Episode 77
How One Rural Hospital Increased Its Cancer Care Capacity by 400%
Dr. Ronald Weigel joins host Dr. Randy Lehman on The Rural American Surgeon to discuss the American College of Surgeons Commission on Cancer’s new rural accreditation pathway and what it could mean for hospitals, surgeons, and cancer patients in rural communities. In part 1 of this 2 part episode, Dr. Weigel shares his path from engineering and surgical training at Duke to cancer research, leadership at the University of Iowa, and his current role as medical director of cancer programs for the American College of Surgeons.
The conversation then turns to the challenges of delivering cancer care in rural America, where patients may face long travel distances, limited access to general surgeons and oncology specialists, and fewer hospital resources. Dr. Weigel explains how the Commission on Cancer Rural Accreditation track was designed to adapt established cancer-care standards for smaller hospitals while helping more patients receive high-quality, guideline-concordant care closer to home.
Dr. Weigel also walks through the accreditation process, including cancer leadership, multidisciplinary care, registrars, data collection, site visits, and building referral networks when services such as medical oncology or radiation therapy are not available locally. He and Dr. Lehman discuss how accreditation can strengthen rural cancer programs, increase patient volume, attract specialists, and reinforce the role of broad-spectrum general surgeons in maintaining viable rural hospitals.
Key Takeaways
00:38 Introducing Dr. Ronald Weigel and Rural Cancer Accreditation
02:08 From Engineering to Medicine and Surgery
02:44 Training at Duke and Lessons From Surgical Mentors
03:51 Developing a Leadership Style in Surgery
07:58 Surgical Training, Cancer Research, and Stanford
09:10 Becoming Chair of Surgery at the University of Iowa
10:16 Joining the American College of Surgeons Cancer Programs
12:37 Why Rural Cancer Accreditation Matters
14:18 Understanding the Needs of Rural Patients
17:12 Cancer Disparities in Rural Communities
17:31 How the Rural Commission on Cancer Accreditation Track Works
19:30 The Accreditation Process and Timeline
21:13 Building Multidisciplinary Cancer Care in Rural Hospitals
21:37 What Hospitals Need to Meet Accreditation Standards
24:46 Building Cancer Care Networks Without On-Site Oncology
26:13 How the ACS Supports Rural Hospitals Through Accreditation
27:51 Is Any Rural Hospital Too Small for Cancer Accreditation?
29:10 How Accreditation Can Strengthen Rural Surgical Programs
30:28 Supporting Multiple Surgeons in Rural Communities
31:22 The Broad Scope of Rural General Surgery
Resources Mentioned
American College of Surgeons
https://www.facs.org/ ACS
Commission on Cancer
https://www.facs.org/quality-programs/cancer-programs/commission-on-cancer/ ACS
National Cancer Database
https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/ ACS
University of Iowa
https://uiowa.edu/ uiowa.edu
American Board of Surgery
https://www.absurgery.org/
Episode Transcript
Dr. Randy Lehman (00:32):
Welcome back to the Rural American Surgeon. Today, I'm joined by Dr. Ron Weigel from the American College of Surgeons, and the Commission on Cancer. We're talking about a major challenge in rural America. How do we provide high-quality cancer care close to home when many rural hospitals simply don't have the resources or the volume of a major cancer center? The Commission on Cancer has developed a new accreditation pathway specifically for rural hospitals, and Dr. Weigel is here to explain why it was needed, how it works, and what it could mean for rural surgeons and their patients. Here's part one of our conversation. Welcome back, listener, to the Rural American Surgeon Podcast. I'm your host, Dr.
Dr. Randy Lehman (01:17):
Randy Lehman, and I am pleased to have with me today Dr. Ronald Weigel, who is the medical director of the cancer programs of American College of Surgeons, including the Commission on Cancer. And today we're gonna be talking about the new Rural Commission on Cancer Accreditation program that's rolling out, I believe, in 2026. So we're going to get into the nitty gritty. Thank you so much, Dr. Weigel, for joining me today.
Dr. Ronald Weigel (01:40):
Thank you, Randy. Pleasure to be here and I appreciate you taking the time to talk with us today.
Dr. Randy Lehman (01:46):
Yes, this is a very relevant topic. And so let's start with just a background of you, what your practice was like and training and and then get us quickly into your experience with the ACS and then we'll dive into the into what these new changes are.
Dr. Ronald Weigel (02:00):
All right. Well, I'm not sure what you'd like to know about my background. I did my bachelor's and master's in chemical engineering. So I come from an engineering background. I was at MIT for four years and then went to Yale University where I did my MD degree and a PhD in molecular biophysics and biochemistry. And that really set the tone for the rest of my career. I have always combined clinical care of patients and research, both basic science and clinical research for the last 35 years of my career. I did my surgery training at Duke under Dr. Sabiston. I know he's an icon in American surgery. And then when I... What was Dr.
Dr. Randy Lehman (02:56):
Saviston like? Just to take a quick sidebar.
Dr. Ronald Weigel (02:59):
Yeah. He was a force to be reckoned with. Every question he asked, there was one answer. It was, yes, sir. And he was a brilliant guy, hardworking guy, ran a great program, very much dedicated to resident training and had an outstanding faculty. So I was pleased to train there with Dr. Sabiston. Um, he was definitely a force to be reckoned with.
Dr. Randy Lehman (03:24):
Yeah. Okay. Thank you.
Dr. Ronald Weigel (03:27):
I mean, the terrifying thing was when he would look at you and say, oh, call me Dave. And you'd say, yes, sir. Dr. Sabiston.
Dr. Randy Lehman (03:37):
Yeah. Oh, that's fantastic. I'm sure there's some stories that I don't know if there's anything appropriate to share, but I've heard some stories from several surgical mentors of mine from not necessarily Dr. Sabiston, but the era, you know.
Dr. Ronald Weigel (03:49):
The era. We are in a kinder and gentler era, and when I became chair of surgery here at the University of Iowa 21 years ago, I adopted a lot of things that Dr. Sabiston did, but I also developed my own style, which was much more, we'll just say, kinder and gentler. And so, for example, when I, I stepped down as chair about a year ago and continued with my lab here, and I'll get into some of that. But one of the things that I did when I became chair, I reinstituted what Dr. Sabiston did, which was morning report. He met with chief resident and he went through the OR schedule.
Dr. Ronald Weigel (04:32):
He went through the admissions that night and any other things that he needed to talk about. I did that for 20 years as chair here. Every morning at 6:45, met with the chief resident. So there were things that I learned from him that were very helpful and very useful. And as chair, I would see somebody walking down the hall and I'd say, so how did that Whipple go today? Or how did that colon resection go? And so people recognize that I knew what they were doing every day. Great way to run the department.
Dr. Randy Lehman (05:04):
So I had a mentor of mine who told me a story about Dr. Altemeier. I've said it before on the show, so skip ahead if you've heard this, but you have neat stories like this. Let me just share one real quick. So supposedly, Dr. Altemeier had a tradition, he would scrub in on every parathyroid at Cincinnati. And there was a chief resident, my mentor was an intern, doing a rotating internship there. And... Chief residents, you know, reportedly it's a seven year program at that time. And by the time they kind of ran the hospital and it was just like they walked on water and everything.
Dr. Randy Lehman (05:36):
And so this chief resident's doing a parathyroid naturally by themselves, doing the whole, uh, taking the parathyroid out, drop it in water, you know, see if it floats and everything's got it all. dissected out, the operation is basically complete. Then he lifts up the thyroid and puts the parathyroid adenoma back where it initially was anatomically, places the thyroid back down and tells the nurse to call Dr. Altemeier. And Dr. Altemeier comes in and he says, we'll say Jack, you know, he comes in, he says, Jack, how's it going? Dr. Altemeier, sir. Thank you, sir. I'm having a little trouble finding the parathyroid, sir. Oh, let me scrub in and help you, Jack.
Dr. Randy Lehman (06:13):
So he scrubs in with a flourish and everything, opens the incision, lifts up the thyroid. Well, there it is, Jack. Oh, thank you, Dr. Altemeier, sir. He scrubs out and that's the end of it. Anything like that happen with Dr. Sabiston?
Dr. Ronald Weigel (06:31):
Well, yes and no. I think it was pretty hard to hide things from Dr. Sabiston. He was pretty savvy. I don't think that would trick him. I mean,
Dr. Randy Lehman (06:42):
I think Dr. Altemeier was in on the joke.
Dr. Ronald Weigel (06:44):
Yeah, right. Exactly. You know, he used to round with the team. We used to do what they call staff rounds. Dr. Sabiston would round with the whole team as part of an educational process. And he certainly had a way to find out what was going on. And I remember one time we're on rounds and... he turns to one of the medical students who was just, you know, so pleased that Dr. Sabiston recognized him. He knew everybody's name. He knew all the students' names. And he says to the student, he said, so who on the service has the most interesting incision? And the student says, well, there's Mr.
Dr. Ronald Weigel (07:30):
Jones and, you know, he's got an incision from here to here, but then one over here and another one over in Dr. Sabiston goes, oh yes, let's go see that patient. He had a way of figuring out what was going on.
Dr. Randy Lehman (07:47):
I love it. All right. Well, we digress, though. This is wonderful. So, basically, you trained over, that was Duke, correct?
Dr. Ronald Weigel (07:57):
Yeah, yeah. I trained at Duke. I was at Duke. I had already done my PhD, so I only spent one year in the lab. Okay. So, it was five years of general surgery training and a year of research. And my research has always been involved with studying mechanisms of gene regulation in cancer. And when I graduated from Duke, I took a job at Stanford University, and I was there for 10 years. I was a tenured faculty member there. And it gave me an opportunity to build my endocrine practice. I also always did breast, so I did breast and endocrine. Also took general surgery call and trauma call.
Dr. Ronald Weigel (08:40):
did all of general surgery, essentially, and was a great time at Stanford, developed my lab, got my, had my NIH funding, which I've had NIH funding to study mechanism of gene regulation my whole career, and then left Stanford. And was in Philadelphia for a couple of years. I had a clinical practice at Jefferson, was vice chair there, and also did my MBA at Wharton. And then basically two, three months after finishing my MBA, I came to University of Iowa as chair of surgery. And it was a great opportunity. Really, the stars aligned. My wife grew up in Des Moines and went to the University of Iowa as an undergrad. And so it was like coming home. And so we were here.
Dr. Ronald Weigel (09:35):
We raised our four children in Iowa City, which is a great place. to raise children. It's, I mean, I know it's probably, it's not considered a rural town, but it's a small town and it's a college town. And, um, I ran the department for 20 years, maintained my lab. And then, um, I was really interested in taking my career into a more national level. I felt like I had done what I could do as chair of surgery. And when I, I think it's important to, I mean, I stayed for, I was thinking when I took the job, I'd do it for 10 years and end up being 20, but.
Dr. Ronald Weigel (10:14):
I had an opportunity to come to the American College of Surgeons to run the cancer programs, and it was a wonderful opportunity. Dr. Patricia Turner, as you know, is executive director and CEO. of the American College of Surgeons, does an outstanding job. And I took the opportunity to run cancer programs under her leadership, and it has been just fabulous. When I took the job as medical director, I was still running the Department of Surgery, running my NIH-funded laboratory, had a clinical practice, and now... was going to be taking on a major role in running cancer programs for the college. So I had to give something up. And so I started decreasing my practice and I stopped practicing surgery.
Dr. Ronald Weigel (11:05):
And I felt like my unique contributions were in my administrative role of the department, doing my research. And then having this administrative role at the American College of Surgeons, I felt like the other members of my department could do what I did clinically. And so I decided to close my practice, which has been closed now for a couple of years. And now I still have my lab here at the University of Iowa. We study gene regulation. We also just got a T32 grant for surgical oncology research. And that's open to residents all over the country that are interested in coming here to do either basic science research or clinical oncology research. And then I have my role at the American College of Surgeons.
Dr. Ronald Weigel (11:53):
So I'm between here, Iowa Many things that I do are like what we're doing here on Zoom calls and other ways, virtually fulfilling my role at the American College of Surgeons.
Dr. Randy Lehman (12:07):
Yeah, the crazy thing is that the age we're living in, I've got a 97-year-old grandfather. And you think about the things that you're talking about, the things that you've touched in your lifetime and how those things have changed. from somebody that was born in 1929 to 26 it's just unfathomable and i had a recent interview with uh somebody who's in the shetland islands and we just met just like this and no lag no problem you know it is it's crazy and so i guess that brings us into
Dr. Randy Lehman (12:40):
2026 uh commission on cancer accreditation for rural hospitals uh i would say to a degree i feel like what's old is new again and i'm sort of the i mean personally people have told me you're the renaissance man of surgery right like go back and do broad spectrum general surgery in the community. And I kind of do that.
Dr. Randy Lehman (13:02):
There's a lot of ways that I view like what I do, but I strongly believe in rural surgery and that we've lost well over a hundred hospitals in the last 10 years in the United States and many of those small rural hospitals, critical access type settings where many times they don't have a surgeon or they lost a surgery line or department and then the hospital kind of fizzles. Obviously, viability, economic viability matters. You also have to meet people at their point of need in order for them to believe in the hospital and be able to come there. Unfortunately, of course, all across America, the best hospital is usually 60 miles away, you know, in everybody's mind. So you have to constantly fight that.
Dr. Randy Lehman (13:39):
And this might be a way, you know, something you could do. for your own rural hospital to show them that the standard that's being met is the same, you know, as if they were going somewhere else. And then the other thing we've talked about is in the rural place, the care could be the same medically, but it's actually better. because of the follow-up and the coordination and the family involvement and those kind of things, if you can keep things close to home. So maybe give me a 10,000-foot overview of what you're trying to do with this new program, and then I'm sure that's going to trigger a lot of other questions.
Dr. Ronald Weigel (14:17):
Sure, absolutely. Well, I'm strongly committed to providing care for patients in rural communities. As I said, I've spent the last 20 years, and by the way, my father-in-law still lives in Des Moines. He's 101 and completely independent. And these, you know, learning about rural communities. you recognize how the culture of rural communities plays a critical role in what you said, treating patients where they're at. Now, as an example, I was a director of the American Board of Surgery. And when I took the job here at Iowa, I had a lot of discussions, drove around the state.
Dr. Ronald Weigel (15:06):
and met a lot of surgeons and other providers in rural communities, and I recognized a critical need to train individuals who could take on the role of being a rural surgeon. And my hat is off to you, Randy. others who train, who work and provide care in these rural communities, because it's really a huge challenge. And I remember I talked to Frank Lewis, who was the director of the ABS, and he was of the mindset like I think most people were at that time. Well, those rural communities, those patients in those rural communities can just travel to the academic larger medical center.
Dr. Ronald Weigel (15:53):
And I think if you spend time taking care of patients in these rural communities, they would prefer to stay in their rural community, both from the fact that their lives are so complicated and having to, they live there in that community. It's not easy for them to travel. don't have the resources to make sure that the farm is taken care of, or their kids are taken care of, or be, you know, be gone for six, seven hours to have an hour-long, you know, meeting with a physician. And they would rather stay in their community, even if you tell them that their care would be better if they traveled.
Dr. Ronald Weigel (16:39):
they tend to be much more stoic and they trust whatever services they can get at their local hospital. And Iowa's got, you know, 99 hospitals, basically one in every county. And you're right. They are being threatened with extinction. The critical access hospitals are an important aspect of our care that we deliver. And what we're trying to do with cancer programs and the CoC is essentially bring the mountain to Mohammed. Those patients in these communities. want to stay in their communities. We know that cancer mortality is about 15% higher in rural communities than they are in our urban settings. About 60% of rural counties lack a general surgeon, and about two-thirds of them have no oncology specialists.
Dr. Ronald Weigel (17:31):
And so what we're trying to do with the Commission on Cancer Rural Accreditation Track is create a framework to provide high-quality cancer care in rural communities.
Dr. Ronald Weigel (17:45):
And the model that we developed were based on pilot studies that were done both in Kentucky and in Iowa to figure out what it is you need to do to create CoC accreditation, Commission on Cancer, American College of Surgeons Commission on Cancer accreditation at a rural hospital, and to try to figure out exactly how we should modify standard CoC accreditation so that it was more appropriate for a hospital that had less resources, and really took care of a different patient population so that more patients can be treated in their local community and receive the same high-level quality care. And what those pilot studies, for example, that were done in Iowa showed
Dr. Ronald Weigel (18:32):
is that if a hospital becomes CoC accredited, you can see an increase in the patients treated there having guideline-concordant care and improved mortality. And so what we're trying to do is roll out this program nationally to rural hospitals across the country and then be able to figure out within that network how to provide the resources that they need. Some of those resources are based on having registrars locally, cancer registrars who can pull the data because what we try to do is provide that data back to the hospital. so that they can focus their resources on areas that we know evidence demonstrates we can improve the quality of surgical and overall cancer care for patients in that community hospital.
Dr. Randy Lehman (19:26):
So how far into this are you? Have any hospitals signed up?
Dr. Ronald Weigel (19:30):
Yes, but here's the process. So in order to sign up means that they have to, the hospital has to commit to becoming accredited. They then have to function as an accredited program, put in place everything that's required for accreditation, submit data to the National Cancer Database, and then function like an accredited hospital. And then after a year, they get a site visit. And it's an on-site visit from a site visitor who's been trained and helps them determine whether they have fulfilled accreditation for all of the standards that is required for accreditation. And if they don't, then they have an action plan. to correct any deficiencies. And then once that's accomplished, then they are accredited. So it's a multi-year process.
Dr. Ronald Weigel (20:29):
And this was rolled out in 2026. If a hospital signs up now and decides they will be accredited, we don't actually know that because there's no, we don't have a mechanism to know because they may start and say, this is too difficult or whatever. But we believe many hospitals have contacted us and we're hopeful that they will fulfill the accreditation standards to become accredited. So the first hospital to be site visited and accredited will be roughly a year from now towards the end of 27, early 28.
Dr. Randy Lehman (21:03):
Okay. And so the Commission on Cancer is an ACS program. but it does not just include surgical cancers, right?
Dr. Ronald Weigel (21:13):
Correct. It's not just surgery. The standards are designed to deliver high-quality, multidisciplinary cancer care.
Dr. Randy Lehman (21:24):
Okay. And so what would be that first year, for example? What sort of resources would a hospital have to deploy to get through the first year and get themselves to a site visit? What they have to track?
Dr. Ronald Weigel (21:37):
So we modified the conventional CoC standards to be appropriate for a rural hospital. And what they have to do is put in place an administrative structure that includes a cancer liaison physician who oversees the program. They need certain specialists. They don't need all the specialists, but they do need some multidisciplinary care. And again, those hospitals can tailor to the services that they provide. For example, some rural hospitals maybe do radiation. Some of them may have an infusion center. And so they may provide medical oncology care or radiation oncology care. And then from that, they put together a cancer committee to oversee how the patients are being treated. They have to put in place ways to track the standards.
Dr. Ronald Weigel (22:34):
They need registrars who can come in and look at their program and pull data related to patient care, how they were treated. And not all hospitals obviously do. For example, they may not do operations for lung cancer. That's okay. But if they do breast cancer care, they have to fulfill the standards that we've established for synoptic reporting, for lymph node or axillary dissection. melanoma, if they do colon resections in terms of number of nodes that are resected. So we have certain standards that have to be fulfilled. We just introduced a new standard which will become active, which is, was the patient screened for smoking? And were they provided ways to stop smoking? Things that have a real impact on patient care.
Dr. Ronald Weigel (23:28):
And then those standards and outcomes get put into the National Cancer Database. There is a way for them to check, have they fulfilled all the standards, and then have a site visit from one of our site visitors and become accredited.
Dr. Randy Lehman (23:45):
Yeah,
Dr. Randy Lehman (23:46):
it's probably best if there's a point person at the hospital, right?
Dr. Ronald Weigel (23:48):
Correct.
Dr. Randy Lehman (23:49):
That person normally would be like a RN or what would be the ideal?
Dr. Ronald Weigel (23:54):
The ideal person would be a medical oncologist or a surgical oncologist or a general surgeon or anyone who is involved in taking care of cancer patients. And then, yes, there are administrative structures for nursing and care navigators and other groups of individuals that are involved in creating... Well, yeah,
Dr. Randy Lehman (24:18):
the medical supervision needs to be, you know, like you said, but... but then there has to be somebody that's helping to pull all this stuff and then my second follow-up question is say that there was like an RN and a physician whether, say, it's a general surgeon since this is a Rural American Surgeon Podcast say i wanted to do this um so i'm in I could not do it at that program or at that hospital, or could I?
Dr. Ronald Weigel (24:47):
You could. You could do it at that. That's not a requirement that they have a medical oncologist. But for example, when you're having a multidisciplinary tumor board, you may be able to do things remotely. You may be able to set up a structure to allow patients to have access. to levels of care that you may not provide there. And there's plenty of part of what we provide in hospitals deciding they want to become CoC accredited is to help them develop a network of care so that those patients receive high-quality cancer care.
Dr. Randy Lehman (25:20):
Yeah.
Dr. Randy Lehman (25:21):
So like, for example, I did a colon cancer resection there Tuesday at critical access setting, 84-year-old lady. She came to me. I did her scope, found her cancer, did her resection. Now I'll send her to an oncologist in a town about 50 minutes away that is with a different system. So we'd have to involve those people. I mean, obviously we just communicate directly, but then if I came along with somebody that was maybe like an OR manager-type nurse person, that might be a good person. Or if there was a nursing manager in some other way, CNO or something like that, who was wanting to own it.
Dr. Randy Lehman (26:00):
The next question is, what sort of resources during that first year does ACS provide to the hospital to help them with their accumulation of all this data, tracking things, make sure they're doing it according to the standards?
Dr. Ronald Weigel (26:14):
Right. So we have a system in place. And I'm happy to provide the contact information, but we have a system in place where hospitals can get a consultation about what it is that they would need to set up in their own hospital in order to become accredited. And, you know, what you're also pointing out is the fact that you and other clinicians, nurses, social workers, other people at these rural hospitals really want the resources to provide high-quality cancer care. And what this program is involved with is trying to help you understand where you put your limited resources in order to accomplish that. And so it's like providing a roadmap.
Dr. Ronald Weigel (27:02):
providing a guideline for where you should be focusing your effort in order to provide that high level of care, and then helping you sort through the networks that are required, like you just said, where would the patients go in order to get their chemotherapy, if that's required, or radiation therapy. And we recognize that every hospital is different. Some hospitals have certain sets of resources and other hospitals don't. And so we can come in and provide consultative services to help you figure out what it is you need to do to fulfill all the standards.
Dr. Randy Lehman (27:39):
How big of a hospital would be big enough that this rural commission on cancer accreditation doesn't really apply to them and they just do the regular old accreditation?
Dr. Ronald Weigel (27:50):
Well, so good question. We helped get CoC accreditation for a small hospital in North Carolina. And the surgeon there, who was the champion of this and got the administration on board. basically said no hospital is too small to get accredited. If you're taking care of cancer patients, it would serve you well and serve the patients well to become accredited. And what they found is actually a multiple increase, something like 400% increase in their ability to take care of cancer patients in their hospital once they became accredited. And so I think it's one of these things that can have a snowball effect where you put in place systems to help you take care of cancer patients.
Dr. Ronald Weigel (28:40):
And the result of that is you actually have an increase in volume because you're able to take care of a greater number of those patients and develop the expertise. And then. You know, the medical oncologist, if you became accredited at your smaller hospital, the medical oncologist you're sending them to might say, okay, they've got enough volume and they're accredited and this is a great system and we're increasing the volume. I'm going to spend two days a week at that hospital so the patient doesn't have to travel. Because as I was chair of surgery, I'll just tell you as an aside, not related to the CoC accreditation.
Dr. Ronald Weigel (29:17):
But I would get calls from some of these critical access hospitals, didn't have a general surgeon, wanted general surgery coverage. And the problem is, in order to have enough volume to keep a general surgeon busy 24-7, I mean, that's a problem if it's one person. at a hospital and they want the ER is there, the ED is there, they want coverage for trauma and belly pain because maybe the patient's got appendicitis or a hot gallbladder. It's a pretty hard thing to provide 24/7 coverage 365 days a year. It's a commitment. But the general surgeon allows that program to stay open.
Dr. Ronald Weigel (30:01):
But if you can increase your volume to the point that you can have two or three general surgeons, now it becomes viable because you all can split call. You can help each other with difficult cases. And so it has an amplifying effect. And I think that's one of the things we're seeing with accreditation is that as you do that, you put in place structures that allow you to increase your volume and it attracts other individuals who can take care of cancer patients.
Dr. Randy Lehman (30:29):
Well, what kind of catchment area in terms of patient population do you think you would need to support what you're describing? Not one, but three surgeons, for example.
Dr. Ronald Weigel (30:40):
Um, gosh, I'm assuming you're looking at something like a catchment area of 10 or 20,000.
Dr. Randy Lehman (30:45):
Yeah. I mean, that includes pretty much every rural hospital in America. Then most of these counties that I'm at are 25, 30,000 catchment area, possibly a little bigger with some counties around that have no hospital. And so what you, that catch 22 you're describing is, is very true. I mean, for me with my practice, I give up a lot of the higher level, um, general surgery things. First off the sick patients that are on pressors and need ICU care. And then secondly, the esophagectomies, Whipples, liver resection, you know, things like that, you're not doing. And, but then for me, I add sort of bread and butter, other subspecialties. So one of the big things that a rural surgeon adds is endoscopy.
Dr. Randy Lehman (31:33):
And then depending on OB, C-section can be part of their practice. If it's still at the hospital, none of the places I'm practicing, well, one, there is, three, there's not. Then GYN, for example. very within the skill set of a general surgeon, you know, vasectomies, adult circumcisions, being comfortable, you know, with some minor urology stuff, carpal tunnel, trigger finger release, ganglion cyst, you know, all those things kind of keep you going and keep you busy. But it just, it depends what you sort of consider busy. and what the hospital can justify. And we're going to stop there and split this conversation into two episodes. In part two, Dr.
Dr. Randy Lehman (32:19):
Weigel and I continue our discussion about what rural cancer accreditation looks like in practice, the role of the rural surgeon, and how we can keep more high-quality cancer care close to home while still recognizing when patients need the resources of a... We'll also be talking about our how I do it in part two. Thanks for listening to the Rural American Surgeon. I'll see you in part two.
Timecode:
00:00 Cold Open: Why Rural Cancer Accreditation Matters
00:32 Introducing Dr. Ronald Weigel and the Rural Cancer Accreditation Track
01:46 Dr. Weigel's Training and Career Background
02:56 Training Under Dr. David Sabiston at Duke
03:49 What Dr. Weigel Took From Sabiston's Leadership
05:04 Randy's Dr. William Altemeier Parathyroid Story
06:44 Sabiston's Staff Rounds and Knowing the Service
07:57 From Duke to Stanford, Jefferson, and Iowa
10:14 Joining the American College of Surgeons Cancer Programs
12:40 Why Rural Hospital Cancer Accreditation Matters
14:17 Understanding the Needs of Rural Cancer Patients
16:39 The Rural Cancer Care Gap
17:45 How the Rural Accreditation Track Was Built
18:32 What Accreditation Can Change for Patient Care
19:30 How the Accreditation Process Works
21:03 Multidisciplinary Cancer Care Beyond Surgery
21:37 What Rural Hospitals Need to Put in Place
23:46 Who Should Lead the Program at the Hospital
24:47 How Rural Hospitals Can Build a Cancer Care Network
25:21 A Critical Access Hospital Example
26:14 What Support the ACS Provides
27:39 Is Any Rural Hospital Too Small for Accreditation?
29:17 Why General Surgeons Help Keep Rural Hospitals Viable
30:29 How Large a Catchment Area Can Support Multiple Surgeons?
30:45 Building a Broad Rural Surgery Practice
32:19 Part Two Preview
