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/

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

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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

In this episode of The Rural American Surgeon, host Dr. Randy Lehman is joined by renowned thoracic surgeon Dr. Shanda Blackmon. With a career spanning MD Anderson, Mayo Clinic, and now Baylor College of Medicine, Dr. Blackmon brings a wealth of knowledge on lung and esophageal cancer screening, staging, and treatment.

They walk through practical approaches to lung cancer screening, esophageal reflux evaluation, staging workups, and the impact of new therapies. There’s also an honest conversation about what palliative care really means in a rural setting, and how to know when “doing more” might not be better.

Whether you’re doing EGDs, managing smoking histories, or counseling patients on cancer risk, this conversation is full of insight for everyday decision-making in rural surgery.

0:00 Intro
1:16 Dr. Blackmon’s Background
5:15 Why Thoracic Surgery Is Special to You
9:17 Palliative Care & End-of-Life in Rural Practice
17:19 Lung Cancer Screening & Workup
27:54 Esophageal Cancer & Upper Endoscopy
49:36 Lung Cancer Treatment Strategies
58:13 Surgery After Immunotherapy
1:00:32 Financial Corner
1:10:41 Classic Surgery Story
1:13:07 Resources for the Busy Rural Surgeon

Resources Mentioned:

AJCC Staging Manual:
https://www.facs.org/quality-programs/cancer/ajcc/

NCCN Guidelines:
https://www.nccn.org/guidelines/

USPSTF Screening Guidelines:
https://www.uspreventiveservicestaskforce.org

We all want to set our kids up for success, but that doesn't just mean tossing them a pile of money.

In this episode, Dr. Randy Lehman shares how he talks to his kids about money, work, value, and responsibility—and why teaching them to earn and invest is more important than handing them a big inheritance.

From selling eggs to reading Laura Ingalls Wilder, he shares stories and ideas that shape how he's raising capable, kind, financially wise adults.

It's part money, part parenting, and all about what it really means to pass something on.

0:00 Intro
0:23 Why money lessons start early
1:21 What the culture gets wrong about getting rich
3:18 Rights vs. goods and services
6:10 Why we don’t do allowance
9:31 A story from Farmer Boy that says it all
16:45 Inheritance, legacy, and what actually matters
20:55 Why we talk about money, faith, politics, and more with our kids
23:42 What's next in the series

Resources Mentioned:
Farmer Boy by Laura Ingalls Wilder
The FFA Creed: "Less need for charity and more of it when needed"
Tuttle Twins book series

🌐 Connect with The Rural American Surgeon:
https://www.theruralamericansurgeon.com/

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

What happens when a seasoned Swedish surgeon shares his global perspective on bariatrics, rural surgery, and the personal cost of a life in the OR?

In this episode, Dr. Randy Lehman welcomes Dr. Adrian Sava, a bariatric and general surgeon based in southern Sweden. With nearly 30 years in surgery, Dr. Sava reflects on his journey through academic training, private practice, and cross-border rural surgery in Norway.

They dig into technical details of the Roux-en-Y gastric bypass, debate the role of robotic surgery, and compare healthcare systems between Europe and the U.S.

But this episode isn’t just about operations…it’s about finding balance, maintaining humility, and preserving purpose in a high-stakes profession.

Dr. Sava opens up about family sacrifice, burnout, and faith—sharing how a CT-negative fishbone reaffirmed his trust in clinical instinct, and how a difficult colostomy case helped him regain perspective on the balance between professional duty and personal identity.

0:00 Intro
1:11 Dr. Sava’s Background and Surgical Training
6:57 Practicing Bariatrics in Sweden
13:42 Swedish vs. American Rural Surgery
17:04 Private Practice, Public Insurance, and the Economics of Care
26:56 Why Surgery Is Special to Dr. Sava
30:55 How I Do It: Roux-en-Y Gastric Bypass
55:45 Financial Corner: Surviving Surgery with Discipline
59:13 Classic Surgery Stories from Sweden
1:07:06 Resources for the Busy Rural Surgeon
1:13:12 Finding Balance Through Faith

Resources Mentioned:

IFSO Congress (International Federation for the Surgery of Obesity and Metabolic Disorders): https://www.ifso.com/

Swedish College of Surgeons

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:
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In today’s installment of the Money Miniseries, Dr. Randy Lehman takes a personal turn into the topic of legacy and what it means to give well.

This isn’t just about donating money. It’s about stewarding what you have—finances, time, talent—with the belief that it was never yours to begin with.

From reflections on attending the memorial of Charlie Kirk, to the contrasting worldviews of justice vs. mercy, to practical insights on donor advised funds, we explore what it means to give while you’re living.

The hope at the end of this episode is that you’ll be asking: What will I be remembered for?

0:00 Intro
1:25 Legacy and the Charlie Kirk Memorial
3:59 What Will You Be Remembered For?
7:14 Justice vs. Mercy
15:32 Tithing and the Posture of Giving
19:18 Donor Advised Funds and Tax-Advantaged Generosity
24:40 Giving Beyond Money
28:21 Model, Document, and Pass It On

🌐 Connect with The Rural American Surgeon:
https://www.theruralamericansurgeon.com/

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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:
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