 Breast Cancer and Reconstruction

06:09 Understanding Rural Patient Preferences

10:14 Accreditation and Surgical Standards

10:57 Tumor Boards and Continuing Education

11:26 Building Rural Cancer Quality Metrics

13:01 Why Rural Cancer Data Matters

14:19 ACS Rural Cancer Resources

15:45 Building Trust With Rural Patients

21:13 Rural Surgical Case Decisions

22:24 Managing Recurrent Breast Abscess

25:09 Lumpectomy Incision Techniques

29:03 Using Shave Margins

32:42 Thyroid and Parathyroid Surgery Pearls

35:09 Bringing Endocrine Surgery Back Locally

36:29 Is Nerve Monitoring Necessary?

38:28 Parathyroid Surgery Without Intraoperative PTH

41:25 Deciding What Stays Local

41:53 Final Advice for Rural Surgeons

Resources Mentioned

American College of Surgeons

https://www.facs.org/ ACS

Commission on Cancer

https://www.facs.org/quality-programs/cancer-programs/commission-on-cancer/ ACS

National Cancer Database

https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/ ACS

University of Iowa

https://uiowa.edu/ uiowa.edu

American Board of Surgery

https://www.absurgery.org/

ACS Rural Cancer Programs

https://www.facs.org/quality-programs/cancer-programs/

Dr. Ronald Weigel joins host Dr. Randy Lehman on The Rural American Surgeon to discuss the American College of Surgeons Commission on Cancer’s new rural accreditation pathway and what it could mean for hospitals, surgeons, and cancer patients in rural communities.

Dr. Weigel shares his path from engineering and surgical training at Duke to cancer research, leadership at the University of Iowa, and his current role as medical director of cancer programs for the American College of Surgeons.

The conversation then turns to the challenges of delivering cancer care in rural America, where patients may face long travel distances, limited access to general surgeons and oncology specialists, and fewer hospital resources.

Dr. Weigel explains how the Commission on Cancer Rural Accreditation track was designed to adapt established cancer-care standards for smaller hospitals while helping more patients receive high-quality, guideline-concordant care closer to home.

Dr. Weigel also walks through the accreditation process, including cancer leadership, multidisciplinary care, registrars, data collection, site visits, and building referral networks when services such as medical oncology or radiation therapy are not available locally.

We also discuss how accreditation can strengthen rural cancer programs, increase patient volume, attract specialists, and reinforce the role of broad-spectrum general surgeons in maintaining viable rural hospitals.

Key Takeaways

00:38 Introducing Dr. Ronald Weigel and Rural Cancer Accreditation

02:08 From Engineering to Medicine and Surgery

02:44 Training at Duke and Lessons From Surgical Mentors

03:51 Developing a Leadership Style in Surgery

07:58 Surgical Training, Cancer Research, and Stanford

09:10 Becoming Chair of Surgery at the University of Iowa

10:16 Joining the American College of Surgeons Cancer Programs

12:37 Why Rural Cancer Accreditation Matters

14:18 Understanding the Needs of Rural Patients

17:12 Cancer Disparities in Rural Communities

17:31 How the Rural Commission on Cancer Accreditation Track Works

19:30 The Accreditation Process and Timeline

21:13 Building Multidisciplinary Cancer Care in Rural Hospitals

21:37 What Hospitals Need to Meet Accreditation Standards

24:46 Building Cancer Care Networks Without On-Site Oncology

26:13 How the ACS Supports Rural Hospitals Through Accreditation

27:51 Is Any Rural Hospital Too Small for Cancer Accreditation?

29:10 How Accreditation Can Strengthen Rural Surgical Programs

30:28 Supporting Multiple Surgeons in Rural Communities

31:22 The Broad Scope of Rural General Surgery

Resources Mentioned

American College of Surgeons

https://www.facs.org/ ACS

Commission on Cancer

https://www.facs.org/quality-programs/cancer-programs/commission-on-cancer/ ACS

National Cancer Database

https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/ ACS

University of Iowa

https://uiowa.edu/ uiowa.edu

American Board of Surgery

https://www.absurgery.org/

Dr. Levi Smucker joins host Dr. Randy Lehman on The Rural American Surgeon to discuss his path to rural general surgery, from growing up in Pennsylvania and training at Bassett Healthcare in Cooperstown to building his practice in Goshen, Indiana.

He shares how a close knit group of six surgeons has given him strong mentorship, broad operative experience, and the opportunity to develop his own areas of expertise while serving multiple hospitals.

Dr. Smucker also takes a practical look at pilonidal disease, walking through patient presentation, conservative management, the Gips procedure, excision, wound healing, and the Bascom cleft lift.

The conversation explores how he approaches recurrent and complex cases, technical considerations for different procedures, and the importance of choosing treatment based on the individual patient.

They also discuss cost sharing within local Plain Church communities, an unusual rural surgery case involving an esophageal food bolus, preparing for challenging cases without letting anxiety take over, and why mentorship remains so important for the next generation of rural surgeons.

Key Takeaways

00:38 Meet Rural General Surgeon Dr. Levi Smucker

01:20 From Pennsylvania to Rural Surgery in Indiana

02:18 Why Bassett Healthcare Was the Right Place to Train

02:52 Building a Career in a Supportive Rural Surgery Practice

04:21 Resources and Capabilities Across Three Hospitals

05:09 Finding a Surgical Niche in Rural Practice

05:52 Bringing Vascular Surgery Into General Surgery Practice

06:25 The Broad Spectrum of Rural General Surgery

08:30 Why Rural Surgery Still Matters

09:15 Understanding Pilonidal Disease

11:27 Evaluating Patients After a Pilonidal Abscess

12:09 Treatment Options for Pilonidal Disease

13:05 How the Gips Procedure Works

15:02 The Bascom Cleft Lift Procedure

16:43 Technical Approach to the Gips Procedure

18:13 Choosing the Right Treatment for Complex Cases

20:48 Performing the Bascom Cleft Lift

24:52 Creating an Off Midline Closure

26:03 Coding Considerations for Pilonidal Surgery

27:42 Lessons From Plain Church Communities and Cost Sharing

29:10 A Classic Rural Surgery Case

30:06 Preparing for Difficult Cases Without Burning Out

32:46 Why a Culture of Mentorship Must Be Passed On

Resources Mentioned

Bassett Healthcare

https://www.bassett.org/

Gehrig Surgical Associates

https://www.gerigsurgical.com/

Critical Access Hospitals

https://www.cms.gov/medicare/health-safety-standards/certification-compliance/critical-access-hospitals