EPISODE 56
Setting Goals as a Surgeon: Building Direction, Discipline, and Financial Freedom
Episode Transcript
Dr. Randy Lehman (00:00):
Hello, listener and welcome back to the Rural American Surgeon Podcast. I'm your host, Dr. Randy Lehman. It's been busy and I'd like to address the new year and I'd like to talk about goals just myself today. In the wintertime we have a series of trips that we like to take and we always like to get out of the cold, so we've been going to Denver, going to the National Western Stock Show goal of taking our cattle out there someday. We always seem to chicken out thinking about driving all the way out there in the cold. I've been going to the North American Rural Surgical Society, which is a big highlight that we just went to and I thought it was a great, very relevant conference. I also love that my medical student went with me and his friend and my other buddy and his other friend, and there's a bunch of people that are kind of at the show.
(01:06):
I mean, not the show, but the conference because I've kind of introduced 'em to it. That was fun. It was a great group of people, lots of connections and a lot of, like I said, very relevant topics. If you haven't been and you're interested in rural surgery, I would strongly consider, I think that's the best, most condensed conference that's going to just have something to do with every part of your practice. Obviously a CS is great. The other thing we do is we go to the Mayo Clinic Interactive Surgery Symposium in Hawaii, which rotates around, and that is three things in one. It's essentially vacation, CME and a reunion because there's certain, I always see a bunch of people from my training there, but not everybody. So it's a way to break out of the ice and cold of the Midwest. We've had a ton of cattle and baby calves be born here.
(02:03):
The farm is coming together and every year, oh, I also went to my mastermind conference and that involves a thing called a one sheet. And a one sheet is essentially my personal goals. The group that I'm in has life kind of broken down into categories. I know there's a lot of different ways to think about that. The one thing by Gary Keller talks about the seven areas of life, spiritual, physical, personal life, key relationships, job and career, business and financial. But you may listen to a list like that and think there are things missing and you may also not want to include some of those things. The group that I'm in talks about a financial metric, a giving back metric, a physical health relationships, accountability and bucket list adventures. So that's a totally different way, but you think about these categories of life and then goal setting.
(03:13):
And so why does goal setting matter? Most people, and you might be one of them, don't set goals. Only about 3% of people actually write their goals down and the ones who do believe it or not, dramatically outperform the ones who don't dramatically. If you just write your goals down, you are 42% more likely to achieve them, and yet every January people set resolutions and by February now 80% statistically are already gone blown. Only about eight to 10% of people actually achieve their New year's resolution goals. So what's the difference? A resolution, it's a strong word, but it's more or less a intention and just general vague intentions tend to fail, whereas specific measurable goals improve your performance, statistically improve your performance, they do not guarantee your success.
(04:28):
But even more than that, if you share goals with someone else and you send regular progress updates, you are significantly more likely to achieve them than if you keep your goals to private self, even if you wrote them down so that you can then use to your advantage. Because my opinion is I don't want to go through life and arrive at the end and just kind of have bounced around through it. I would like to have some direction and some intentionality to what I do. I guess you could do the 7-year-old thing and say why, and you could go further and further back on that. But for the sake of today, why don't we assume that that is better, the active life is better than the passive life. And then let's talk about what I want to tell you is not here's how you need to do your life because I don't really care how you do your life, I guess except for if you think that what I say has some value for you, then take it and do it.
(05:53):
And I feel like I am doing things quite differently than most of the people that I know and most of the people that I trained with and generally come in contact with. I get along great with a lot of different kind of people. I have respect and value for them as individuals, and I'm not saying that what I'm doing is necessarily better, but it is different and it seems to be getting results that I intended, which are also different results than what the average people are getting. So with that in mind, I'm going to run through sort of how I set goals because I do set a lot of goals and then how I kind of carry it out. I'll tell you that I'm not perfect at my own strategy first and that it also waxes and wanes and my enthusiasm waxes and wanes. I do think that the character trait of consistency is if I had to juice myself up on something a little bit more, it would be that.
(07:21):
And I think that is one of the most powerful things that you can do is just be consistent. Try to get maybe 1% better every day. It's a phrase that I've come across or you can just, if you set a big goal and you know what the big goal is, you can move yourself a little closer every day and then maybe you can do multiple other things. But if you just kick the, send the email that you need to send to do them whatever and move things further, all of a sudden the phrase you overestimate people tend to overestimate what they can do in a year, but underestimate what they can do. In five years has been extremely true for me pretty much from year to year. Almost every year looks the same from the new year to the next new year, I can't tell that big of a difference, but every five year block of time, going back to when I was didn't exist.
(08:24):
I have been a drastically different person every five years. I can think if that's true for you or not, and I'm happy that that's the case. I feel like that's growth. It's a journey. It's not dull and it's something that I'll be able to look back and say that I'm glad that that amount of change happened. But the point of recognizing the difference between a year and five years is that it doesn't have to be that way. And if you're not pushing towards something, then you won't move far and maybe that's fine. Maybe your goal because just the sake of movement for the sake of movement might not be good. Growth for the sake of growth might not be good. All of these things put a big asterisk on it and make your own decision. But all I'm going to tell you is essentially for your entertainment purposes, what I actually do when I was single, I had an opportunity to go to college.
(09:32):
I just did it. I just did the next thing in front of me, the next logical thing, and I feel like I was being guided, providentially guided without really knowing it. And I ended up in surgery residency at the Mayo Clinic. There were big guiding principles which were I wanted to come back and help my hometown, but other than that, I just kind of fell through things. So my core identity, being a rural farm kid from Indiana and wanting to be back home and now I'm sitting here in my house that I was born in were basically core longstanding principles that probably guided me to a certain extent, but it wasn't this intentionality of goal setting. Then when I got married and immediately we got pregnant, all of a sudden I felt more responsible, which is good because I now had dependents and I had to think about it.
(10:39):
The other thing that happened was before I kind of felt like my assets were my money and my stuff, and now it was more of like, wait a minute, do we need to, if there's going to be more than one person spinning out of this, do we need to have a budget so that we have a plan, we don't have unmet expectations, things like that. But then also my whole strategy has also been to out earn rather than save. So I wouldn't say that although don't take this to contradict other things that I've said on the show, but I heard recently that when you're young, you should chase massive income, not passive income. And I do kind of endorse that logic because if you don't have something to work with, it's very hard to frugal your, you can anybody in any level of income can frugal their way to financial independence. I do believe that.
(11:49):
But is it a big full life of abundance and impact? Because you could probably retire early, you could probably get from any level of income to financial independence within a decade. I'm sure you can. And I find it easy. It's much easier when you have a margin that you can work with. I found myself married with a baby on the way, and then my wife and I started paying off debt and we paid off student loan debts and different things and made our own decision. We put all of our debts, we did the debt snowball, the Dave Ramsey thing. We celebrated every debt that we paid off with a spaghetti dinner at home. The last one we went to FLIs.
(12:48):
So yes, I mean don't waste money on things that don't have meaning to you, which to me, fancy dinner doesn't, good dinner, good food does, but that doesn't actually have to break the bank. And then we started, I was about a year into this, not quite where I realized, wow, we've made a lot of progress and this was in 2017 and I started tracking my net worth that. So what gets measured gets managed that action of tracking something, you can't beat it in terms of just eye on the ball. So what do you need to track? Do you need to track your BMI? Do you need to track your weight? Do you need to track your time?
(13:40):
You got to decide what's important to you. But then that was sort of an overarching goal. We also had some other sort of stated goals. Every year we wanted to do something together that was working on our marriage, which we decided to do that at the beginning. So then whether that's like a course or a weekend thing or reading a book about marriage together or relationships together, something to continue to learn about the skills because I believe that marriage is work and skill, sort of like a muscle that can be exercised. And then you're going to have, it's the hardest thing I would say that I have done, but probably one of the most worthwhile things that I have done at the same time. So all the things in my life that are worthwhile, they've all been hard and not hard in that they're just miserable.
(14:44):
Just meaning that it takes a lot of effort and work and discipline and consistency. So we're back to that. And if you can apply certain principles. So for example, a lot of business people, they're often broke. I mean they're very good at business. They can make a budget, but then they're living paycheck to paycheck. And this is a very, I'm not saying that all business people, I'm saying that there are people that are like that where it seems like the principles they really understand and they can put them in place in a business setting, but they don't want to apply them to their personal life. Well, same thing's kind of true for setting goals. So if you can set goals for financial things or for business things or whatever your other goals are, then why not apply the same concept to relationships and why not apply it to health and fitness?
(15:46):
So you can think about how you personally want to do it. But the other nice thing about setting goals is you can look back years later and see the goals that you actually wrote down and you can see the progress that you can make. And there's a book called The Gap and the Gain, and it's like what are you most focused on? Ideally you focus on the present moment because anxiety is living in the future. Depression is living in the past, both of which are cured by living in the present moment. It's one way to think about it. The other thing is the gap and the gain. So you're thinking about the gap between who you are and where you want to be, or are you thinking about the gain from the past you to where you are now? And if you set goals, you go back and you look at 'em and like, wow, did it, and then you can became irrelevant.
(16:44):
So I didn't do it, and it's okay. Then there's other things that maybe you're like, oh, I wrote that I did. I wish I did that. Then you figure out some way where you can make it happen in the future. So I want to go back to basically when I started really having written annual goals, and I started that actually only in 2020. So before that it was get through residency. I have a big goal. Basically my big overarching career goal is get through residency with as many cases as I can, as much experience as I can, as prepared as I can for my career because I know that that will be my ultimate initial lever to get me started in life on all the aspects. So that will then allow me to make money with my job, but will also allow me to make impact in a community with a one-on-one person.
(17:50):
It will be life-changing lifesaving for some people, and then it will then allow me to, from a charitable giving perspective and a community impact to basically rising tide lifts all ships and come in and make a big difference. So obviously there was a big period of time where I was just focused on doing that, focused on trying to get the little family of mine off to the right foot. But then we got towards the end of presidency and we're starting to look ahead and I had flipped an apartment during residency apartment building with my grandpa's a partner, and we sat down. I had been doing some moonlighting and I would bring my family with me, and I think we spent New Year's Eve of 2020 working an overnight shift, and we created what we called kind of tongue in cheek 2020 vision. And so now it's like Vision 2021, vision 2022 or whatever, or 2026 vision each year. And I pulled that up for preparing for this. And basically I've got interesting things that some of you may relate to if you've been through surgery residency. So as a chief resident, I'm a half year from my first job. I have known about this job for three years now because I signed a contract pretty early.
(19:35):
I had written down for my wife, so this is her goal, pilot's license in January. She did it, it's crossed off, get a dough this winter hunting that's hers, it's crossed off, get a house in Indiana and remodel to our style, crossed off, make budgets for food, weekly grocery list. I don't know if we did that. Food is less than 10% of the average American's spending. And it becomes, like I said, very irrelevant. So you don't want to be wasteful, but if you're just reasonable, if you're focused on other out earning, you could maybe do that. I wrote greater than 70 percentile on ABSITE. That was obviously for me, that's the lag measure. But the lead measure is 50 questions a day until ABSITE. So lead measures are the things that cause the result to happen and it's something that you have control over and I strongly encourage you to consider what lead measures are required for the lag measure goals that you set.
(20:41):
The lag measure goal is the outcome, like say you want to be financially independent, which you define as net worth is 25 times your annual spending for example. What do you need to do to get there? And then if it's max out this account, this retirement account each year, save this percentage of each paycheck, whatever, that's something you have control over. And then are you hitting that at a high degree of success, 90% plus of the time, and then you have almost certainty that you will actually achieve your lag measure. Well, I have that crossed out. So I think it was in the eighties on that chief ABSITE, and of course that made me feel just great because I didn't have to have the, there's no reason that I needed the ABSITE score for anything. I wasn't going to any fellowship or anything like that.
(21:36):
So I guess I was just competing for the sake of competing, which I guess is fine. Passing the certifying exam, passing the qualifying exam, get robot certified graduate. Those are all huge goals. It's like a long time coming I guess. So that's a cool time in life. But we have other things like a monthly cash pile party, which is two hours to budget. It's basically time for me and Brittany to sit down and talk about our finances. So the goal is that we sit down and talk about them. There's no other outside just because we know if we sit down and talk about them, things are going to happen. Also, give 10% pre-tax income to charity. Exercise three days a week, massage one day a week. Read children's book, heartfelt discipline, read five love languages for children, bedtime, 8:00 PM dance time, weekly, date night, make a calendar with all family members with birthdays, anniversaries, send cards.
I don't think if you're my family member, I'm not sure if you've got all those cards, but at least it's on the list. Sell Med City apartments and I have details about that which we didn't do. And then real estate professional status for Brittany for 2020 clock, the hours, we did do that. And then there's also buy River Bluffs apartment, didn't do buy Family Dollar, didn't do become financially independent, 25 x, which I think we did in that year. But again, that would be on a very sparse level of spending. That's just to clarify how things were for me. And then now we have continued that annually. And I have two other, well, three other documents that I kind of use. One is a daily to-do list. That daily to-do list is the things that I need to do to kick things forward. It's a printed piece of paper.
(23:31):
And I started doing that in residency because I was doing a lot of different things. I was doing this real estate stuff outside of residency and really didn't take that much of my time, but I needed to send a couple emails a day basically to get things moving, make a couple phone calls during business hours too. And so I would just write it down and it would show up, okay, yeah, I got to do it. I do it. I make my little notation, I get back to the hospital, I saved it on the hospital computer every morning, I'm coming in, I'm getting numbers, I'm getting ready to round. So I would just do that as part of my daily routine. When I print off the list, I printed off my daily checklist and I made it with the little check boxes and in a certain way where it just kind of looks like a checklist. I wanted to share my vision 2026 document, my to-do list, my net worth statement and my one sheet. So now on our vision document, we still do it. We have broken out into categories that are relevant to us. So one is organization and household. So as things become important, then they become higher. One is spiritual health, marriage, kids and family. That is page one.
(24:56):
Then page two, career, financial, giving, recreation. Finally, aviation and ranch, because those things are sort of big hobbies that we have and it's nice to write down what you want it to be because then it doesn't become an all consuming hobby. And you can limit and you can say, okay, wait, these are our goals. For example, last year we sold a couple heifer calves and for the price that we intended to get them this great, we want to have certain other things. Like right now it says have 16 calves this year and do it well paint the airplane. It's another thing. Major infrastructures, we're planting two new pastures. Okay, those are the things that are making it on the list for us this year. How I measure the financial metrics mostly has to do with net worth on a relatively conservative judgment. But then I have started, let's move into that.
(26:12):
So the net worth statement's on a big Excel document, and I've added a lot of things to it, one of which is I do it every month and then I update all my accounts, put all the dollar amounts. Now I actually have my assistant do it, but obviously for the longest time I did it myself and I put in all the retirement accounts, the dollar amounts, the checking accounts, savings accounts. If I put money in for my kids to something like a 529, I don't put that on there. It's not my money anymore. If I put money into my charity saving account, I don't count that into this net worth statement. Whenever I have a property, there's usually a loan associated with it. So I make its own tab where I create a mini balance sheet just for that property and the value is based off the last appraised value and the loan balances there, then the cash balances are there.
(27:18):
So there's usually some spread and then I bring that forward into the major one. The one issue where my spreadsheet suffers it's not very good, is it doesn't account for taxes that are accruing that I may be owing. So it kind of has swings as income taxes get paid. Also, property taxes given month out of the year when all the property taxes are due, boom, it looks like it comes down and it goes up. But really it's just like this little ride of a wave. But what's very interesting is there was this hockey stick pattern to the graph when I looked at the first two years from 2017 to 2019. If you overlayed that on the bigger picture of the graph from 2017 all the way now up to 26, it looks the same, the shape is the same. And so now what would've been a year's worth of progress we make in a month many times.
(28:23):
And that's where the gap of the game comes into play, because I can feel like I'm not making progress when really I'm basically on a decade long tear. So if you're going to compare yourself, it's worthwhile to compare yourself to your future self. It's worthwhile to think about where you'd like to be. I don't think it's very worthwhile to compare yourself to others. It's very tempting to do, but I think it's great to compare yourself to your former self. That's probably the best thing you can do. And if you are going to compare yourself to somebody else, the best person to compare yourself to would be a king from about 500 years ago, king or queen. And then you recognize, wow, I have internal plumbing and heat and insulation in a draft free home, and I have lights that work even at nighttime from the flick of a switch and barely cost anything.
(29:30):
I have safe food and water supply. I can turn on the faucet and drink as much as I want. And I have generally good life expectancy. And if I get something such as appendicitis, it's not a death sentence. I'm trying to think what other transportation travel, how cheap it is, even though it may be inexpensive cost or whatever. But generally speaking, how much you can travel compared to how life was just a few hundred years ago, but even the best life 500 years ago, I would definitely not trade the simple conveniences of the 21st century for something like that. That's just gratitude exercise. And if you're going to make comparisons and looking back is a great way to have a lot of gratitude. So I talked about my net worth statement, my to-do list, just like work on off the to-do list writing and pin on it.
(30:35):
And then the next morning I save a new file with the new date work off of that. Now, there's times where this is not what I do. I may have a handwritten to-do list that I kind of hang on to for a few months and I get out of habit of doing that. But in an ideal world, I would get up at five o'clock in the morning and first thing I would do is make my to-do list and then I would carry on. It becomes harder to gain, to keep your energy level of focus when you have a lot of things pulling you in a lot of different directions. Again, consistency will give you, take you to places that just pure goal sitting alone won't. Thanks for listening to this episode of the Rural American Surgeon Podcast where I talk about my 2026 goals and I want to encourage you to the more active way of thinking about your goals you're planning for your year.
(31:30):
And I wanted to mention one last thing that is sort of another piece of my system and it's called the one sheet. And this comes from my mastermind group and it's where I track those hard numbers that drive my life. So I had a few notes on that and I wanted to share it with you. So my give to income ratio, net worth physical health markers, like heart rate variability and blood pressure are on there. And the nice thing is on my one sheet, looking back at last year, it reminds me of the wins. So last year I hired a new surgeon, took a trip to Scotland. I finally solved the issues that I was having with my hands, which were leading me to think that I might almost end up disabled because I was having, it turns out an allergic reaction to the accelerant that is in the protexis PI gloves.
(32:16):
So now I use accelerant free gloves and I use cotton under gloves and it's not really a prep related thing, but I switched to Avagard™gard and I feel that that's helping me too. So looking forward. Then I have bucket list adventures on this one sheet. These aren't just vacations or something I could do just in a day if I just wanted to. I mean, they're big picture, big swing goals. So for example, I have a goal of breaking the world flight record for endurance flight. So I'd like to fly for a hundred days without stopping. It'll be like a huge thing obviously for me. But I want to use the technology that they used to break this record back in the fifties, but upgrade it with what we have today and just kind of do it the same way but better. So it's really not that groundbreaking, but also travel to space is on there.
(33:05):
I think it's going to get cheaper over time. I'll eventually do it, but a lot of things have to align stars aligning, so to speak. Build a hospital in my hometown has been on that list for a long time, but then that kind of changes. There's a question mark behind it now, and I used to think I'll save my money 50 million, put it down myself, buy the hospital, run it. But that was naive and I started my own practice, lost a lot of money and learned that basically I don't know what I don't know and I don't want to lose 50 times as much money. So then I thought, well, I'll do it with the community and maybe build a new community hospital. And then I thought, well now that the updated thing is I'm now in three different major systems and you're realizing the power that can exist with a system and if you come in aligned correctly to begin with, I may do it that way, but without having the goal on paper, how do you know what to think about and what to push basically towards?
(33:59):
And one of the other goals that's on my bucket list, my one sheet is to be a leader in the space of rural surgery nationally. Okay, how do I do that? What do you do to lead? Well, it's doing it myself, paving away. And then now for me personally, it's documenting it through this podcast and sharing it with you all. So that's unique to me. Not everybody has to do the same exact thing, but I have different people that I've worked with that are just inspirational. I'm coaching track for my brother's high school track team, right? Coach Coker is one of the most inspirational people just in the way he talks and the way he thinks and tries to say, you may not be able to do it, you may not. But what good does it do to say that you can't and why not try?
(34:46):
We are much more often limited by our own beliefs than we are limited by reality. But it may require thinking that is different than the thinking that got you to the point that you are now today. So that's sort of what I want to leave you with. And you can focus then because the rural surgeon in America of anybody should be inspiring your community, and I know you are and leading your community and making an impact and influencing change for the better, having fun along the way, taking care of yourself and your family along the way. And to me, that's rich full life, which I think is what we're designing created to have. And I want that for you, and I want that for as many people as possible. So that sort of wraps up my current list of big picture goals for 2026 and how I even just think about it.
(35:35):
The intentionally active life I believe will always outperform the passive one. And so whether you use a one sheet net worth tracker, a simple daily to-do list or all three, or use people to lever or you use AI to help clarify these things and lever for you, the act of measuring your progress, the act of writing things down, that is what actually I think drives the results in the long run. You can also go back and look at that gain. I hope you enjoyed this solo cast, and if you did, please consider leaving me a review on Apple Podcasts or Spotify, wherever you listen. It's the best way to help other rural surgeons find the show and join the conversation. And I really appreciate you. Thank you for listening. I'll see you on the next episode of The Rural American Surgeon.
