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 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. 

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

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.

Resources Mentioned:

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

Swedish College of Surgeons

https://www.theruralamericansurgeon.com/

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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

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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:

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

Resources Mentioned:

https://www.acog.org/

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https://www.theruralamericansurgeon.com/

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What does it really mean to be efficient?

In this fifth installment of the Money Miniseries, Dr. Randy Lehman takes us deep into the philosophy and practical tactics of operating with maximum efficiency–whether you’re in the OR, clinic, or managing investments.

From streamlining surgical workflows to understanding your personal dollar-per-hour, this episode covers it all. Dr. Lehman shares his real-world methods for doing laparoscopic cholecystectomy in 18 minutes, maximizing passive income from real estate, and building a practice that works for you (not the other way around).

He also issues a challenge: what are you doing that doesn’t even need to be done?

This episode is for rural surgeons, high-performers, and anyone who wants to reclaim their time, energy, and money by focusing on what really matters.

0:00 Introduction

Connect: 

https://www.theruralamericansurgeon.com/ 

What do you do when the gallbladder just won’t behave—and the duct isn't clear?

In Part 2 of our conversation, Dr. Randy Lehman and Dr. Seung Gwon get deep into advanced gallbladder surgery, rural surgical reality, and the wisdom behind bailout decisions. From fenestrated cholecystectomies to lost stones, lost nights of sleep, and lost support staff, Dr. Gwon outlines the tactical and mental tools rural surgeons need to stay sharp and stay sane.

Then they head into the financial corner, discussing disability insurance, budgeting philosophies, and how new surgeons can avoid lifestyle creep. Dr. Gwon closes with a memorable hernia case and two essential resources every rural surgeon should know about.

If Part 1 was about building a career, Part 2 is about protecting it.

0:00 Introduction

Resources Mentioned:

International Hernia Collaboration (Facebook Group)

Women in Rural Surgery (Facebook Group)

American Hernia Society

ACS Video Library

What if you could design your own job out of residency…and make it stick for 20 years?

In Part 1 of this two-part episode, Dr. Randy Lehman sits down with Dr. Seung Gwon, a general surgeon from El Centro, California, to explore what it takes to build—and keep—a solo rural practice. They dive deep into income guarantees, sign-on bonuses, practice models, and the realities of mentorship (or lack thereof) when you go independent.

Dr. Gwon walks through her early contract, how she avoided debt, and why she still prefers solo practice even after years of cross-coverage and evolving hospital partnerships. Then they jump into technique: gallbladders in rural America, why these cases are tougher than in residency, and how Dr. Gwon has refined her approach over hundreds of challenging cases.

If you’ve ever considered going solo or wondered how to safely handle a gallbladder that’s “nothing like you saw in training,” this episode is for you.

0:00 Intro

1:07 Dr. Gwon’s Background

2:28 Why I Stayed in Rural Surgery

5:51 Income Guarantee & Starting Solo

9:25 Practice Model Evolution

11:15 Call Coverage & Compensation

13:11 Dr. Lehman’s Practice Journey

21:45 Four Models of Surgical Employment

22:11 You Have Negotiating Power

27:21 How I Do It: Acute Gallbladder Surgery

52:47 Three Memorable Open Cases