Today Dr. Lehman sits down with the most special guest, his daughter Charlotte.

And this time, she’s in the host seat asking the hard-hitting questions!

She covers everything from fear in the operating room to money, parenting, and of course, the grossest thing dad’s ever seen in surgery.

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Locums surgery is often treated as temporary coverage, but many rural hospitals rely on it to maintain consistent access to care. Surgeons step in without relocating, often filling roles that cannot support full time hires.

Megan Hoot, a physician recruiter at CompHealth, has spent over eight years placing surgeons into roles that often become long-term solutions. She has worked closely with Dr. Randy Lehman across multiple assignments and brings a clear view of how these arrangements develop.

In this episode, Megan and Dr. Hoot break down how locums works in practice, including licensing, privileges, malpractice coverage, and how surgeons are selected and paid. They also address common misconceptions about ease and competition.

For rural surgeons, locums becomes a way to maintain coverage while building flexibility without sacrificing continuity.

0:00 Intro

01:54 Megan Hoot’s Background

11:14 Why Rural Surgery?

16:31 How I Do It: Locums Setup and Entry

39:44 Financial Corner: Locums Rates

58:55 Resources for the Busy Rural Surgeon

Resources Mentioned:

Book a call with Megan:

https://snshqsc.co/uVf0y3

CompHealth:

https://www.comphealth.com/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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

In rural surgery, there’s no “waiting until you feel ready.” There’s only action, because sometimes you’re the only one.

Dr. Scott Nelson, a colorectal surgeon in Grants Pass, Oregon, built a solo practice after losing his partner early in his career. What followed was years of figuring it out in real time, often without backup.

In this episode, Dr. Randy Lehman and Dr. Nelson break down what it actually looks like to grow into responsibility: managing cases outside your training, making decisions without a safety net, and learning through repetition, not confidence.

They also walk through practical approaches to common perianal disease, including hemorrhoids, fistulas, abscesses, and fissures in a rural setting.

From handling GI bleeds without formal training to building a full colorectal practice in isolation, this conversation highlights a core reality of rural medicine:

Competence often comes after you accept responsibility.

If you’re early in your career (or stepping into situations where you feel unprepared) this episode will shift how you interpret that feeling.

0:00 Intro

01:54 Dr. Nelson’s Background

04:23 Why Rural Surgery Is Special to You

14:26 How I Do It: Managing Perianal Disease

48:03 Financial Corner

53:31 Resources for the Busy Rural Surgeon

Resources Mentioned:

North American Rural Surgical Society:

https://www.northamericanrss.org/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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

In rural surgery, not everyone fits the environment the same way.

The work doesn’t slow down, and the community expects you to stay, serve, and carry responsibility without backup.

Today Dr. Randy Lehman speaks with Dr. Jesse Van Maanen, a rural general surgeon practicing near where he grew up. They examine why surgeons with rural roots or early commitment tend to integrate more naturally, and why moving rural to escape a busy system often fails.

The discussion centers on how that fit shows up in practice, from handling complex cases with limited staff to using robotics as a tool for control rather than convenience, and building trust through direct, honest patient conversations.

Rural surgeons will leave with practical takeaways: choose the environment intentionally, understand what the community expects of you, and build your practice around those realities rather than trying to reshape them.

0:00 Intro

00:50 Dr. Van Maanen’s Background

05:54 Why Rural Surgery Is Special to You

16:56 How I Do It: Robotics in Rural Practice

44:39 Financial Corner

46:36 Classic Rural Surgery Stories

54:39 Resources for the Busy Rural Surgeon

Resources Mentioned:

North American Rural Surgical Society:

https://www.northamericanrss.org/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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

A complex operation only works if it can be executed reliably inside the system you have.

In this Part Two episode, Dr. Randy Lehman continues with Dr. Cate Straub, focusing on how pancreatic surgery is actually performed without consistent teams, subspecialty backup, or standardized support structures.

She walks through operative sequencing, vascular decision making, and how technique changes when you cannot rely on experienced assistance or ideal exposure.

The discussion ties technical execution back to responsibility in rural practice, where outcomes depend on adapting the operation to the environment, not the other way around.

0:00 Intro

00:07 How I Do It: Whipple

40:08 Financial Corner

42:43 Resources for the Busy Rural Surgeon

Resources Mentioned:

WWAMI program:

https://www.uwmedicine.org/school-of-medicine/md-program/wwami

SAGES:

https://www.sages.org/

American College of Surgeons:

https://www.facs.org

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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

She started with one distal pancreatectomy alongside a senior partner and built a referral base by handing out her personal phone number across rural Washington.

Dr. Randy Lehman and Dr. Cate Straub focus on what it actually takes to keep complex cancer care local when patients are otherwise absorbed into distant systems. Mentorship, referral control, and internal case review became the structure that made pancreatic surgery possible in her setting.

Volume did not come from advanced cancer. It came from incidental cysts, earlier identification, and creating a pathway that kept patients from leaving in the first place. That shift changed both case mix and outcomes.

The work holds only if selection stays disciplined, outcomes are measured, and the surgeon is willing to stop if those standards slip.

**Tune in next week for Part Two of this conversation where we’ll deep dive into the “How I Do It” segment for Dr. Straub’s pancreatic surgery technique.**

0:00 Intro

00:51 Dr. Straub’s Background

05:41 Why Rural Surgery Is Special to Dr. Straub

07:01 Classic Rural Surgery Stories

20:24 How I Do It: Building a Pancreatic Surgery Program

52:46 How I Do It: Pancreatic Surgery Technique

Resources Mentioned:

AmeriCorps

https://americorps.gov

Virginia Mason

https://www.vmfh.org

American College Of Surgeons

https://www.facs.org

Confluence Health - Wenatchee Valley Medical Group

https://www.confluencehealth.org

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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

In rural surgery, you are often the one covering problems that would be handled by multiple specialists elsewhere.

Today Dr. Randy Lehman speaks with Dr. Bob Sticca, surgical oncologist and national leader in rural surgery. They examine how rural training has evolved, why scope of practice remains wider, and which surgeons are most likely to build lasting rural careers.

The discussion centers on difficult gallbladders–including subtotal cholecystectomy, fenestration, and when to convert to open–with emphasis on judgment, safety, and avoiding bile duct injury.

Rural surgeons will leave with practical takeaways: know your limits, use bailout strategies early, and match your training and career decisions to the realities of rural practice.

0:00 Intro

00:27 Dr. Sticca’s Background

03:37 Why Rural Surgery Is Special to Dr. Sticca

07:30 How I Do It: Difficult Gallbladder Decision Making

32:58 How I Do It: Open Technique and Complex Cases

52:07 Financial Corner

58:03 Resources for the Busy Rural Surgeon

Resources Mentioned:

North American Rural Surgical Society:

https://www.northamericanrss.org/

American College of Surgeons

https://www.facs.org

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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

Rural patients shouldn’t receive lesser care simply because of geography. Delivering that standard takes intentional systems, good data, and the right team around you.

Dr. Randy Lehman sits down with rural surgeon and ACS Governor Dr. Jill Ties to talk about how she built a breast surgery program inside a critical access hospital in Wisconsin.

They walk through the real work behind it: aligning with administration, earning the trust of referring physicians, shortening the time from abnormal mammogram to biopsy, and building a reliable process around a dedicated nurse navigator.

For rural surgeons trying to strengthen cancer care close to home, this conversation offers practical ideas on building systems, relationships, and teams that make high quality care possible.

0:00 Intro

00:14 Dr. Ties' Background

03:37 Why Rural Surgery Is Special to Dr. Ties7:30 How I Do It: Building a Rural Breast Surgery Program

32:58 How I Do It: Breast Surgery Technique and Workflow

55:54 Financial Corner

57:36 Classic Rural Surgery Stories

1:00:16 Resources for the Busy Rural Surgeon

Resources Mentioned:

UpToDate:

https://www.uptodate.com

North American Rural Surgical Society:https://www.northamericanrss.org/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

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