EPISODE 52

Money Miniseries 8: When The Dream Doesn’t Go As Planned…

Episode Transcript

Dr: Randy Lehman: Welcome back to the Rural American Surgeon. I'm Dr. Randy Lehmann, your host. Today we are wrapping up the Money Mini Series with an episode that, believe it or not, I feel like I've shared quite a lot of personal details already, but is a little bit more raw. It's called When the Dream Doesn't Go As Planned. This one's a little more personal. You've heard me talk about principles, investing, giving, freedom, tax strategy, principles, efficiency, legacy.

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kids, but none of that matters if you haven't also been through disappointment and learned to stand back up. So today I'm going to talk about a few things that haven't gone the way that I thought they would. And I'll share what I've learned about money, about people, about calling, and about how the freedom that financial independence brings is often less about yachts and more about exits.

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So first, let me tell you this story about how I started Liberty Clinic. oh

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graduating high school, my county gave me a scholarship to go to college. It actually came through the Eli Lilly Foundation, which each county in Indiana gets two scholarships. Anyway, long story short, I told them I was going to come back home and I was going to make a difference. I didn't even know what I was going to do. And before that, I didn't even want to go to college. I kind of wanted to go into business or something, you know, entrepreneurial. uh

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start something, build something and work hard. And then I kind of got this scholarship. And so then I said, okay, I'll go to college. didn't know where I wanted to go. My buddy was going to Purdue and I was like, I want to go live with him. So I only applied to Purdue. And then I had a day where I was with my...

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principal of my school. He was like, what are you going to college by? have like, I have no idea. You know, I'm kind of like the person voted most likely to succeed in my high school class, for example. So I'm that guy and I'm sure it's breaking my principal's heart that he has no idea what he's going to do. he, my principal's wife was a pharmacist. He suggested, I told him I want to go to Purdue. said, I want to go to pharmacy school. So I went to Purdue to pharmacy school over a full ride scholarship, basically. And I

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Didn't really try that hard. kind of hated it. And I had four semesters of declining GPA. And then after two years, I applied to pharmacy school and I didn't get in. I don't know if I've told this story before on here, but this is one, I guess, area where the dream didn't go as planned. Right. And at that point I had all these science classes.

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And I didn't really want to waste time. And I had known a couple people that had gone to medical school and I watched, you know, uh, there's a thousand pre-pharmacy students at Purdue each year and only a hundred of them get in. So I'd watched 90 % of my classmates essentially switched to easier majors, which was what everybody else was doing. And I was really full of spite and I did not want to do that. And so I said, uh, I'm going to go to med school. I went and I told my pre-med advisor, met with a pre-med advisor, told him that he's like, this is

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idea, this is not going to work well. Look at your trajectory of your life and it's unlikely to be successful. Perhaps you want to consider hospitality and tourism management or whatever. And so I said no. And I actually took a summer physics class and a lot of things hung on that class. And then actually in the very first day of physics lab, I

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sat down and I had a partner who I told him I'm going to work in Remington. And my partner's like, oh, my dad works in Remington. then basically found out that I was essentially working at the company that his dad owned, who I totally should have known because we have tons of connections and I never met him. And we were like a week apart. And it's actually Brogan Baylor, who's a few episodes back, one of my best friends. basically they're these little

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uh, nuggets or Ebenezer's like in throughout life that kind of stand to show me, um, that there is a plan. And a lot of times I think I know the plan, but it turns out I never actually do. And then it just kind of goes on without me and it makes sense in the rear view mirror. Brogan was also pre-med and, um, he was working on taking the MCAT and so was I. And so anyway, I got an A in that physics class.

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And then we took the MCAT test prep together and it got straight A's from then on out, partly because I was mostly because I was motivated, I think, but partly because I was more selective with the courses that I was taking, you know, I was smarter about it. And I did one or, you know, got ninety nine, I can't remember, like 96 percentile or something like that on the MCAT. And then and then applied again to pharmacy school, got in and went in and then and then turned them down after they accepted me. And I was so vindicated, you know.

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And then I decided to go to, figured I would get into med school. and I did. And then I went to Cincinnati for medical school and I thought I was going to do emergency medicine. My idea was have a good paying job that was like shift work and then on the side, then I would be able to do whatever entrepreneurial pursuits that I wanted to or impact my community. You know, maybe I wanted to farm, who knows? Then I got to...

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medical school and I just fell in love basically with surgery. And I always knew I wanted to come back home. And then I discovered that there was a field of rural surgery and there were actually training programs for rural surgery. And so then I applied broadly, but I included those programs as I was applying. several times I got taken back to, what did I tell the scholarship committee?

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when I was leaving town and how did I feel about it? I felt like my small town had given me a great start. For me, first of all, was a good childhood. So that helps, you know, having a good family. I think that doesn't always have to be the case. just, think there's a lot of value to the roots of a small town. And I actually found an article that I wrote in high school, I think probably like a FFA thing titled,

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the American farmer, the moral backbone of America or something like that. This is my bias, obviously, that I'm coming at it with, um but I have the bias for a reason um and it's founded in a lot of experience. And so I went to college, I went to medical school and I discovered surgery and then I basically said, I wanna be a rural surgeon. I wanna come back home to my hometown and now...

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It's been over decade that I've been basically saying that exact same thing. uh And the other experience in medical schools is my mom passing away, which I think I've talked about that. That's a way that the dream didn't go as planned, but it sort of makes sense in the rear view mirror. It made sense also as it was happening. It's another story maybe for another day. And then I went to Mayo Clinic and there was some personal, just like...

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improvement that needed to happen and resetting and going to the Mayo Clinic helped me with that. Maybe not Mayo so much as just getting changing scenery. then, and then that led to me getting married. And then we got pregnant on our wedding night. And there's another time where the dream doesn't go as planned, but very exciting. And, and then I'm always planning ahead quite a bit. m

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And so as an intern, I mean, even before I went to medical school, I was calling my hometown hospital and telling them, hey, I wanna be back in like Rensselaer, Indiana in the building that I was born in. But I called them in 2015 before I had like a few weeks in between med school and residency starting. And I'm like, I'm gonna be in town. Do you guys wanna meet with me? Because I'd like to come back here.

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And they're like, I don't know, pretty, the CEOs of the other Jasper County Hospital said, you know, we'd like to, but, um, actually we're selling to the Franciscans, not public knowledge yet, but, know, you should know that this is what's going on. So we had to pass it on to them. Well, then, you know, the Franciscans taking over is totally different story. they, they wanted totally, I mean, they just weren't interested in really talking about it. They didn't recognize the value of, what, you know, what I brought and they,

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To illustrate that point, said, uh yeah, we'd love to talk to you. Of course, this is like months later after I'm already up in Rochester. And uh they said, we'd love to talk. You know, our recruiters are down in Indianapolis, so you could, you know, meet with them down there. uh I, you know, I did it. I drove all the way down to Indianapolis, or flew home and drove to Indianapolis and still met with them. But they were basically saying, you know, we're part of a bigger chain and

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We don't really, now I don't want to be too critical because they just celebrated 10 years of owning this hospital and they have kept the doors open and they are investing in the space. know, and then on the back end, because the hospital's there, it does allow me to do surgery in my hometown. And so what I was going to say is that it doesn't seem like they care about Jasper County. Sometimes it feels like that, but definitely, you know, it feels like they bought the hospital.

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just to ship to their bigger center. ah But they have their own, ah I guess, needs and demands. And so I'm not trying to criticize. It's ah just to say for you as a listener, if you're a rural surgeon or thinking about rural surgery or training to be a rural surgeon, ah your value will be seen, I think, more by an independent hospital than it will be by one that's owned by a chain.

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Um, because the ones that owned by the chain are run by people that sit at the big hospitals in the center of the chain. Um, and I found that to be true throughout time. So anyway, that's another way that the, the thing didn't go as planned. Like I just thought I was going to go get a job, you know, I kind of wanted to have an independent practice. Um, I wanted to have the brick and mortar thing, but I thought, you know, I'm going to have student loans. Maybe I have to get some loan repayment or something. So, so that's what I was trying to figure out.

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And then it just didn't really, uh, happen. And then I, we got pregnant and I went to Honduras with one of my mentors from central Kentucky and, they had a, like a loan forgiveness program type of thing, or just a recruitment thing. Sign, sign people early in their training so that they'll come back. And he came home and told his CEO, we need to offer this to Randy. And so they did. We thought about taking that job. We went down and interviewed in Kentucky.

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being that we were pregnant then said, well, let's think about it. Let's wait till the baby comes. And then as it became closer, it just became obvious we wanted to come closer to home because my wife and I are both from the same area oh for no other reason for the kids. So uh I then went on Google maps to my hometown and I zoomed out and I searched hospital and there were five hospitals sort of like uh the center one and then four around all like a five dice, know, equidistant.

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So I called all the hospitals and basically the ones that were part of a chain told me, call us back when you're a five, when you're like ready to start work. And then the ones that were independent, which there were two, they both said, we'd love for you to work here and like gave me a contract. Like point blank. There's another place that I also interviewed through a recruitment firm, just because I felt like I shouldn't just take the first job, you know, that was offered. I should look around and I kind of felt like maybe that was the right thing too.

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Uh, but then I ended up, uh, there, there was a hospital in Indiana, the next County over, and that's where I ended up deciding to go. And they, they did give me a great like loan repayment package, give me a great start to my practice. And I told them that I was, I wanted to go to my hometown, which is the next County over and have an independent practice at some point. And it was a four year contract and I thought I would do the four years and then, and then leave and save my money, save my pennies in the meantime, and then go over and start.

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independent practice. Well, then a series of things happened. While I was working that first job, first off, I landed in a town of 12,000, 1200 people in a county of 12,000 with three full-time general surgeons working there. And if you don't know the data, there's one general surgeon for every 19,000 population in the United States.

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And there's a study that says we're underserved and it should be one per 14,000, right? But three per 12,000, like everybody would say, you know. So there was very little work, honestly, to be done there. And very quickly, at first I was very happy because it was COVID and I landed there and there wasn't a ton to do. And I was like, okay, I can decompress. And I did. My wife said she feels like she married a totally different person. Like I kind of like came out of my shell, guess, or something, because we were...

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in residency the whole first five years of our marriage. And then really quickly, I was like, I'm not going to be able to maintain my skills with this low volume. And I did actually quite quickly pick up mostly because I went to my hometown community and I talked to all the doctors and I explained my deal and people started referring to me for everything from all over. also had after a year, some like extra vacation time. And so then I ended up taking that time to go do some locum's work.

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And that was like paid vacation kind of, but still doing surgery. And, know, even like me, I go, my missions, you know, I go and I do surgery. So, you know, there's a way to make sure that you stay very busy. And then very quickly, I was like last year, my productivity was the highest. It was actually too high. It's like capping out at, um, my goal was to do 10,000 RBUs and I did. And that, um,

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I just wanted to see how it felt and how it felt is I don't really want to do that, but like 8,500 is no problem. You know, like you can kind of gauge it off of that. And I think it's probably based off other things that are going on in your life too, but I digress. And the conclusion of what happened there at my first job is

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I actually started getting privileges at my hometown hospital because mostly because the privileging process was ran so poorly initially that I couldn't do anything for quite a while when I first started. And I just figured I'd get privileges and whatnot. I didn't even know what I didn't know, you know, because there's hospital privileging and credentialing and then there's insurance credentialing. would I, you I had no idea.

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In the process of doing that, I'm talking to the CEO of my hometown hospital. This would be the place that, you know, was purchased by the Franciscans. uh he was ah very helpful. And then something terrible happened to a surgeon at that hospital had a debilitating stroke and he was running wound care for them several days a week and doing general surgery.

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Then it became like this emergency where they wanted me to come over there. Well, then I approached the hospital that I was the first hospital I was working at next County over. And I explained the situation and, then I said, I wanted to go over there like independent, you know, and so we, ended up working out a thing where it was, and I said, it's going to be good for you because I'm going to have things that they don't have the capabilities there that we do here. I'm going to be, um,

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There will be natural flow of patients over here. Like you don't need to be scared about me, you know, not being invested in not doing things here. Um, but, uh, you know, I, I'm planning to go there at some point anyway, and I think they wanted to prove that I could do both at the same time. And so then they, they agreed to let me do it. And we, put it on paper and said, I was allowed to have a limited independent part-time practice over in my hometown.

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So I, and then one of the days I was walking into the hospital to like work on this stuff in the new hospital where I was born, doctor comes walking out and he says, kind of recognize him. never talked to him before. like, are you Dr. Darnaby? And he's like, yeah. It looks at me kind of weird, you know, if you know him then, you know, he's creeped out or whatever. And I just jumped right into my elevator speech. was like, I'm Randy Layman and, know, I'm from here and I'm a surgeon and I want to come back here.

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By the way, and at this time I was thinking about buying a building downtown and putting in my own like little office. guess I kind of imagined copying some of the law firms downtown, you know, or something. I don't know. And I said, by the way, you should sell me your building someday. And I pointed right across the street from the hospital at this building that was where I grew up going as a kid to the doctor. And he kind of looked at me sort of uh oddly and said,

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It's funny that you mentioned that because we just had it appraised and we're planning on auctioning it this fall. So I'm like, well, you know, and then he has me over like that evening, talk about it. And I ended up buying the building and the surrounding property. They gave me a very fair deal on it. It just kind of fell in my lap. Then I, then I find out, well, I knew that my mom had worked here, but she actually worked here until my due date. That was the last day that she worked here.

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And this is actually the building I'm sitting in it now in the basement. That's where my podcast studio is where my wife and I actually first met. And there was a, had to go back home to get my shots for medical school. mean, I guess I kind of theoretically we knew of each other because we went to the same high school a couple of years apart and I really, you know, talked her to each other. And, they had a rule here. She was working as a medical assistant. And if somebody has to get their blood drawn because everybody knows every everyone else.

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I guess the old rule was if you pick up the chart, you have to co-try the blood regardless of who they are. So she picked up the chart and I guess she threw the chart down because I guess I was a bit of a annoying loud mouth from high school and somebody saw her do it. One of the old nurses, said, ah, ah, ah, you have to go in there. And so she comes in and draws my blood. And literally that's like the first time that I talked to my wife. then...

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She Facebook friended me, you know, and we became friends and long story short, six years after that, I believe, um we walked down the aisle. And on our one year wedding anniversary, my wife bought me a framed silhouette of the state of Indiana with a little heart coordinates for this building, like kind of tongue in cheek.

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cute, but like as the place that we met, you know? And I had almost forgotten about that. I mean, I was reminded and I remembered, but I would not have thought of it. And then I'm like closing on this property and Brittany finds that and shows it to me. And it's like this whole round circle thing. And it just felt so like I was doing the right thing.

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And several other things happened. People fell into my lap. So there was somebody still working for the existing clinic that was doing credentialing who my parents had baby, she was a single mother and my parents had babysat her son, uh like when I was a baby and uh she was helping with my credentialing and uh all these other connections. uh I'm not thinking of all of them right now. I know there's more, but.

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I even said at the time that usually my life makes sense 10 years later. But at this time, it was making sense as I went along. And I was like, God was sort of revealing his will, you know, as I was happening. I felt like I was doing the right thing and everything. Great, except um what ended, oh, and a nurse practitioner fell into my lap. That's another thing who is just awesome. um

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And just like sort of serendipitously. then another, uh, an MA who was actually a classmate of mine who was like perfect for the position and had like the perfect experience. Um, kind of like reached out to me and, and all this time, like all the pieces came together. My dad also in some ways got like pushed out of a job that he was in for a long time, but we were talking for decades about trying to do something together. So then he started this other job, but.

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Um, you know, was less tied, you know, and more, more feeling free and able. he kind of, uh, was it was then able to leave that and join me and has been working for me full time ever since helping me along. Um, we bought this building. We're like bootstrapping it. We loved it. I like had a couple, uh, mattresses that I threw down on the floor and a small building that's part of the clinic space. And I'm like staying in there with.

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my family on like Monday nights, uh, you know, after I do surgery and stuff and like truly, you know, think back, like those are the good times, you know, of course. And we knew that they were because we put the kids, little kids to bed and then, you know, we get chicken wings from a place in town where I'm going to go right after this and, and get some. And, uh, we would just eat it like on the table in the clinic and everything felt like great. But then.

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What I ended up building, what I didn't know is I didn't really have a good business plan. And what ended up happening was my overhead was like $600,000 a year. By the time I built everything that I thought that I needed, it mostly was payroll, over half was payroll. And my total collections is $350,000 annually. And that was with me kind of part-time understanding that some of the surgeries weren't appropriate for that hospital. So I was doing them at my W-2 job.

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And so I guess I was getting paid on a bonus from them. But the reality is I built a business, so that's between me and my nurse practitioner, both those collections, that was losing like 20 to $30,000 a month. And I was coming out of pocket to pay these expenses. Certain other things had happened, like real estate things that I had done, the savings and investings that I had done that was sort of funding this, but it was still not sustainable.

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And it got very stressful, very frustrating. ah It was hard to talk to nurses at the hospital who worked for the hospital were getting paid hourly. then when there's like easy things to beat, like some, some case gets canceled for a stupid reason, you know, and it's their fault, but they don't really care. And they're like, Oh, just reschedule. Right. But I have limited like, that's like my kind of my margin. It's not even my margin. I'm losing money. went to on a mission trip to Africa.

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And I was with Brittany, there were some people over there that like they charged them for the surgery, but the amount that they charged them is much less obviously than surgery costs, super cheap, right? But they still charge them something so that it wasn't abused. So it'd be like $85 for an inguinal hernia, you know? And some of the people still couldn't pay that. And Brittany and I paid for several of the operations while I was over there. And

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I'm standing there doing an inguinal hernia that I paid $85 for the person to be able to do on my volunteer time. And meanwhile, that same year, the average loss that I had per case that I did with Liberty Clinic loss was $2,000. I literally paid two that it's almost unimaginable amounts of money, know? And I, like the previous whatever I had studied it. And so I knew that and I said, man, it'd be a lot cheaper if I just move over here and we could just

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you know, operate on these people because it's cheaper to operate on them than it is in Indiana. And that got very stressful. And it came to a point in late 23 where, like, Brittany and did something we don't normally do, we're driving home from church and we just like said this prayer out loud, like while we were driving. And I basically, there were other things that I was trying to do, trying to make work. Like, I thought what needed to happen is I needed to contract my business.

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to the hospital and really that's what ended up happening. That's kind of a spoiler alert, but I was trying for a long time, like a year to get this contract and it just wasn't coming through. And I'm like, what do I not know? that, is there something they're like really trying not to make this contract with me or what? And then my building, the space, then I wouldn't be using anymore. And I was told that the urgent care in town,

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Um, was going to add on to their space because they were kind of all over, just like didn't have enough space. My building was bigger, bigger. I'm like, and that's part of the same hospital system. I'm like, they just need to move into my building, you know, because it's bigger. It'll be perfect. It's already built out like medical office, be a lot cheaper, you know? And so I, um, I'm trying to reach out to the person to do that. And I call like several times.

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And the phone is like glitching and I'm not, the call's not coming through. I left voicemails, not hearing anything back, just like, and I just felt completely hopeless. Like I felt like I knew what the right things were, like that the practice could be contracted and, you know, rent my space out. And the blocks were up, you know, like it's like not getting into pharmacy school. The door is shut and there's,

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these phrases that you hear in life that are buzzword phrases like one door shuts and other door opens. Okay. But you can say that sounds very cute and trite, but what's it really mean until you have a little bit of experience and it colors it, then you, don't know. And a lot of these risks in this situation that I was able to put myself in, even buying the building in the first place, they happened because of

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financial independence and because I had a financial margin and it happened because I took a job with a high guaranteed salary and I bought a house that was whatever it was like eighty some thousand dollars and that just didn't matter and so I had so much margin because I still drove my truck which I still drive right now you know that I bought in residency for five thousand dollars and the tailgates all ripped up and my kids names are scratched in the side with the rock.

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And I don't really care. Matter of fact, there's a point of pride because the great irony of it is when I take off for work in the helicopter, you know, and the reality of this, everything about my situation is just so like bonkers now, but it all started with that extreme frugality and like hard work ethic, trying to earn and save, invest, you know, thinking about um things in a way that I've talked about throughout this whole series. So anyway, um we have this prayer.

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driving in the car. And the prayer was, I cannot do this anymore. I felt like you, God, wanted me to do this. Like it was, there were these obvious signs, like you're supposed to do this. And it is not working. And it is unreasonable for you to continue to ask me to do this because it's not working.

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And do you want to say hi? Jackson, here he is with me. He gives me a little note. When are we going to leave? From the side so that the camera can't see him. I have to write, know, 15 minutes. So I got to wrap this up, I guess. So anyway, if the prayer was, I'm done, I'm shutting this down. If you want it to work, feel free, you know, but I feel like I've done everything I can. And I have to shut this down, which means firing people.

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and shutting down the team and this dream of having my dad working with me and now maybe he has to go get another job. And um then these people that I had developed relationships with and um it was very sad. And the funny, the Christmas party the year before was like very exciting, a lot of growth. And then we like, I didn't even want to have a Christmas party that year. And we kind of did what we just like went to dinner and it was just.

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morose. Well, that was on a Sunday afternoon on our way home from church. And the next day, I get a call from the urgent care, the guy that I'd been trying to get a hold of and like I my phone is glitching and I didn't and the door was shut. And the door opened. Right. And it moved quickly. And

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Because of all my experience with real estate, like when they're asking for tenant improvements and a build out and stuff, it was because of the experience that I had in real estate that I was like comfortable moving forward with a lot of the things that we talked about and was able to negotiate with them and kind of know what they were saying. ah And probably that's the reason that the deal went through. And then within a week or two, I can't remember, it was very quick. I had the contract.

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that I'd been trying to get for probably almost a year in my email inbox, right? And it all kind of like came together very quickly. And within about a month, was working on that contract. You know, I had ride it a lot of my overhead. was not making money. I was like breaking even, but I wasn't losing $20,000, $30,000 a month. And I don't think that I've written a check to my business.

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since that moment, which I just made that realization right now. That since I made that prayer, not sure. have to fact check my own self on that. But it's something like that. Everything got better at that moment. That moment of basically surrender and giving up, maybe something that I was clutching onto, maybe something that I thought was mine, and I was treating it like mine, I guess.

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And then, uh sort of in preparing for this podcast, I thought to myself, if I'm done with this show, this is the last of the Money Mini Series. um What do I want to say? And I guess I want to say why I feel like I started the podcast, the Money Mini Series by saying, what's the purpose of life, right? Well, what's the purpose of me doing the Money Mini Series podcast? It's for me to share with you my experiences and also my perspectives and

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and opinions and why I have them so that it can help you in your life in some way. you know, yes, it's probably I should say that it's legally for entertainment purposes only, you know, and whatnot, but I do want other people to have success. And so in preparing for this, I thought, you know, what does the Bible say about money? Because that's a good

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maybe way framework. the first thing that I was looking at is that the main thing God says is that God owns everything and we're just stewards and the earth is the Lord's and everything in it. The world and all its people belong to him. We have to say everything we've come, we have has come from you and we give you only what you first gave us. uh And so money is a stewardship issue, not a possession issue. uh

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And sometimes if you're holding too closely to anything, like whether it's your family, whether it's your health, whether it's, you know, it's hard to be like driven on the one hand and a steward at the same time. So you want to be like a good steward that works really hard with what you have, does, the most of it, right? Good and faithful servant turns the 10 talents into 10 more talents, but without it necessarily being, feeling like what you're doing is because of you.

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because it's actually not, and it can be taken away and the doors can be shut and have experienced it. It's a very healthy, just sort of peaceful way of thinking about it. And I have one more thing that has now recently happened. So basically that pivoted into this 1099 contracting business that is now Liberty Clinic, where basically I go in as a contractor to rural hospitals and I meet them and give them whatever they need.

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You know, they tell me what they need and then I tell them what I can offer. And then we find mutually beneficial things and I'm coming at it with a team. Now I'm up to, I've hired my first surgeon. I don't know if I've said that here on the podcast yet, but, um, I've hired a doctor that does endoscopy for us. I have also now hired a surgeon, two APPs and we're actually growing in a sustainable good way where other people are able, you know, to win. Nobody's losing. And, um, the mission is being, you know, sort of carried out.

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But just a few weeks ago, I got a call. The first hospital that I had started at where was an employee, I got a great start. um Helped me with my loans to get repaid, was flexible, allowed me to show that I could work at more than one place. um Then I converted that to a 1099 contract because I was getting to the point where

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I felt that it wasn't really right to say that I'm, you know, at some point I'm not a full-time employee there anymore. And I'm, and I found this model to be so successful. kind of feel like it's the future where, you know, employment was sort of a new concept 20 years ago. Now this is a new concept. This kind of 1099 contracting or, you know, as Todd Stillson would call it, the micro corporation. That's kind of like the new thing. And

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And I'm in some ways leading the way here. And I felt like we had moved to a very sustainable thing that was very helpful and beneficial. And I got a call that my contract was terminated. And it wasn't about patient care. It wasn't about outcomes. And it wasn't even a budget issue. It was politics. Into the day, there's one person that didn't want me there. And I...

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don't need to dive into the whole story, but there's phrases and quotes like about, you know, peace is everything or protect your peace or quotes about toxicity and whatnot that you don't understand until you sort of live through it. And there, I had a scenario like that at my first job to the point where I called mentors like shortly before, after I started, few months after I started.

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And I got advice that I should immediately leave and I stayed anyway. and I, you know, you're, you're surgeons basically, you know, listening to this podcast. So let me give you an example of like what happened repeatedly for years, not too, too extreme because I really tried to distance myself, but it was tough. Um, so I had a patient that had rectal cancer.

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And uh showed up in my office with a CT shows near obstructing rectal mass, but she's not obstructed. She's still passing some stool and gas. Um, but there's some like loss of house tray, you know, like it's getting close sigmoid and I was doing some colonoscopies. And so I had seen some poor preps and I knew I wanted to try and scope above this mass if possible and rule out any.

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synchronous tumor because there's 10 % risk of it. And so I wanted to prep her and get a colonoscopy. And so another surgeon at the hospital was there in clinic, doing clinic as I was. I brought up, I said, I just wanted to ask a question like, have you ever done a two day prep? I didn't really know all the details about all the preps. I'm like still kind of feeling it out. You know, there's so many things you don't know when you first start, you just kind of doing a lot of reading and asking people and

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the, you know, the concepts, core concepts, but some, but you don't really know like some of the little details because someone was taking care of it for you in residency. And so I asked that question about doing a two day prep and then the person kind of digs into the story and then starts telling me like, well, you can admit the patient and you can just do the colonoscopy on the weekend. And you know, if you can just go ahead and go straight to an operation because like clearly they're

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near obstructing and like, no, like I think I'm going to be able to do this in very like short order. And I'd like to name it, stage it and then treat it, you know. And if I can do it right and she's not metastasized, you know, give her the best operation. then also, and this is like a lady in her eighties. And I said, you know, maybe I could, you know, resect it and then, you know, give her an asthmosis and, and now I have to do it emergently and, you know, give her a class to me. And then he just roared.

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And he said, what? And this is in my clinic in front of the secretary and the two MAs that are shared, right? And this is an experienced surgeon that's in town. And in front of those people roars and says, what? You're thinking about putting this lady back together? If she leaks, she's dead. And I was very taken aback.

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Because that's not a true, as you know, that's not a true statement. And just how it was said and in the way, in this very intentional way that it was said in front of key people, right? And anyway, I was in a stage where I was still doing my OPPE. so, you know, because he was involved in the case, I did it the way I described, like I did a two day prep, a sculpture. um

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Lister for the stage here, know, CT chest, having pelvis and CEA and there's no mats. And so we're going for an operation and the intention is reconstruction. And so at this point, I still have to have another surgeon with me because we're doing this OPP thing. And then I go and I'm in the operating room and I choose him to come with me to the operating room because he already knew about the patient. And we get in there and

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One thing that I, it was, it was a mess. was, it was very difficult to do the case, you know, with him. And then there was one, there was a fair amount of bleeding. We got the mass out, but in the middle of, of doing that, um, I had not done a type in screen. And that was like a big thing that was brought up in the middle of the case. And the whole case had to be halted for like 30 minutes to like him to go under the drapes and.

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draw blood in and make a big deal about it. And then of course, by this time, the pressures are getting a little soft. I kind of like mentioned, you know, what happened is there was about this much about, and I know it's audio for some people. So it's about maybe four or five inches of distal colon that where I had transected, there's like a cuff and then the descending colon is coming down. And so I'm looking at it and I had had this question before.

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think the right answer is just to resect down to the pelvic brim and then to put an anvil and just bring it down and put, do a colorectal anastomosis. But the thought crosses your mind, why don't you just do a side by side anastomosis there, because there is enough reach. And so I asked that question. said, so what would you do here? Would you put a side by side anastomosis here or would you re-resect this and bring it down?

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And their response in front of, you know, the only anesthesiology provider in town and several nurses of our group of five total nurses and four total techs and several techs was, what? You're still thinking of putting her back together? If she leaks, she's dead. That's the roaring response. And I mean, it was shocking.

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And before the case, there was like a conversation which was, hey, this is your case and I'm just here to like do your OPPE and basically support you and whatever you decide, you know, that was like this quiet conversation before the case, right? And then in the middle of the case, that was the interaction. And then he said, you know what, if you want to put this patient back together, then you can do

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what you feel you need to do. And I will leave the case and you can proceed however you want. I'm like, so I said, you can leave and I'm not going to put it back together because I know if she leaks that it's going to be essentially raise a crucifix for old Dr. Layman, but I'm going to do, you know, a Harman's and, and, uh, live to find another day.

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And, you are excused and I can handle it from here. And he left. And that was the last time we ever did any case together. I think to my knowledge, I can't really remember, but it definitely should have been if it wasn't. that was, and then that scenario, and I don't want to, I have tons of stories obviously that I could tell, but I don't, I don't want to, I'm telling this for, not for my own self to feel better, but for you to understand.

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reality of a lot of people come on the show and they beat around the bush about, you know, had a toxic partner, but like, what does that really look like? And I got a call, I don't remember if this was before or after, but right around the same time, like a month or two into practice from my program director. And I was like, program director said, hey, how's it going? How's, how's practice? I'm like, wow, this is so cool. My program director cares about me enough that I'm oblivious to call and check in on me. I was so happy and I went on and on.

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about how great it was and how much better it was in residency. And he says, oh, is everything great? I'm like, oh yeah, it's awesome. Is there anything that's bad at all? I'm like, no, no, everything's awesome. He goes, okay. He's like, at all? And then I'm like, well, there's this one thing. And I start talking about this guy. And he said, that's funny that you, after I then go on a big rant about that, right? And he just listens.

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He goes, that's funny. I thought you might say that because yesterday, uh yesterday evening or yesterday afternoon, he called me and he's clearly trying to dig up dirt on you. And then I got advice that was be very careful because he told me about a surgeon that he knew who was in a metro area and was a good surgeon and basically got on the somebody's bad side and

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Uh, and basically got blacklisted from all the hospitals in the area and then worked out his career as a urgent care physician and kind of like brought that warning to me, you know? And then I talked to another mentor about the situation. He said, quit leave, you know, I talked to other people and they said, you know, trust your training and you have broad shoulders and just stand up and just make your practice immaculate and.

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trust your training and things. essentially, long story short, that's what I did. I implemented a strategy called gray rocking, which you can look up on your own and that worked. It's understanding some of, like I said before, these crazy quotes that don't make sense until you live through it. Like again, say, protect your peace or don't stay where you're not valued.

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or freedom as being able to walk away. Right? And that's where the financial piece comes in. I'd heard those things for years, but it wasn't until I had my name on contracts and I got betrayed in meetings and I watched good work go unrecognized. And I felt that not in my stomach walking into certain buildings that I finally understood what the quotes meant because experience is the translator of those ideas. And once they're translated, then

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You can't unhear that true meaning. So I stayed and I kept working and uh then things became revealed to me later. um But I got to say that my motivation to do some of the things like the locums and even to have the idea of going to Liberty Clinic helped me to sort of have a bug out bag, if you will.

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I felt like I needed to protect myself and that's how I did it is I gave myself more options than just one place. And also even investing just in general, like in real estate or saving and also living well below my means. All of those things gave me freedom to be able to stomach when things don't go the way they were planned. that's the message I guess that I'm trying to share with this money mini series to you is

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to offer you some practical tips and tricks and to perhaps inspire you to spend less money on personal spending and be less on the hamster wheel, number one, by throttling back expenses and having a big, nice, big margin, no matter what your income is, having a nice big margin and buying back your freedom and having that sort of...

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emergency fund, if you will, and, and streams of other income so that you can live off of it. Because then you can choose, you know, to do the thing. a last topic, which is kind of weird is leadership. And people talk about it like it's a personality type or a title. But in my experience, leaders are the ones that do things first. Imagine a leader going through the jungle, then slashing through things, paving away. And they're the ones who paved the way. They.

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go somewhere hard, make a way, and then they wave others through it. Like, you're good now, just follow this path. And that's lonely. And sometimes it feels like you're the only one doing the hard part while other people reap the benefit. And there's quotes to that effect. Like an Eleanor Roosevelt quote is, a good leader inspires people to have confidence in the leader. A great leader inspires people to have confidence in themselves.

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This is an example of one of those quotes. They're like, okay, sounds good. But, but then once you actually do the work for a longer period of time, you start to realize these things and, that's the most rewarding part. I've got one example who is a virtual medical assistant that I hired because I'm like throwing everything at the wall just to see what sticks when I'm starting my independent practice and I'm reading everything about it, trying all kinds of things. And I checked in with her recently and.

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I said, how are things going? I update on myself. Hey doc, it's so nice to hear from you. We're no longer with the same company. I'm now focusing on my startup business, my very own VA agency. You and Liberty Clinic have been such an inspiration for me to pursue what I truly love, just like how you started Liberty Clinic. I'm now building something of my own. If you know of anyone looking for a skilled virtual assistant for their practice,

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I'd be grateful if you could refer them to carefree VA. And I would, to be clear, I'm not planning on advertising for her, but I would endorse Lou 100%. She says, it's wonderful to know that you and everyone at Liberty Clinic are doing so well. that is, I mean, I was floored. There's another quote that says, leaders don't create followers, they create more leaders.

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And it doesn't make sense until a little bit of life experience sort of shows you that. another quote is, great leaders encourage leadership development by openly developing themselves. And to a certain degree, that's what I'm doing right here. And I have uh a one sheet, which is all my goals kind of written for multiple categories. And I do that through the business mastermind that I'm in.

51:33

There are five like bucket list things. People write things on their bucket list, like, you know, go to an art or something. I don't have a lot of things like that. Um, but one of the things that has been consistently ever since my first one sheet on there is be a leader in the space of rural surgery nationally. And that's, I like podcasts. I like talking. I have things that I feel like I want to say.

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That's why I have this show, but also it fills this thing. It's part of my give back in. And, um, that's what leads. Okay. When I say give back, right? It's leadership is not about the person. want to be the leader, right? But what is leadership? Leadership is giving back. It's developing other people. It's showing other people the way it's paving the way doing something that nobody else is doing, which is very much a lonely thing. And it's, it's very much what I have felt over the past five years. Now, not lonely, lonely because.

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I have extremely awesome people, starting first with my wife, um who just unbelievably supports me unconditionally. There was a point where I was at a meeting and I was talking to some people about a business meeting, right? One of my masterminds and I was talking about my investment strategy, talking about how much debt I was taking on and my goals for the next year. And uh they said, did your wife...

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You're you this is you should not do this. You know your wife does she know what you're doing that she understand because there's no way she does. I actually called her in she came in early to the meeting and then like stayed the last night with me and I said look I'm feeling very like convicted about this. This is what I'm doing. I want to make sure that you're totally clear. She listens to the whole thing. She said yeah I know that's what we're doing. And she goes I said that means we could possibly we could go bankrupt. You know we can lose everything. She goes yeah that's OK.

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I'll be, there with you. no matter what, it's probably not going to happen, you know, it's calculated like, but even if that happens, like I'm still going to be right next to you and loving you, supporting you. She tells me so many times like how she supports me and um to have a person like that in your corner is incredible. I also, my, dad, you know, and I've got um like a uh good friend, Ryan, who

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The two of them are, I mean, incredible supporters and incredible people. So there's other people too that I'm not naming, but when you have these people that sort of know the real you and then they can be behind you, don't forget them and try, you know, I'm speaking to myself here as much as anybody else to, um recognize that support and recognize how you're not doing it by yourself. uh There's no possible way. this has been a

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a bit of a long episode and a somewhat of a long journey. And if you've listened to the full series, thank you. Thanks for being here. If this is your first episode, go back. We've talked about purpose, frugality, investing, taxes, efficiency, giving, legacy, kids, and now resilience. Now I've told stories I've never shared before. I'm a little nervous about it, but this is the real stuff.

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It's the kind of stuff that I wish that someone had told me before the first dream died. Um, before I learned how to pivot, but that's part of the story, right? But, uh, now, you know, I am facing right now a very new thing. Like I'm at this moment, I'm still working in a contract in a place where I actually want to be with a model that I thought was a long-term model that I just renegotiated a few months ago.

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And that has been terminated sort of surprisingly. And now that's just put it up as another way that the dream didn't go as planned. But I'm not really worried about it at all. I have a lot of peace. don't, know, I'm, you know, a lot of that stems from, again, the financial independence, but even that, like something could happen. uh

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We could go into a big global recession and I could get vacancy and I could get taken down by my own portfolio. Even if that happens, and there's much worse things that can happen than that. My nurse practitioner got a cancer diagnosis, like within the past year in her early 30s. um People die. So it's not just little things like losing a job. It's having that open hand ability to pivot.

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And understanding there's always something bigger going on and trying to like have that calm in the storm that comes with experience and wisdom. And that's why I would recommend that you make margin and you build, but build wisely. Give generously. Don't let the dream own you. And that's it for the Money Mini Series. It's the real story. And you heard it here on the Rural American Surgeon. And I'm your host, Dr. Randy Lehmann.

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and I'll see you on the next episode of the show.