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/

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