The Rural American Surgeon

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 ...

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 worku...

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, ...

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 te...

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 do...

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 sh...

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 laparosco...

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 shar...

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.

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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 sig...

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 pr...

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 growi...

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 qualit...

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 free...

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 c...

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—ho...

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 surg...

How do you perform a carotid endarterectomy with confidence while ensuring patient safety in a rural setting?

Host Dr. Randy Lehman welcomes Dr. Michael Roskos, his former program director for the rural surgery track at Mayo Clinic, to dive deep into this critical procedure. They explore patient selection criteria, detailed surgical techniques, and the evolution of vascular surgery practice over the decades. 

Dr. Roskos shares ...

What does it take to bring advanced foregut surgery to a rural hospital?

Host Dr. Randy Lehman sits down with Dr. Greg Gerrish, a third-generation surgeon practicing in South Dakota, to talk shop on the real-world challenges and wins of rural surgical care. From Barrett’s esophagus to emergency thoracotomies, Dr. Gerrish brings both technical depth and day-to-day experience to the conversation.

They cover Dr. Gerrish’s approach to ...