Do USAF flight surgeons really perform surgery in flight?

[Van Johnston]

I'm pretty sure the answer is no; just wanted to get your attention.

Seriously...my PPL/IR-rated son begins medical school in July. He is weighing whether or not to sign up for the HPSP to pay for medical school. He heard there are 'flight benefits' to being a flight surgeon. His recruiter connected him with an active duty flight surgeon and they communicated via e-mail, but I think it is still fuzzy in his mind exactly what he'd be getting himself into and what the benefits are.

If there is anyone with first hand USAF flight surgeon experience willing to spend 15 minutes on the phone with my son and share your experience, will you PM me?

I am retired USAF but was not a flier, so I can't really help him, except to pass on the lament our one-star pilot wing commander made one time that he was not the highest paid person on base; the colonel med group commander was.

Thanks

 

[TCABM]

As a former USAF flyer, the Flight Surgeon is a PCM for those on flight (and other special duty) status. The Flight Surgeon is also on flight status and has some sort of minimal currency as a crew member, so they about once a month as a guy in back. For the flight surgeons attached to single seat aircraft, I don’t know how they keep current.

They aren’t ‘practicing’ medicine in the jet.

In-flight medical care is an Air Evac mission which I understand is primarily flight nurses and med tech aircrew, but there’s some critical care and other specialized stuff where an MD may be on board and I’m not certain if those folks are flight surgeon AFSCs or not.

 

[AvNavCom]

I'm a Navy flight surgeon. My impression is that we get a heck of a lot more flight time than our USAF brethren. I was goofing off in a P-8 just a couple of days ago, and have flown or flown in just about everything the Navy has that isn't a single-seat fighter. Carrier catapult launches in Super Hornets. Swinging under helicopters in the Sierras. Hell, I even got the USAF to let me fly in a B-52 some years ago.

If your son is dead-set on being a flight surgeon, I'd recommend flying Navy. If I'm honest, right now I'd recommend running screaming from military medicine until we can either kill or subdue DHA. Better to go through medical school the same way everyone else does, finish a residency, and then decide if flight surgery still sounds like fun. The military isn't going anywhere.

Happy to chat with him if he'd like to hear about the current experience and what he could expect.

 

[mcdewey]

This is good info, but what is HPSP, PCM, AFSC, and DHA? I figured out USAF.

 

[murphey]

PCM Primary Care Physician
HPSP Health Professional
AFSC Air Force Specialty Code

But back to the original question...the concept of an Air Surgeon goes back to the early 1900s. The title may be based on the British Navy's definition: "A naval surgeon, or less commonly ship's doctor, is the person responsible for the health of the ship's company aboard a warship" but in today's USAF, they get flight status as a bonus so they understand the physical & mental issues of flight crew, but really don't practice in flight. US Navy, on the other hand, due to size and complement of the ships, will have pharmacist mate and carriers, defininitely MDs and a really good medical facilities. Right now the US Navy has two 100% hospital ships and a 3rd in development.

https://www.med.navy.mil/Medical-Corps/Operational-Medical-Officer/

 

[Llewtrah381]

This is good info, but what is HPSP, PCM, AFSC, and DHA? I figured out USAF.

Health Professions Scholarship Program - the military’s scholarship program for medical officer careers, typically physicians, dentists, optometrists, etc.


Primary Care Manager (/physician, although the term is broad enough to include Physician Assistants and Nutse Practitioners in certain situations).

Air Force Specialty Code - a coding system for specialties within the Air Force (duh).

Defense Health Agency. IMHO a well-intended concept on paper that wasn’t an improvement overall. The thinking was medical resources aren’t “combatant forces” by and large and are tail rather than tooth and should be consolidated rather than Service-specific as much as possible. It fully kicked in after I retired but I heard a lot about it from friends. Fun fact: the guy who fleshed out the idea and became its first Commander was the guy who got me my call sign in my F-16 squadron when I was getting set up to take his place. He was hands down one of the best Flight Surgeons I ever met.

 

[Llewtrah381]

I'm a Navy flight surgeon. My impression is that we get a heck of a lot more flight time than our USAF brethren. I was goofing off in a P-8 just a couple of days ago, and have flown or flown in just about everything the Navy has that isn't a single-seat fighter. Carrier catapult launches in Super Hornets. Swinging under helicopters in the Sierras. Hell, I even got the USAF to let me fly in a B-52 some years ago.

If your son is dead-set on being a flight surgeon, I'd recommend flying Navy. If I'm honest, right now I'd recommend running screaming from military medicine until we can either kill or subdue DHA. Better to go through medical school the same way everyone else does, finish a residency, and then decide if flight surgery still sounds like fun. The military isn't going anywhere.

Happy to chat with him if he'd like to hear about the current experience and what he could expect.

Your comments are true but a bit nuanced.

Back in the day, when there were way more 2-seat aircraft in the AF, we had a fair amount of opportunity to fly, although, in the F-16, they typically told me they’d prefer the extra 1200lb of fuel the D-model (2-seater) gave up. I tell people I got 65 hours of puking in back of an F-16 during my 2 years as a Squadron Flight Surgeon. I also have a few hundred hours in tankers and transports - which is how a lot of current ones get their hours, I think, in F-35 squadrons, etc.

No doubt Navy FSs can have more “fun” options these days - but at the expense of being deployed on a carrier every now and then. For family life, AF is probably the safer bet. For a single person, Navy offers more adventure in some ways. But I’d also suggest spending some time on an Air Force and a Navy base to compare life: there is a difference.

I agree with the comments about the DHA.

Circling back to the OP’s question, while I’d be happy to chat about my time 35 years ago as a Squadron FS, military medicine overall has changed a lot even since I retired (with the DHA) and actually did so over the course of my career. When I first came out of my Family Medicine residency, my first assignment was at a 35-bed community hospital where I was catching babies, helping in the OR, staffing the ER, setting fractures, sewing stuff up, and just a “fun” breadth of clinical practice. After the Cold War many new docs came in from exciting training to go staff a small clinic in south Texas or somewhere and never did much more than prescribe pills. Especially frustrating for some new internists who were adept in ICU medicine.

It’s a great way to pay for medical school and my 4-year obligation turned into a very fun 24-year career. But it’s not for everyone.

 

[AvNavCom]

But I’d also suggest spending some time on an Air Force and a Navy base to compare life: there is a difference.

I'm prior USAF, so certainly agree that the USAF has far better facilities and generally treats its people better. Historically, HPSP has been a good way to pay for med school, but I'm not sure that's quite as true now. It depends on specialty, of course, but income and quality of life for military physicians just can't compare to civilian physicians now. That's particularly the case as DHA struggles to try to accommodate operational medicine into the frankly civilian-style model it is trying to run to deliver the "healthcare benefit". An additional issue with the Navy (but not the USAF and Army, I believe), is that we tend to send people out on GMO tours, which delays residency completion (and subsequent qualification for specialty pay and retention pay).

Specifically for HPSP, I don't think people understand that the "year for a year" payback time effectively doesn't tick down until residency is complete. Some people are signing up for HPSP thinking they're only signing up for four years of military service after med school. The reality is that they're signing up for a minimum of seven years of service and potentially much longer, depending on how many years of residency (and fellowship, potentially) they get.

Again, I've had a great time as a flight surgeon, but I'm much more enthusiastic about flying than I have ever been about medicine. My advice to potential applicants is to really run the numbers and determine what the break-even point is financially. With accession bonuses for residency-trained physicians, I think it would be possible to wipe out any medical school debt and come into active-duty (or Reserves) in a much better position to get maximum bonuses with minimal mandatory payback time. The quality-of-life aspects, such as the frequent moves, family separation, overseas service, and operational/remote locations are very personal decisions.

 

[Llewtrah381]

An additional issue with the Navy (but not the USAF and Army, I believe), is that we tend to send people out on GMO tours, which delays residency completion (and subsequent qualification for specialty pay and retention pay).

That is definitely something a potential HPSP recipient needs to understand and research. Pretty much every med school classmate of mine who went Navy did an internship somewhere of some sort and then got tapped to be a GMO (General Medical Officer) for at least two years, I think - and often shipboard. Then they’d return to do their residency either Navy or civilian. That wasn’t just for FPs: Pediatric Surgeons, Neurosurgeons - they all went that path. Not true for AF.

The reality is that they're signing up for a minimum of seven years of service and potentially much longer, depending on how many years of residency (and fellowship, potentially) they get.

Yep. And if they get a malicious assignments officer, it can be longer: I owed 4 years coming out of residency and, at that time all of us needed to go overseas sometime. But they insisted on sending us stateside for 2 years and then tap us for overseas - either a year without family in Korea or to Europe. But since Europe was more popular we had to “volunteer” to go 4 years - 2 years beyond our payback.

I wouldn’t trade my experience for any other, especially at that time in history and as a FP physician. But it’s not for everyone

 

[Van Johnston]

@AvNavCom @Llewtrah381 Thank you!

...

If your son is dead-set on being a flight surgeon, I'd recommend flying Navy. If I'm honest, right now I'd recommend running screaming from military medicine until we can either kill or subdue DHA. Better to go through medical school the same way everyone else does, finish a residency, and then decide if flight surgery still sounds like fun. The military isn't going anywhere.

Happy to chat with him if he'd like to hear about the current experience and what he could expect.

I've encouraged him to consider the Navy too. I think he's fixated on USAF because that's all he knows. He's leaning toward your recommendation (skip HPSP).

...

Circling back to the OP’s question, while I’d be happy to chat about my time 35 years ago as a Squadron FS, military medicine overall has changed a lot even since I retired (with the DHA) and actually did so over the course of my career. When I first came out of my Family Medicine residency, my first assignment was at a 35-bed community hospital where I was catching babies, helping in the OR, staffing the ER, setting fractures, sewing stuff up, and just a “fun” breadth of clinical practice. After the Cold War many new docs came in from exciting training to go staff a small clinic in south Texas or somewhere and never did much more than prescribe pills. Especially frustrating for some new internists who were adept in ICU medicine.

It’s a great way to pay for medical school and my 4-year obligation turned into a very fun 24-year career. But it’s not for everyone.

Thank you. Similarly, my ROTC scholarship was a great way to pay for an engineering degree and my 4-year obligation turned into a very fun 20-year career. But it’s not for everyone.

I'm prior USAF, so certainly agree that the USAF has far better facilities and generally treats its people better. Historically, HPSP has been a good way to pay for med school, but I'm not sure that's quite as true now. It depends on specialty, of course, but income and quality of life for military physicians just can't compare to civilian physicians now. That's particularly the case as DHA struggles to try to accommodate operational medicine into the frankly civilian-style model it is trying to run to deliver the "healthcare benefit". An additional issue with the Navy (but not the USAF and Army, I believe), is that we tend to send people out on GMO tours, which delays residency completion (and subsequent qualification for specialty pay and retention pay).

Specifically for HPSP, I don't think people understand that the "year for a year" payback time effectively doesn't tick down until residency is complete. Some people are signing up for HPSP thinking they're only signing up for four years of military service after med school. The reality is that they're signing up for a minimum of seven years of service and potentially much longer, depending on how many years of residency (and fellowship, potentially) they get.

Again, I've had a great time as a flight surgeon, but I'm much more enthusiastic about flying than I have ever been about medicine. My advice to potential applicants is to really run the numbers and determine what the break-even point is financially. With accession bonuses for residency-trained physicians, I think it would be possible to wipe out any medical school debt and come into active-duty (or Reserves) in a much better position to get maximum bonuses with minimal mandatory payback time. The quality-of-life aspects, such as the frequent moves, family separation, overseas service, and operational/remote locations are very personal decisions.

All good points and consistent with what he is hearing from others. Thanks

That is definitely something a potential HPSP recipient needs to understand and research. Pretty much every med school classmate of mine who went Navy did an internship somewhere of some sort and then got tapped to be a GMO (General Medical Officer) for at least two years, I think - and often shipboard. Then they’d return to do their residency either Navy or civilian. That wasn’t just for FPs: Pediatric Surgeons, Neurosurgeons - they all went that path. Not true for AF.

Yep. And if they get a malicious assignments officer, it can be longer: I owed 4 years coming out of residency and, at that time all of us needed to go overseas sometime. But they insisted on sending us stateside for 2 years and then tap us for overseas - either a year without family in Korea or to Europe. But since Europe was more popular we had to “volunteer” to go 4 years - 2 years beyond our payback.

I wouldn’t trade my experience for any other, especially at that time in history and as a FP physician. But it’s not for everyone

More good points. Thank you.

I've let him know I've found two people willing to talk to him and to let me know if he wants contact info. Standing by.

Thanks again

 

[Van Johnston]

Update: he took the money; went USAF.

He has thought it through and is comfortable with the decision, as is the fiance. He said it wasn't just about the money, and if he gets the opportunity to fly that's just an extra benefit. Sounded like he received key counsel from one of his former scoutmasters who is a recently retired Army doc.

Before benefits can kick in he had to be sworn into the reserves, and he offered me the honor to administer the oath. Kudos to the Texas Air Museum at Slaton TX (F49) for providing an appropriate venue on short notice. I didn't try to squeeze into the uniform, but I did go light blue over dark blue. His bearing and standards will come after initial training next summer.

 

[Bill]

Congrats, love that you could do the oath. My brother was in the Navy when he swore me into the Navy, and I was active duty and swore my other brother into the Air Force when he joined.

 

[kayoh190]

Congrats - that's very cool!

 

[TCABM]

….Before benefits can kick in he had to be sworn into the reserves, and he offered me the honor to administer the oath. …

That’s awesome! I got to commission my son at A&M a couple of months before I retired.

 

[NavAir]

Retired Navy FS here. I paid my own way through Medical School (it was a lot cheaper back then - I graduated in 1980, plus I wasn’t even thinking about military service). I did a couple of years of General Surgery residency before needing a ‘break’ from every other night on-call. Already had my PPSEL back then.

6 months of FS training in Pensacola was great. Got assigned to a West Coast Patrol Squadron and was lucky to have COs that supported my interest in flying (sent me to Instrument school and gave me tons of flight time in the left seat of the P3C). I did 2 Westpac deployments, and used to boast that I had flown everywhere between the West coast of the US and the East Coast of Africa.

At that time, if you wanted to do Residency training in the Navy, an operational tour was pretty much a requirement - either FS, Undersea Medicine, or a shipboard tour. I did Ophthalmology at Bethesda NH, then my payback tour back in Pensacola, where I continued to get flight time in Navy aircraft almost every week. I eventually retired from the Reserves with 22 years.

Truly one of the greatest experiences of my life, but things in the military have changed a lot since then. I think that for a single person, it can still be an awesome experience. Working and living with a group of guys (and now gals) in the squadron environment is truly a transformational experience.

The other thing I can mention is that it provides some unique opportunities you really can't find anywhere else. One of my FS classmates got assigned to VXE-6, and Wintered-over in Antarctica. At least three others in subsequent classes became astronauts. I had the opportunity to work at NASA on some advisory panels, and actually got to live one of my fantasies - flying to work (at Ellington field), parking my airplane next to the NASA T38s, and getting picked up by a NASA vehicle for the drive to JSC.

Good luck to your son.

 

[Llewtrah381]

Congrats and best of luck to him! It was a great life for us. And not having a mountain of debt from school will give him options regardless of how long he stays in.

Tell him to brace for the inevitable jokes about being Air Force - and tell him to remind others he can’t be responsible for their poor career choices!