What makes rural surgery uniquely rewarding and challenging?

Host Dr. Randy Lehman welcomes one of the greats–Dr. Gary Timmerman, a distinguished surgeon from South Dakota–to share his journey and insights into rural surgical practice.

Dr. Timmerman discusses his career path, the role his faith has played throughout his many years of surgery, and offers a detailed exploration of esophagectomy techniques and feeding tube placement.

Tune in for an episode packed with wisdom and inspiration for every medical professional committed to excellence in rural healthcare.

0:00 Intro

5:57 Dr. Timmerman's Background

9:19 Why Rural Surgery Is Special to Dr. Timmerman

12:46 How I Do It: Esophagectomy Techniques

24:02 Tips for Diagnosing Esophageal Cancer

38:45 Colonic Conduit and Anastomosis Techniques

53:24 Financial Corner

55:45 Faith's Role in Dr. Timmerman's Practice

58:33 Classic Rural Surgery Stories

1:02:40 Resources for the Busy Rural Surgeon

1:07:34 Sanford Health Residency Programs

Resources Mentioned:

🌐 American College of Surgeons (ACS): https://www.facs.org/

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

🌐 Sanford Health: https://www.sanfordhealth.org/

🌐 Sanford Medical Education division: https://www.sanfordhealth.org/initiatives/medical-education

🌐 South Dakota and North Dakota Chapter of the American College of Surgeons: https://www.sdsma.org/event-5616925

How can rural surgeons navigate the complexities of modern surgical techniques while maintaining financial stability?

Host Dr. Randy Lehman welcomes back Dr. Eugene Shively, a retired general surgeon from Campbellsville, Kentucky, to explore this question. They discuss the critical role of rural surgery, delve into common bile duct exploration techniques, and examine the growing presence of robotic surgery in rural hospitals. Dr. Shively also brings up the debate about government-subsidized insurance and recounts a memorable case from his career.

Tune in for a compelling episode packed with practical notes and inspiring stories for every medical professional.

0:00 Intro

5:18 Why Rural Surgery is Special to You

16:44 How I Do It: Laparoscopic common bile duct exploration

24:09 Volumes and equipment for common bile duct exploration

29:45 Open common bile duct exploration techniques

32:03 Dr. Shively's thoughts on robotic surgery in rural locations

38:11 Case discussion: Sigmoid colon polyp management

49:27 Financial Corner: Hospital employment for surgeons

51:17 Classic Rural Surgery Story: 1989 case

54:17 Resources for the Busy Rural Surgeon

56:12 Outro

A family emergency gave Dr. Randy Lehman an unexpected perspective—from the waiting room instead of the operating room.

In this episode, he shares the story of his grandfather’s emergency gallbladder surgery and how that experience reshaped his approach to rural surgical care.

From the weight of urgent decisions to the strain of limited resources, Dr. Lehman reflects on how these events transformed his approach to pre-op communication and deepened his commitment to compassionate, patient-centered care.

0:00 Intro

5:28 Grandpa's emergency

11:26 Resource limitations in small hospitals

18:30 Unexpected turn of events post-surgery

24:38 Lessons learned

38:13 Importance of rural surgeons

For Dr. Randy Lehman, “rushing to surgery” sometimes means taking to the skies.

In this episode, he shares how aviation became an unexpected solution to some of rural healthcare’s biggest hurdles: time, distance, and access.

From unforgettable landings to the real-world logistics of owning and flying a helicopter, Dr. Lehman gives us a front-row seat to how this unconventional approach is transforming his surgical practice in Indiana.

...and let’s be honest, flying is just plain awesome!

0:00 Introduction

1:58 Family Aviation Roots and Grandpa's Flying Legacy

12:47 Trading Long Drives for Short Flights During Residency

19:51 The Real Economics of Maintaining Three Aircraft

25:31 Robinson R44 Operations and Beating the Air into Submission

29:23 Why a Helicopter Provides Crucial Direct Hospital Access

34:03 Getting a Helicopter License in Just 54 Days

38:17 Landing at Hospitals, Schools and Family Farms

41:53 Transforming Friends Through Rural Peace After City Chaos

47:03 Weather Limitations and Always Having a Safety Plan B

52:24 When $400 Per Hour Flying Actually Makes Financial Sense

54:08 Small Minds vs. Creative Rural Transportation Solutions

59:09 Designing an Intentional Rural Surgical Practice

Resources Mentioned:

Cleveland Helicopters https://clevelandhelicopters.com/

One Six Right https://www.onesixright.com/

Join host Dr. Randy Lehman as he welcomes Dr. Rebekah Wever, a passionate young rural surgeon who returned to her Appalachia, Ohio roots after training in South Dakota.

In this episode, Dr. Wever shares candid reflections on her first independent cases while delivering a masterclass on the innovative Transversus Abdominis Release (TAR) technique for complex hernia repairs. She reveals how her dedication to building healthcare resilience in her underserved Appalachian hometown means the difference between life-threatening transfers and keeping critical care local.

Whether you're a healthcare provider considering rural practice or simply curious about delivering exceptional surgical care in underserved communities, discover why Dr. Wever believes returning home might be the most rewarding decision a surgeon can make.

0:00 Introduction

1:26 Dr. Wever's Background

7:01 Why Rural Surgery is Special to You

8:49 How I Do It: Ventral Hernia Repair - Transversus Abdominis Release

37:55 Resources for the Busy Rural Surgeon

39:27 Financial Corner

42:01 Classic Rural Surgery Story

Resources Mentioned:

Book: Hernia Surgery: Current Principles by Yuri W. Novitsky

After a week of medical missions in rural Honduras, host Dr. Randy Lehman sits down with Dr. John Haeberlin to reflect on their experience and discuss laparoscopic cholecystectomy techniques.

Dr. Haeberlin shares insights on robotics and breaks down an excellent "How I Do It" segment on a gallbladder case. Dr. Lehman also recounts a compelling case from their time in Honduras, offering a firsthand look at the challenges and decisions they faced in the field.

0:00 Introduction

1:41 Dr. Haeberlin's Background

3:26 Why Rural Surgery Is Special To You

8:10 How I Do It: Laparoscopic Cholecystectomy

38:47 Classic Rural Surgery Story

45:26 Financial Corner

47:04 Resources for the Busy Rural Surgeon

Host Dr. Randy Lehman sits down with Iowa rural surgeon and former Navy doctor, Dr. Dave Kermode, for a gripping deep dive into an emergency C-section case. Together, they explore the key differences between elective and emergency C-sections in a rural setting, offering valuable insights for general surgery residents. Beyond medicine, they also discuss the intersections of finance, marriage, and faith, making this an episode packed with wisdom both in and out of the operating room.

0:00 Introduction

0:48 Dr. Kermode's background

4:08 Why Rural Surgery Is Special To You

7:55 C-Sections as a Rural Surgeon

16:59 OB Department Closures

29:01 How I Do It: Emergency C-Section

52:24 Technical Differences: Elective vs. Emergency C-Sections

1:03:02 Financial Corner

1:11:22 Classic Rural Surgery Stories

1:13:21 Resources for the Busy Rural Surgeon

Resources mentioned:

North American Rural Surgical Society

Really Rural Surgery Podcast

Rural Medical Training Collaborative

Welcome back for this Part Two conversation with host Dr. Randy Lehman and distinguished breast surgeon, Dr. Mel Johnson. Listen for a technical walkthrough on sentinel lymph node biopsy, plus a very unique bonus “How I Do It” section involving surgery on a farm! Stay through the end for Dr. Johnson’s powerful encouragement for the new resident who might wonder what life looks like ahead.

00:00 Introduction

02:39 How I Do It: Sentinel Lymph Node Biopsy

05:43 Ongoing Trials in Breast Cancer Surgery

13:27 How I Do It: Patient Prep

20:54 Resources for the Busy Rural Surgeon

21:57 How I Do It: Piglet Hernia Repair

26:52 Financial Corner

28:43 Classic Rural Surgery Story

Resources Mentioned:

NCCN Guidelines

CoC Guidelines

New England Journal of Medicine article: "Sentinel Lymph Node Biopsy in Early Stage Breast Cancer: Is It Obsolete?" by Monica Morrow (December 2024)

INSEMA trial - Ongoing clinical trial on sentinel lymph node biopsy in breast cancer

SOUND trial - Ongoing clinical trial on sentinel lymph node biopsy in breast cancer