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

In this episode of the Money Miniseries, Dr. Randy Lehman sits down with a very special guest—his wife, Brittaney—to share the tax strategy that’s become a cornerstone of their financial plan: Real Estate Professional Status (REPS).

They walk through what REPS is, why it’s so powerful for high-income households, and how Brittaney’s role as a full-time real estate professional allows them to combine active and passive income for significant tax advantages. From tracking hours and managing properties to navigating cost segregation and bonus depreciation, this episode is packed with practical, real-world insights.

Along the way, they share personal stories of fear, learning, teamwork, and even a few landlord-tenant adventures that reveal how relationships, integrity, and persistence create opportunities.

Whether you’re a surgeon looking to optimize your tax strategy, a spouse considering REPS, or just curious about how to leverage real estate for long-term wealth and freedom, we hope this conversation will provide both inspiration and actionable takeaways!

Resources Mentioned:

Real Estate CPA Podcast: https://www.therealestatecpa.com/podcast 

BiggerPockets: https://www.biggerpockets.com/ 

IRS Guidelines on Real Estate Professional Status: https://www.irs.gov/taxtopics/tc42

What happens when you're learning one of surgery's most technical procedures from a living legend?

Dr. Benji Smith, an advanced endoscopy fellow training under the renowned Dr. Vitale in Louisville, joins host Dr. Randy Lehman to share his journey from general surgery residency to mastering ERCP. 

The two discover a surprising connection to the same medical mission in Guaimaca, Honduras before diving into the nitty-gritty of procedures most surgeons only hear about in referral notes.

From scope positioning and sphincterotomy techniques to stent placement and EUS biopsies, Dr. Smith breaks down what makes this specialty so challenging and so critical. 

Plus, find out why he actually enjoys treating pancreatitis patients (yes, really!) and a perspective shift that might change the way you think about collaborating with advanced endoscopists.

0:00 Introduction

1:03 Dr. Smith's Background

7:09 What We Have In Common

9:33 How I Do It: ERCP

22:26 How I Do It: EUS

38:54 Financial Corner

43:21 Classic Surgery Stories

53:21 Resources for the Busy Rural Surgeon

Resources Mentioned

🌐 ERCP Fellowship Program, University of Louisville: https://louisville.edu/medicine/departments/surgery/fellowships

🌐 Guaimaca Medical Mission, Honduras: https://www.honduranmission.org/

🌐 PRISMA Health Upstate General Surgery Program: https://academics.prismahealth.org/graduate-medical-education/residencies/general-surgery-greenville

What if the biggest ROI isn’t measured in dollars, but in freedom?

In this third installment of his finance miniseries, Dr. Randy Lehman unpacks what it really means to invest—beyond the usual “just put it in a 401(k)” advice.

From real estate and business ownership to tax liens and even cattle, Dr. Lehman pulls back the curtain on investment opportunities most professionals never hear about. This episode isn’t just about growing wealth—it’s about understanding risk, stewarding wisely, and building a life that money alone can’t buy.

With personal stories of loss, faith, and lessons from the parable of the talents, Dr. Lehman invites you to rethink what it means to truly invest—in assets, in people, and in yourself.

0:00 Introduction

3:45 Beyond Stocks and Bonds: The Full Investment Spectrum

8:20 Understanding Risk

15:30 Risk Tolerance Through Life Stages

22:15 Personal Stories of Loss and Faith in Investing

35:40 The Biblical Foundation of Investment Strategy

42:10 From Debt Elimination to Asset Building

48:25 Real Estate

55:30 Business Ownership and Alternative Investments

1:02:15 Cash Flow vs. Appreciation Strategies

1:08:45 The Freedom That True Wealth Provides

What happens when you bring cutting-edge robotic surgery to one of the poorest regions in America?

Host Dr. Randy Lehman welcomes Dr. Quince Gibson, a UAB-trained general surgeon serving rural Alabama's Black Belt region. Born in Jamaica and shaped by a life-changing encounter with poverty in inner-city Baltimore, Dr. Gibson made the bold decision to leave a successful business career to pursue medicine. His mission: bring quality surgical care to communities where 31% of residents live below the poverty line.

Dr. Gibson shares his remarkable journey of establishing trust in a community skeptical of healthcare, the challenges and triumphs of implementing robotic surgery in a critical access hospital, and why the robot ultimately couldn't be sustained with just one surgeon. From managing post-operative bleeding without call coverage to performing emergency surgery with limited resources, he reveals the stark realities of rural surgery in America's most underserved regions.

Discover the three A's of surgical success, learn the technical details of robotic ventral hernia repair, and understand why sometimes the most advanced technology isn't the answer to healthcare disparities.

0:00 Introduction

1:16 Dr. Gibson's Background

5:25 Why Rural Surgery Is Special to You

29:40 How I Do It: Robotic Ventral Hernia Repair

54:02 Financial Corner

1:00:32 Classic Rural Surgery Stories

1:17:28 Resources for the Busy Rural Surgeon

Resources Mentioned

📚 “Atomic Habits” by James Clear: https://a.co/d/dV7BWeH

📚 “The Talent Code” by Daniel Coyle: https://a.co/d/fxzAOVU

🌐 UAB Rural Surgery Program: https://www.uab.edu/medicine/home/education/md-program/rural-medicine/rural-medicine-program

Beyond the 'why' of money lies the 'how'—and it starts with a practical paradox most doctors never hear: the less you need, the richer you become.

What if the secret to true wealth isn't earning more, but spending less? In episode two of his finance miniseries, host Dr. Randy Lehman reveals why frugality is the unsung hero of wealth building. This isn't about pinching pennies or living like a monk—it's about buying back your freedom. 

Dr. Lehman shares his remarkable journey from a negative $150,000 net worth in residency to positive $400,000 by graduation, achieved through four strategic moves that most doctors never consider. From his $83,000 house two blocks from the hospital to the 12-unit apartment deal that taught him everything about real estate investing, Dr. Lehman demonstrates why your spending dictates your freedom more than your income ever will.

Discover the 4% rule, learn why minimalism is the upgrade to frugality, and understand how living below your means creates the margin needed for true financial independence.

0:00 Introduction

2:45 The FIRE Movement and 4% Rule

8:30 Frugality vs. Scarcity Mindset

12:15 The $83,000 House Story

18:20 Minimalism as an Upgrade

22:10 Four Ways to Build Net Worth in Residency

35:45 The 12-Unit Apartment Deal

42:30 Why Nothing is Permanent

44:15 From Saving Phase to Growth Phase

What happens when you're the only surgeon for hundreds of miles and every decision matters?

Host Dr. Randy Lehman welcomes Dr. Dan Margo, a seasoned rural surgeon from northern Minnesota, who has spent decades mastering the art of surgical practice in isolation. Dr. Margo shares hard-won insights from his years serving remote communities, including the unique challenges of being a visiting surgeon and the critical importance of collegiality in rural practice. 

They dive deep into colonoscopy techniques–including abdominal pressure maneuvers and advanced lesion removal strategies–while exploring everything from Miralax prep protocols to pre-anesthesia evaluation timing. Dr. Margo demonstrates why rural surgeons must be master diagnosticians, skilled technicians, and compassionate caregivers all rolled into one.

Tune in for an inspiring episode filled with practical surgical wisdom from the frontlines of rural healthcare, where innovation is born from necessity and every patient interaction truly counts.

0:00 Introduction

2:58 Dr. Margo's Background

5:22 Why Rural Surgery Is Special to You

23:52 How I Do It: The Colonoscopy

1:35:40 Financial Corner

1:37:06 Resources for the Busy Rural Surgeon

Resources Mentioned:

🌐 Foregut Disease Foundation course: https://foregutdiseasefoundation.org/2025-course

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

🌐 American Society for Gastrointestinal Endoscopy (ASGE) Guidelines: https://www.asge.org/home/resources/publications/guidelines

🌐 Cologuard test (alternative screening method for colorectal cancer): https://www.cologuardtest.com/

Introducing a new miniseries on money—starting with the question beneath the dollars: What’s the point?

Before we talk finance, we’re digging into foundations. In this episode, Dr. Randy Lehman shares an unexpected conversation with ChatGPT about evolution, intelligent design, and the meaning of existence—revealing why, for him, the evidence points to faith over chance.

But this isn’t just about science. It’s about worldview—how what you believe about life shapes how you handle money.

Dr. Lehman pushes back on the pursuit of wealth for its own sake, arguing that without a higher purpose, money is meaningless. He challenges listeners to redefine what it truly means to be “rich”—and why, in the end, the means are the ends.

This episode sets the stage for the entire series: exploring money as a tool for freedom, purpose, and lasting impact.

0:00 Introduction

2:15 The Most Important Question

3:30 A Conversation with ChatGPT About Evolution and Design

15:40 Why Darwin's Finches Don't Prove Macroevolution

18:55 The Cultural Fallout of Teaching We're Cosmic Accidents

25:30 ChatGPT's Stunning Response

31:20 From Utilitarian Thinking to Faith-Based Purpose

34:10 Money as Freedom vs. Monument Building

36:05 Redefining “Rich”

What happens when a rural hospital loses its only surgeon and faces closure?

Host Dr. Randy Lehman welcomes Dr. Manu Kaushik, who stepped in to save a dying critical access hospital in Greenville, Alabama. After 40 years of service, the hospital's longtime surgeon retired, COVID hit, and the OR shut down completely - threatening the entire community's access to care. 

Dr. Kaushik shares his incredible journey of rebuilding surgical services from scratch, training staff, fixing broken equipment, and literally buying his own instruments to keep patients from having to travel hours for basic care. 

They dive deep into his innovative modified Smead-Jones hernia repair technique, discuss IPOM and component separation procedures, explore the transition from laparoscopic to robotic surgery, and cover everything from inguinal repairs to emergency trauma management.

Tune in for an inspiring episode filled with practical surgical techniques and unforgettable stories from the frontlines of rural healthcare.

0:00 Intro

1:54 Dr. Kaushik's Background

6:43 Why Rural Surgery Is Special to You

11:00 How I Do It: Ventral Hernia Repair

20:22 How I Do It: Smead-Jones Stitch

28:23 How I Do It: IPOM Technique

35:13 How I Do It: Robotic Inguinal Focus

43:51 How I Do It: Mesh Placement in Hernia Repair

55:48 Financial corner

1:06:06 Classic Rural Surgery Stories

1:23:18 Resources for the Busy Rural Surgeon

Resources Mentioned

🌐 American College of Surgeons (ACS) Rural Trauma Development Course: https://www.facs.org/quality-programs/trauma/education/

🌐 ACS Stop the Bleed Program: https://www.stopthebleed.org/

🌐 ACS Rural Surgery Resources: https://www.facs.org/for-medical-professionals/education/programs/so-you-want-to-be-a-surgeon/section-iii-surgical-specialties/rural-surgery-program/

🌐 MGMA (Medical Group Management Association) Data: https://www.mgma.com/mgmadata