Episode 15

Rural Surgery Research with Dr. Dorothy Hughes

Episode Transcript

Dr. Randy Lehman: [00:00:07] Welcome to the Rural American Surgeon. I'm your host, Dr. Randy Lehman. On this show, you'll receive powerful insights and resources for rural surgeons. I'm a general surgeon in northwest Indiana, and this show is tailored around the nuts and bolts of rural general surgery practice. But you'll find topics ranging from practical surgical tips to a host of others, including rural lifestyle, finance, training, practice models, and more.

We'll have a segment called Classic Rural Surgery Stories where you'll get a feel for how practice in the country differs from the city. Whether you're a surgeon, other specialist, or primary care, or simply someone interested in healthcare for rural America, I'm glad you're here. Now let's get into the show.

Dr. Randy Lehman: [00:00:47] Welcome back, listener, to the Rural American Surgeon Podcast. I am honored today to be joined by my guest, Dorothy Hughes. Dorothy is the daughter of one of the most prominent rural surgeons in the United States, which is Tyler Hughes, my first guest. You can check out episode number one. Dorothy, thank you so much for taking time to talk with us today on the Rural American Surgeon.

Dr. Dorothy Hughes: [00:01:10] Thank you so much for having me.

Dr. Randy Lehman: [00:01:13] So this is part of my mini series on children of the rural surgeons, or I'm not sure if I have a name for it, but I interviewed my own daughter and she's seven, turning eight, and just I feel like there might be some differences, and it probably really matters more on the surgeon than their true environment. But I think that you can have a family life without compromising, you know, having a busy practice or whatever.

And I just wanted to hear it from. From some others. And so we're going to get your perspective on that a little bit today. But before we get started, why don't you just tell us a little bit more about your background and the very interesting work that you're now finding yourself doing.

Dr. Dorothy Hughes: [00:01:56] Sure. Thank you. When I left my small town, I thought that I never wanted to come back, frankly. I went to undergrad out on the east coast and I majored in international service. Then I eventually figured out that that is not what I wanted to do. I had the good fortune to intern for my hometown congressman and got into health policy at that time and just really loved it.

And because my hometown's in a rural area, I was therefore doing rural health policy at a pretty young. I was still in undergrad when that started and so continued to work on Capitol Hill for a couple of years after graduation and then decided I didn't want to live in D.C. forever and moved to Kansas City and moved into the government relations side of policy where I worked for KU Medical Center and did a couple other things and eventually got into teaching health policy.

The folks at Rockhurst University gave me my first chance at teaching, and I really, really enjoyed it. And they said, well, you know, if you want to keep teaching college, you kind of need a terminal degree. I went back to grad school for the second time and got a PhD in health policy and Management from the University of Kansas School of Medicine. And then they were kind enough to take me on as faculty in the Department of Population Health. And that is where I have been for the last about five years.

Yeah, it's been five years now on faculty. I transferred to our small rural campus three and a half years ago. I am the assistant dean for Student Affairs on our Salina campus in Salina, Kansas, and I also do rural surgery research and continue to teach health policy.

Dr. Randy Lehman: [00:03:44] So you're a professor?

Dr. Dorothy Hughes: [00:03:46] I am. That's a short story. Yes.

Dr. Randy Lehman: [00:03:50] Yeah. Very good at distilling down that information. A good quality in a podcast host. So you're at Salina. Your dad's at Salina.

Dr. Dorothy Hughes: [00:03:59] He is.

Dr. Randy Lehman: [00:04:00] So how cool. How often do you see him?

Dr. Dorothy Hughes: [00:04:04] Every day. Our offices are two doors down from each other.

Dr. Randy Lehman: [00:04:08] And how does that make you feel?

Dr. Dorothy Hughes: [00:04:11] You know, feelings are complicated. No, I feel extremely fortunate to get to work with my dad. I really do. It's really special. And I think we do a good job of being professional at work, and we don't treat each other like father daughter. Although he does buy me lunch a lot, and it's really wonderful.

So in my role in student affairs, I actually report up to a senior associate dean who's in Kansas City. So my dad is not actually my boss, even though he's currently our campus dean. So I report up to both my Population Health chair and then that student affairs dean, and I think that separation is very important.

Dr. Randy Lehman: [00:04:53] You made it sound like that job's not going to last, honestly, too terribly much longer.

Dr. Dorothy Hughes: [00:04:59] His campus dean position.

Dr. Randy Lehman: [00:05:01] Yeah.

Dr. Dorothy Hughes: [00:05:01] Yeah. He has announced his retirement.

Dr. Randy Lehman: [00:05:04] Okay.

Dr. Dorothy Hughes: [00:05:04] Yeah.

Dr. Randy Lehman: [00:05:05] So, you know, when, you know, it's like a limited. It's a. You have a generational thing. So there's gonna be a retirement coming. So you get this opportunity to work together and you know that it's gonna end. It maybe makes it a little bit more, you know, let's just savor and enjoy it.

I don't know. My dad's working with me now, and that was a dream of ours. Now, I don't know. It's. It's. He. I've taken him on a bit of a whirlwind over the last three years, maybe a little bit less so than what you have going on. You guys are like, you know, academic, like track, working for the university, whereas I was doing a lot of crazy entrepreneurial things. But that is a very special opportunity and it says a lot that you're choosing to do that.

So maybe we'll move into the next segment where I just like to know what. First off, do you have siblings?

Dr. Dorothy Hughes: [00:05:55] I do. I have a younger brother.

Dr. Randy Lehman: [00:05:57] Okay, so. And how much younger is he than you?

Dr. Dorothy Hughes: [00:06:00] Four and a half years.

Dr. Randy Lehman: [00:06:01] What was it like growing up as the daughter of a rural surgeon? How was it different than any of your friends? Maybe, if it was at all.

Dr. Dorothy Hughes: [00:06:10] Well, I don't think a whole lot of other kids got told on a regular basis that your dad had saved their relative's life.

That, you know, that's sort of a strange experience for a middle schooler or a high schooler for somebody to say, "Oh, yeah, I know your dad." You know, they saved my uncle's life for this or that. And one of my close friends in high school, she actually had a surgical issue when we were in our 20s and my dad saved her life, and, you know, that kind of thing. Yeah, that's... I think that's very different from perhaps the experience of a lot of children of even other professionals in rural towns.

Dr. Randy Lehman: [00:06:55] Yeah. So how did that make you feel?

Dr. Dorothy Hughes: [00:06:59] Again? Feelings are complicated. I think as a kid, I didn't totally get it. I knew that was, yes, obviously, life and death, very important, yada, yada, yada. But as kids, you're kind of selfish and you're like, "Yes, but what about me? And I'm bored and why you're just always talking about my dad. What about me as a person?"

So mixed feelings about sort of being small-town famous, if you will, and certainly could never get away with anything because, you know, everybody knew who your parents were. But, but overall, you know, I ended up very proud, very, very proud of my dad and what he did for our community.

Dr. Randy Lehman: [00:07:42] So tell me how I can downplay that or make that to be... I mean, it's not a huge problem. That's kind of like one element of a first-world problem, you know, but with my daughter, you know, because I'm just proud of her already for what she's done and I don't... I almost care more about her success. I heard a thing recently that said—I think I might have said this already on podcast—but one of the great ironies of life is that we never love our parents as much as they loved us. Or a parent never loves their... a child never loves their parent as much as the parent loves their child. And it's like you can't understand the love that your parent has for you until you have children of your own. You have children?

Dr. Dorothy Hughes: [00:08:33] I do not.

Dr. Randy Lehman: [00:08:34] Not yet. So now that I have my own kids I kind of get it. Like I love my parents so much. I'm so grateful for what they did for me. But you see, even by saying that it's like what they did for me, it's not like... I don't know with your kids, it's just what I would say is I want to give them everything that I can do. You see the difference? It's like I'm glad what they gave to me and I want to give them. So it's more of passing it on.

And when parents get older, my dad's moving into a phase where my grandparents—grandpa is needing a lot of help. And I'm not saying there's not a give back for sure, there is a lot of give and take, but it is... I definitely don't want, my kids don't need to live under my shadow. I don't want them to live under my shadow. I just want them to go be successful in their own right and do their own thing. And I want to help them as much as possible do that. And I don't need their help so much to do my thing. But I needed my parents' help, you know, so how can I avoid making them feel like they're under my shadow? Or is it just sort of part of the name of the game?

Dr. Dorothy Hughes: [00:09:53] You know, I think that by being aware of the possibility that's kind of, that's kind of all you can do really. And I think you're articulating that you are actively not trying to make your daughter feel that way. So you're probably not, you know, I think you're probably succeeding if that's your intention and how you're acting.

And I will say my parents also did a very good job of treating both me and my brother as individuals and understanding that we were not mini-mes and we were not going to grow up to be just like them. And neither my brother nor I became physicians and dad is totally okay with that. And my mom is a physical therapist by training and neither of us wanted to go into that field or anything adjacent either. And she's totally fine with that. And my parents have just always done a great job of really, like, honoring whatever we have to offer as individuals and embracing what we want to do. And so I think that's really all you can do, I guess.

Dr. Randy Lehman: [00:10:52] Yeah.

Dr. Dorothy Hughes: [00:10:53] Yeah.

Dr. Randy Lehman: [00:10:53] How about... Have they ever guided you away from something, though?

Dr. Dorothy Hughes: [00:10:59] Bad relationships maybe? Yeah. Well, I think my brother and I are very fortunate that we were raised with really small, solid logic skills, I suppose. And I think our parents really trust us to make decisions that are in our best interests, both personally, financially, professionally. And so, no, I don't think that we've really ever considered anything that was too terribly far afield that they've had to steer us away from.

I mean, even my brother, right now, he's in the midst of a startup. He's starting his own company, which I got to say, to me sounds incredibly risky. I mean, I am very happy with my little state employee job that is incredibly stable, and I'm up for tenure this year, and I really hope I get it. But... But my brother's a little bit more of a risk taker. But, you know, my parents are 100% supportive and, you know, they... They trust us.

Dr. Randy Lehman: [00:12:00] Yeah, that's great. So what, you know, I'm thinking of right now is I had a patient of mine who's, you know, currently on house arrest for whatever crime I guess he must have committed coming out of prison, and I had to do an operation on him. And his dad's a physician, and I'm like, man, you know, how do you... you know, what was your anti-drug you turned out to be? Not a physician. Like, I totally strongly feel that. Of course, I love it when my kids, like, you know, pretend like they're me. That's cool. Like, I find that cool, but I don't expect them to do anything like that. Whatever they want to do. But I do have expectations for my kids. Like, I don't want them to, like, steal or do drugs.

Dr. Dorothy Hughes: [00:12:58] Right.

Dr. Randy Lehman: [00:12:58] Or be mean. You know, I have very clear expectations on these things. Yeah. So were... Were you, like, when you're a teenager or whatever, were you ever at risk of going off the rails or were you always pretty much just like, I'm right on straight and narrow, you know, or, you know, did your brother have any problems with that? Nah.

Dr. Dorothy Hughes: [00:13:22] I mean, I think every teenager kind of flirts with rebellion a little bit.

Right. And kind of chafes against, you know, curfews and that kind of thing. But no, I don't think I was really ever at risk of going off the rails. And I don't know. I don't know why my parents had such faith in me, but, you know, they let me go to college 1,000 miles away and, you know, just. And I, and I went a little bit early. I was 17 when I left home.

And, you know, I don't, I honestly don't know what possessed them to let a 17-year-old go off to D.C. and like, you know, just hope everything goes well. But it did. You know, the first couple of years were rocky because you don't know what you don't know. And I was probably not as socially mature as I thought I was. You know, academically I was pretty okay, but, you know, socially, there's still a lot to learn.

But no, yeah, never at risk of going off the rails. But I think what especially dad's profession instilled in us was a sense of service. You know, wherever you're going in life, whatever you choose to do, it's really not for you entirely. I mean, it is and it's great if, if you, you know, if you find something that you really love doing, I mean, I think that's a goal for a lot of us, is to find something you really enjoy doing, but it can't be just about that, you know.

And so I think he really instilled that whatever you're doing, you're also serving others in some way, shape or form. And that's how I view everything that I've done too, since college. You know, I haven't always been in academia. And so even before academia, I really felt like I was there for, you know, other people. You know, when I was working on the Hill, I was working for other Kansans and trying my very best to represent them well as a staffer. And when I came back to the state, I was really trying hard to represent the interests of the university and students and look out for people and try to make things better. I think if that's your orientation, if you're always trying to make things better and if you have a heart for service, then it's hard to fall off the rails.

Dr. Randy Lehman: [00:15:37] Yeah, no, that's beautiful because really, it's actually a selfish thing. If you start doing drugs, for example, if you look at the bigger society as a whole, and that's a great segue into how I do it, which I normally talk to a surgeon about a specific case, but for you, I want to talk about your research because I heard the spoken word evaporates, but the written word is eternal. But I don't know about a podcast when you have an AI transcript that you post online. Maybe that's the best of both worlds. But you have published some research. That's how I first got to know you. Were presenting some of your research at the Northern Plains Rural Surgical Society a couple years ago in Denver. And if you guys haven't signed up for this year, you guys need to be there in January at the Brown Palace. Just a little plug. It's now called North American Rural Surgical Society. But tell us what sort of research you've done and why it's important to you, especially the rural surgery stuff.

Dr. Dorothy Hughes: [00:16:39] Sure. So I figured out very quickly in my PhD program that my roots of rural surgery are where I wanted to come back to and stay professionally. So I do qualitative research, and my favorite thing in the world is interviewing rural surgeons. And there are a number of research questions that I have explored and hope to explore in the future that involve, you know, gaining knowledge from rural surgeons.

But my dissertation was about practice location choice among Midwestern general surgeons. Essentially, why do you choose the communities that you do? What do those communities have to offer? And how might life as a rural surgeon look different from life as an urban surgeon? So I did interview both urban and rural surgeons for that project. So I was able to draw some comparisons, and I really enjoyed it.

And, you know, I think the takeaway from that work that really sticks with me in future, in future studies is this idea of, in urban areas, people operate in several circles, sort of. You have your circle around your kids' school, you have, you know, maybe your church or place of worship, and you have your workplace. And the people that you interact with in those places may not know each other, and you may interact with them separately, but there's really no venue where they all come together.

But in a rural area, it's all one circle. The people that you are operating on are your friends and neighbors, and the people who are your neighbors are also the people bagging your groceries and teaching your children. And everyone is doing life together. And over and over and over, rural surgeons would say to me, everybody knows everybody. I wrote a little bit about the social fabric of places like this and how meaningful that is to rural surgeons. That concept of the social fabric being really important and actually factoring into recruitment and retention decisions. That is a big underpinning of my work.

So I've continued to do work in the rural surgery space. I've done some narrative reviews about the economic impact that surgery has on smaller communities, and I've reviewed how do we use qualitative work in the rural surgery field? What are the types of things that are appropriate to explore. Now, I am engaged in a study that looks from a strengths-based perspective on what rural surgeons feel is going well and where there are gaps and where they might want some additional support from the profession, whatever source that may mean, whether it's a society or a professional association. So that's what I'm up to now.

Dr. Randy Lehman: [00:19:43] Yep, that's perfect. And we can clearly see why it's important to you. We have something in common, which is we both like interviewing rural surgeons. Apparently so. And I think it's pretty fun. Yeah. So the financial corner of my show. I normally ask for financial tips, but for you, I wanted to ask about the impact of the rural surgeon financially on their community because as you just mentioned, you're so good at this. You should just have your own podcast about this. You seg right into it. What's the impact?

Dr. Dorothy Hughes: [00:20:18] Yeah, it's very clear that surgical services are a major economic engine for rural hospitals. And for a lot of rural hospitals, they really are the difference between being in the black versus in the red. I actually now serve on the board of my local hospital.

So now the other Dr. Hughes is now on the board, whereas my friends like to call him, the OG Dr. Hughes was once on the board, but I'm now...

Dr. Randy Lehman: [00:20:48] You're talking about the McPherson Hospital.

Dr. Dorothy Hughes: [00:20:49] I am.

Dr. Randy Lehman: [00:20:50] Is that where you're born?

Dr. Dorothy Hughes: [00:20:51] No, we're transplants from Texas. I don't know if you knew that, but. So I was born in Texas, but got to Kansas as fast as I could. And no. So I serve on the board now. And so I am very privileged to serve with one of the surgical partners in my dad's former practice.

And it's very clear that as we move into the next phase of facility planning that we've got a plan for expanding surgical services. We are unique in our area in that we are still a PPS hospital. We are not critical access, but we are surrounded by critical access hospitals. And we are about 40 miles from a larger PPS hospital and an hour from two level one traumas in Wichita.

So we really have to be doing it better than everybody else to stay in business. And surgical services are a key part of that. And we're not unique in that sense. In the sense that surgical services really are such an engine. The billing that goes out the door, the dollars associated with surgical cases, no matter who the payer is, assuming there's a payer, and it's not just all a self-paid population, the dollars that come in the door are frankly larger than what the primary care specialties can bring in. So it's really important.

Dr. Randy Lehman: [00:22:18] Yeah. You also have to meet people at their point of need. If you do that, then they'll think about you when their elective thing comes up.

Dr. Dorothy Hughes: [00:22:29] People want to stay close. I mean, we know that. And I think sometimes my urban colleagues on our Kansas City campus underestimate the impact of traveling for care and how difficult that is, not only logistically, but financially for patients. And so I hope that I am a voice for kind of reason and helping to remind some of our urban colleagues about the value of staying local.

Dr. Randy Lehman: [00:23:01] Yeah, I've got the classic rural surgery stories, a story that is just so classic rural surgery, and the urban surgeon will never believe it. And you said you got a good story from your dad's practice that you couldn't believe that he didn't say on his podcast. So I've been dying to hear.

Dr. Dorothy Hughes: [00:23:19] Yeah, I've listened to his episode, and I was really surprised. This was not the story he picked, but what sticks in my head. So pretty soon after we moved to McPherson, my understanding is that dad was on call and he actually had to go out to the field. They said, you know, we need you to meet us at the interstate, basically.

And so he went out to the interstate, and there were firemen with hoses pointed at a vehicle. And what had happened was a boat trailer had had one of the L-beams come loose and go through the truck behind it. So the beam went through the engine and the cabin and pinned the driver to the seat. And so Dad's task was to help keep this person alive while they tried to extricate him from the vehicle somehow, all the while, like, wondering if something was going to explode. So he was out there with emergency crews.

And my understanding is that the patient did all right, but I just... You know, how many people get called to the scene like that? You know, the surgeon, you know, usually it's only emergency crews out there. And that was one of his first, I think, big emergencies after we'd moved up here from Dallas. So.

Dr. Randy Lehman: [00:24:49] Wow, you were there.

Dr. Dorothy Hughes: [00:24:51] I was not on site. I was young. I was probably about 12 at the time, but I heard about it, and that story has always stuck in my head.

Dr. Randy Lehman: [00:25:01] Yeah, that's a beautiful one. So thank you very much for sharing all this with us. We have a last segment called Resources for the Busy Rural Surgeon. And in your interview is what have people said is some of the best resources? Like, if you're just going to use your qualitative research and conglomerate, it that's really useful in rural surgery.

Dr. Dorothy Hughes: [00:25:25] Yeah. I often hear that folks have trouble getting enough time off to go to conferences. Anything that they can do at home is really important. People talk about Selected Readings all the time. Selected Readings in General Surgery. That's one that I'm familiar with.

When folks are able to get away, some that I have interviewed are very involved with College and go to Clinical Congress and those types of meetings. Obviously, the North American Rural Surgical Society is a great resource for folks. But yeah, Selected Readings gets talked about over and over and over and I believe you can listen to them. I think that's what I've heard surgeons do is that while they're going to their outreach clinics at different places, they'll put it on in the car. Especially for those rural surgeons who are doing procedures at several sites, that perhaps is an option to be listening as you go.

Dr. Randy Lehman: [00:26:18] Well, that's great. Well, Dorothy, thank you for all this wealth of information. Is just one of the coolest interviews and it's a great little mini series. So I just really appreciate you and keep up the good work. What you're doing in Salina.

Dr. Dorothy Hughes: [00:26:30] Oh, you're most welcome. Thank you.

Dr. Randy Lehman: [00:26:31] Again, if you enjoyed today's episode with Dorothy Hughes and you'd like to be in touch with her, read her work or learn more about her, she has shared her Google Scholar account and that will be in the show notes. And there may be ways that you could even participate in some of her research. So, Dorothy, how could people get in touch with you or learn more about you?

Dr. Dorothy Hughes: [00:26:52] Yeah. If people would like to share their stories about being rural surgeons, you can email me at Dhughughughes5. That's D-H-U-G-H-E-S number 5 at UMC.kumedicalcenter.edu. So feel free to email me if you would like to share your story. I have several open projects that it would be great to get to know your experiences a little bit better.

Dr. Randy Lehman: [00:27:19] Thank you. That is a great, not only ask, but offer, I think, to our listener. So thank you so much again for being here. This has been the Rural American Surgeon. We'll see you on the next episode.