What Is Aerospace Medicine? Dr. Gray Is Interviewed

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Session 22

Aerospace medicine is a subspecialty of preventive medicine, and it is quite unique to the military, though there are civilians equivalents. Since I, Dr. Gray, am a flight surgeon, today’s episode will be an interview with me.

Of course, I won’t be interviewing myself. I will be interviewed by Ian Drummond, a fourth-year medical student and the host of The Undifferentiated Medical Student podcast. Ian interviewed me back in Episode 24 of his podcast, and I’m playing a part of his interview with me specifically relating to aerospace medicine.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[03:29] What is Aerospace Medicine?

AAMC’s Careers in Medicine resource didn’t actually have a description of aerospace medicine, although it was listed under preventive medicine. So we’ll start our discussion with this description provided by the Aerospace Medical Association:

Aerospace medicine concerns the determination and maintenance of the health, safety, and performance of persons involved in air and space travel. Aerospace Medicine, as a broad field of endeavor, offers dynamic challenges and opportunities for physicians, nurses, physiologists, bioenvironmental engineers, industrial hygienists, environmental health practitioners, human factors specialists, psychologists, physician assistants, and other professionals.

Those in the field are dedicated to enhancing health, promoting safety, and improving performance of individuals who work or travel in unusual environments. The environments of space and aviation provide significant challenges, such as microgravity, radiation exposure, G-forces, emergency ejection injuries, and hypoxic conditions, for those embarking in their exploration. Areas of interest range from space and atmospheric flight to undersea activities.

The environments studied cover a wide spectrum extending from the microenvironments of space to the increased pressures of undersea activities. Increased knowledge of these unique environments of ‘Spaceship Earth’ helps aerospace medicine professionals ensure participants are physically prepared, physiologically safe, and perform at the highest levels.”

Those in the field of aerospace medicine are dedicated to enhancing health, promoting safety, and improving performance of individuals who work or travel in unusual environments.Click To Tweet

[05:28] Relationships with Patients in Aerospace Medicine

One of the biggest things missing from the above description of aerospace medicine is the unique relationships you have with your patients. In fact, it is a huge factor in aerospace medicine.

I will speak specifically to being a U.S. Air Force flight surgeon, although it’s pretty similar for the army and navy, which also have civilian flight surgeons. There are AMEs (Aviation Medical Examiner) out in the real world who do physical exams for pilots. So there is a civilian equivalent; it’s just a little bit different for the military.

When Do Patients Go See a Flight Surgeon?

For the military, specifically for pilots, they usually go and see the flight surgeon for a few things. One is the mandatory annual physical examination (crossing their fingers that nothing is found). Second, they go to the flight surgeon if something is really wrong and they need help.

Typically, a pilot doesn’t want to go and see the flight surgeon outside of those two things, because every visit to the flight surgeon is an opportunity to lose their wings, which means they would no longer be able to fly. Flight surgeons have the control to make sure pilots and other people interacting with aircraft are safely operating the aircraft. It’s a flight surgeon’s job to determine if military personnel have any medical conditions and if they should continue flying or not.

It's a flight surgeon's job to determine if military personnel have any medical conditions and if they should continue flying or not.Click To Tweet

Getting Diagnosed with MS as a Flight Surgeon

As a flight surgeon, I was a rated flyer. I got to wear a flight suit and had wings. I was required to fly four hours per month to be part of the aircrew. It helped me to build that rapport and trust with patients. But I went for an MRI one day because I was having some symptoms, and I got diagnosed with MS. Eventually, I was no longer allowed to go up in an airplane for the air force.

Because of that fine line between being allowed to fly or not being to allowed to fly anymore, you need to have trust and rapport with your flight surgeon. It’s one of the best parts about being a flight surgeon. There could be cases where patients are lying and hiding things from doctors, like a cat and mouse game, because they want to keep flying. These pilots love their jobs, and everybody working on the plane love the camaraderie that comes with it and everything else, so their jobs are a large part of who they are.

One of the best parts of being a flight surgeon is the rapport and trust you build with your patients.Click To Tweet

Personally, I thought it was a stupid rule that I got grounded. MS is one of those weird things for aerospace medicine. The Israeli Air Force lets their pilots with MS fly. Our military is less progressive, so they worry more about the cognitive decline. 75% of MS patients have some sort of cognitive deficit, and that’s what worries them. I did argue for a while, but I lost.

[11:32] Do You Fly the Plane as a Flight Surgeon?

In the U.S. Navy, flight surgeons go through some pilot training courses. The Army may do it like the Air Force, where you go through a little bit of ground pilot school. For instance, they get to ride in a small Cessna plane and fly to see what it’s like. The whole point of the flight surgeon is to make sure that the pilot and other people on the plane can do their job, so you have to understand what they’re going through. Then you get to see how much there is to do.

The whole point of the flight surgeon is to make sure that the pilot and other people on the plane can do their jobClick To Tweet

I have my private pilot license. I have always been fascinated with airplanes. So when I had the opportunity to get my private pilot license, I jumped on that.

Flying Time as a Flight Surgeon

As a flight surgeon, I had to fly four hours a month. It meant being part of the aircrew. The majority of aircraft that I was in were bigger airplanes, so I would just hang out in the back or in the cockpit, not actually controlling anything. Sometimes I would talk on the radio and help them with the radio stuff. The one time I got to fly something was in the backseat of an F-16 because the controls are right there.

The one time I got to fly something was in the backseat of an F-16 because the controls are right there.Click To Tweet

When you have wings, it means you’re in some way affiliated with the airplane. So it’s not just the pilots, but also loadmasters, navigators, flight surgeons, etc. Having wings is a designation that you’re “real” Air Force and you’re part of the plane. There are other jobs in the Air Force that have nothing to do with planes (ex. bus driver, cook, etc.).

[16:08] Civilian Physician vs. Air Force Physician

When you’re, say a Primary Care physician, you rarely think about what job a patient does and whether they can continue to do it. It’s usually the patient that asks for some time off because they don’t want to work. But as a flight surgeon, that’s always the first question at the top of my mind. I have to know what your job is and whether or not you can continue to do it.

So, if you’re a pilot and you come in with knee pain, I know that if an engine goes out and you need to push full rudder to keep the plane straight and land it, you’re probably not going to be able to do that with how bad your knee is. You can be grounded for a week or two to make sure your knees get better, and then you come back and see me again, so I can reevaluate.

Do Flight Surgeons Do Surgery While Flying?

To be clear, there is no such thing as a “flight surgery” that we do, but the name “flight surgeon” is an old name that’s been held onto for a long time. The actual practice is aerospace medicine, and there are aerospace medicine residencies, but you are a “flight surgeon” as an aerospace medicine specialist. There is flying, but there is no surgery, and there’s definitely no surgery while flying.

As a flight surgeon, there is some flying, but there is no surgery, and there's definitely no surgery while flying.Click To Tweet

[18:44] A Typical Week for a Flight Surgeon

A typical week for a flight surgeon is in an ambulatory setting where you’re seeing patients, similar to a family doctor, but at a military base. At some bases, you see dependents (the family members of the active duty member), while in others, you see retirees. So the types of patients you’re seeing vary but you’re seeing normal clinical stuff.

You’re seeing a lot of occupational health visits. When a pilot comes in for their annual flight physical exam, it’s an occupational physical where you check their vision, hearing, and other things to make sure they are healthy. But a lot of the visits are focused on making sure the patient meets the qualifications for continued flying. If you’re seeing dependents and retirees, flight surgeons are basically a family practice physician. So family members are treated for normal aches, pains, and colds, etc.

Depending on where you’re at, 50% of your time is seeing patients and another 50% is hanging out with aircrew and building rapport, doing “shop visits.” As a flight surgeon, you’re an occupational health physician. So if your base has airplanes, you’re visiting the flying squadron to make sure things look good there and the facilities are clean.

Making Sure the Base Stays Healthy

You go to the maintenance squadron and make sure people working on the airplanes are keeping a clean environment. You make sure they’re not working with lead-based paint and bring it into their offices and where they eat. Simply put, you’re making sure the base stays healthy. You’re outside of the clinic a lot of the time and interacting with the rest of the base population, which keeps things varied, and you get a lot of variety.

Simply put, as a flight surgeon, you're making sure the base stays healthy. Click To Tweet

When you go to site visits, it’s like carrying a clipboard with a checklist making sure they keep separate wipes for their masks or have separate sinks for different things. A lot of the things are structured that way, while some of it is just using your intuition and question-asking skills. Usually, you go out with a team consisting of public health or bio-environmental engineering folks, while you’re focused on the health side. It’s a very collaborative, team-based thing.

[23:16] Flight Surgeons Can Have Training in Any Specialty

A large majority of flight surgeons are general practitioners, which means they’re only internship-trained. This is the way the Air Force gets flight surgeons—a lot of them are fresh out of their internship.

There are also a lot of flight surgeons with residency training, like OB/GYN, orthopedics, family medicine, or internal medicine. You can actually have training in any specialty and be a flight surgeon if you choose to. If you have specialty training and then become a flight surgeon, you have to go through all the aerospace medicine training before becoming a flight surgeon because it’s unique and different.

Aerospace medicine is a subspecialty available to all physicians in the military. They usually need flight surgeons, so there are some physicians who jump ship from their specialty or subspecialty and come over to the aerospace medicine world.

Aerospace medicine is a subspecialty available to all physicians in the military, even if they started with a different specialty.Click To Tweet

[24:50] Patient Outcomes in Aerospace Medicine

Typical outcomes would be just like a family practice doctor, where you’re seeing people with their aches and pains, sniffles, and flu. So you’re treating an acute thing for a week or two, grounding them for a week or two, and then they come and see you again, and things are better.

There are also some unique things that could happen, like somebody losing their vision or having a random new diagnosis. There are a lot of bad things that can happen to cause somebody to lose their wings. As a flight surgeon, you also take care of firefighters, which is another big occupational health job.

The outcomes are usually normal healthy people, but when you get those random diagnoses, it’s a life-changer for the patient.

Aerospace medicine has you usually dealing with normal healthy people, but when you get those random diagnoses, it can be a life-changer for the patient.Click To Tweet

[26:23] Most Exciting and Mundane Parts of Aerospace Medicine

The most exciting thing about aerospace medicine is being able to go out and be part of the aircrew and fly around the world, fly an F-16, or do all sorts of missions, experiencing what the rest of the base is doing.

The most mundane part of aerospace medicine is dealing with normal aches and pains, like dealing with blood pressure management or diabetes management. Basically the boring, normal doctor stuff.

[27:10] What I Wish I Knew About Aerospace Medicine

When I got the call to say I was going to be a flight surgeon, I didn’t know what it was. When I was in it and now that I’m out of it, I don’t think there’s really anything that I wished I had known about. I just I wish I would have known about it before I become one.

You should consider doing aerospace medicine especially if you are on an HPSP scholarship. It’s an amazing job, and there are so many things you can do. Even if you’re interested in a specialty, go be a flight surgeon for a couple of years, and then go live the rest of your life. The stories I can tell now, having been a flight surgeon, are going to stay with me forever.

The stories I can tell now, having been a flight surgeon, are going to stay with me forever. Click To Tweet

[28:40] What is the HPSP Scholarship?

HPSP refers to Health Professions Scholarship Program. The program offers about 150 scholarships a year You apply for the scholarship after you’re accepted to medical school. Once you get accepted to HPSP, they pay for your medical school. Then you owe them a year of service for each year of scholarship. You can do a 3-year or 4-year scholarship.

[Related episode: Air Force HPSP Scholarship Interview.]

[29:28] Combat Flight Surgeons vs Non-Combat Flight Surgeons

As a non-combat flight surgeon, you can be stationed anywhere throughout the world. You can be stationed at a location without planes. The majority of your job is to make sure that the population of that base is healthy. It’s always an ambulatory setting. There would be no need for an in-patient hospital-based flight surgeon.

When you’re deployed as a combat flight surgeon, you can run different parts of the medical evacuation triage tents and stations along the way. When somebody gets injured in combat, they’re evaluated and triaged to see if they need to be evacuated out to a bigger hospital or if they can just be treated where they are.

As flight surgeon, you have to do that evaluation and determine what kind of aircraft they need to fly on. Is this an injury that is going to get worse at a high altitude? Do they need to be in a helicopter and stay in an unpressurized aircraft at a low altitude? So, you’re basically doing a lot of cool triage to figure out what’s best for the patient as far as the aircraft, altitude, and other things.

What is an Aviation Medical Examiner (AME)?

An AME is an Aviation Medical Examiner. It’s a designation where you get certified through the FAA. As an AME, you’re usually a family practice doctor, an internal medicine doctor, or somebody interested in aviation. It’s a cool job because it’s usually a cash-based business. You can see Class 1, 2, and 3 pilots, who all need a certain number of physical exams depending on the class. You have to go through FAA training, which is free.

The population of AMEs has significantly decreased over time, so it’s now getting more difficult for pilots to find an AME and get their physical exams. An AME is very similar to a flight surgeon, where there are strict guidelines that determine whether or not the patient is able to fly. Flight surgeons base patient evaluations on those guidelines and make recommendations based on that. FAA training is not the same as an aerospace medicine residency. It’s a one-week to two-week long course that the FAA puts on.

The population of AMEs has significantly decreased over time, so it's now getting more difficult for pilots to find an AME and get their physical exams.Click To Tweet

Being a Flight Surgeon at NASA

You can be a flight surgeon at NASA. I’ve been down to the space center in Houston and visited the world’s largest swimming pool, where the astronauts do all their training for weightlessness. And as a flight surgeon in the air force, I did see patients who wanted to be astronauts. I would do their initial physical exams before they’d go down to Houston to get their full physical.

[36:15] Becoming a Pilot Physician

Moreover, you could be a Pilot-Physician. The Air Force only has about 20 spots for Pilot-Physicians. A student I’m working with is in the Air Force right now and wants to go back to medical school, but she’s also a pilot. She’s not a pilot in the Air Force, but she is a private pilot with 600 hours, and she flew with the academy on their stunt team.

The typical path for a pilot-physician is that you're a pilot and, for some reason, you get interested in medicine.Click To Tweet

The typical path for a pilot-physician is that you’re a pilot and, for some reason, you get interested in medicine. You go to medical school, and you still want to be in the military, so you become a pilot-physician. So, you’re a physician first, but you have the pilot training and usually, you’re doing a lot more higher-level things than just seeing patients in a clinic.

What do Pilot-Physicians Do?

As a pilot-physician, you’re looking at a lot of the regulations being written, research into new technologies, etc. There are only 20 slots for pilot-physicians in the Air Force, but there are actually not enough pilots that are going on to be physicians, so they’re looking for physicians who may be interested in pilot training. I did look into this, but I was too old to start, since 29 is the oldest to start the training, and I was already 30 or 31.

The Air Force takes any physician, but you obviously have to go through their aerospace medicine training at some point. The unique thing a job as a pilot-physician offers is the research experience, a deep knowledge base, the foundation of having both careers under your belt, being able to make those regulations, and see things from both sides.

[39:56] The Biggest Challenge in Aerospace Medicine

One of the biggest challenges of aerospace medicine is that a lot of people don’t understand us, so there is a lot of pressure for us to start doing more and seeing different types of patients. Apparently, there is a lot of misunderstanding from the greater Air Force about what our job is.

The Future of Aerospace Medicine

Aerospace medicine will change as we go more and more toward autonomous aircraft, where we have drones that are remotely piloted. They are not “unmanned aircraft”—they’re manned, just in a different location. We will still need physicians to be seeing those drone pilots. But because of this shift, interest in aerospace medicine will go down. Part of the lure of being a flight surgeon is being able to go fly, so why would you be doing it if there is no plane you can fly on?

There could also be unique psychological challenges that come into play for drone pilots. We’re also going to fighter planes (F-22 and F-35) that are only single-seat planes. This means the flight surgeon can’t go up there, and again they get less experience of what flying is like for the patients they’re treating. But there will still be the heavier aircraft like the C-5, C-17, and refuelers.

[44:35] Final Words

Aerospace medicine is an awesome job! Although pretty much specific to the military, there are civilian residencies for aerospace medicine, too. Check it out if it sounds interesting to you!

For the Specialty Stories podcast, we’re not going to dive into all medical specialties in the military for two reasons. First, the practice of pediatrics in the military is not very different from pediatrics in the civilian world. Second, there aren’t enough military premeds out there to warrant individual episodes on every subspecialty in the military.

Still, I’m a huge advocate for doing the military to pay for medical school and to serve. See the links below for more MedEd Media podcast episodes about military medicine!

Links and Other Resources