Air ambulance doc, great profession?

[PsychPop]

Hey so I am a pre-med and normally I would stay out of this thread as I don't really belong here, but I figured I would ask the source as becoming an emergency doctor for an air ambulance seems to be a very exciting and interesting profession. I understand some of you will have to do a rotation in an air ambulance so I figured you guys could offer me some insight! How competitive is it for residency? How good is the compensation? What does an average week look like?

Thanks appreciate it!

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[gamerEMdoc]

There is no such thing as an air ambulance residency. You can technically become an air ambulance physician no matter what residency or training you have, you don't need to be boarded in EM; it would be whatever the air ambulance company wants for their physician on board. If they want to hire an ED doc, or a critical care doc, or an FP physician... they can hire whatever they want. Should you go the EM route, I think maybe an EMS fellowship may make sense, and those are not competitive. As for the questions about compensation, hours, etc... IDK, I've never entertained doing anything like this and don't know anyone who does, so I can't answer that for you.

 

[martvubo]

There was an interview in The Undifferentiated Medical Student podcast with someone who works at, not sure but I wanna say Cincinnati, splitting time between being involved with their EM residency and doing air ambulance flights. If I remember right, he said it's a pretty big pay cut to make that a part of his job (because in the US it's a role typically filled by nurses or paramedics). He suggested that the air ambulance shifts did have immense training value (in terms of building confidence at least) for residents (who have the opportunity but not obligation to fly in many programs) also.

Edit: I think this was it Ep 045 – Emergency Medicine with Dr. Christopher Wyatt so actually Cleveland

 

[PsychPop]

Hey thanks guys for the timely responses! I have to admit I was not expecting to hear that they take pay cuts as the job is no doubt more intense than just being in the ER; but yeah I guess in most cases paramedics and nurses can fill the job for a lot less money. I just watched a documentary that takes place in England where it seems there, that air amb docs are a regular thing that tend to make around $150k a year which seems pretty good. But in comparison to my other interests like Anesthesiology and cardiology, It would make less considerably. It's not all about the money but I do want to try and live in California so unfortunately, it will cost me a lot to do so.

Thanks a bunch for the info!

 

[miacomet]

There is no such thing as an air ambulance residency. You can technically become an air ambulance physician no matter what residency or training you have, you don't need to be boarded in EM; it would be whatever the air ambulance company wants for their physician on board. If they want to hire an ED doc, or a critical care doc, or an FP physician... they can hire whatever they want. Should you go the EM route, I think maybe an EMS fellowship may make sense, and those are not competitive. As for the questions about compensation, hours, etc... IDK, I've never entertained doing anything like this and don't know anyone who does, so I can't answer that for you.

EMS fellowships in desirable areas and with name recognition (FDNY, for example) can be tough to get. But as Gamer says, this job isn't really a thing in the US. You could try the Royal Flying Doctors in Australia.

 

[cyanide12345678]

Hey so I am a pre-med and normally I would stay out of this thread as I don't really belong here, but I figured I would ask the source as becoming an emergency doctor for an air ambulance seems to be a very exciting and interesting profession. I understand some of you will have to do a rotation in an air ambulance so I figured you guys could offer me some insight! How competitive is it for residency? How good is the compensation? What does an average week look like?

Thanks appreciate it!

Almost no physician jobs exist for being a flight doc anymore. Every crew usually has a flight nurse and a paramedic. You basically don't need med school to have that job.

There are a few residencies in the country where as a senior resident you can work shifts as a flight doc and are an active part of the team (instead of just being an observer). Those are the few instances of having a flight doc on board that i know of, otherwise usually it's always a nurse and a paramedic.

The last time i was quoted a moonlighting rate to be a flight doc as a resident was $65/hr.

Your week consists of basically several 24 hour shifts. Depends on where you work and how busy it is, most places you do 2-4 flights a day. In the winter that number goes down significantly especially if you live in a region with crappy weather.

 

[cyanide12345678]

Hey thanks guys for the timely responses! I have to admit I was not expecting to hear that they take pay cuts as the job is no doubt more intense than just being in the ER; but yeah I guess in most cases paramedics and nurses can fill the job for a lot less money. I just watched a documentary that takes place in England where it seems there, that air amb docs are a regular thing that tend to make around $150k a year which seems pretty good. But in comparison to my other interests like Anesthesiology and cardiology, It would make less considerably. It's not all about the money but I do want to try and live in California so unfortunately, it will cost me a lot to do so.

Thanks a bunch for the info!

Job is more intense than being in the ER??? 😛 😛 😛 😛 LOLOL.

That's funny.

I've flown for a year as a resident. Always relaxing, a lot of downtime of doing nothing, several days of NO transportation and literally just watching cable and hanging out. It was a nice break between real work at the ER.

Now an ER shift on the other hand..... you see 2 patients an hour, not two patients a day. You also are the first to stabilize the said sick patient that the flight crew flies for you, often times after you've done the initial stabilization while running a busy department and seeing many more patients.

Think about it... Is having one sick patient for 20-30 minutes harder or having multiple sick patients with multiple non acute patients harder?

 

[GonnaBeADoc2222]

150k/yr is not good.

 

[VA Hopeful Dr]

150k/yr is not good.

OP said that was in England which in fairness is more than I as an FP would make in England.

 

[BoardingDoc]

as the job is no doubt more intense than just being in the ER;

I understand that you're a premed and deserve a bit of slack, but this is just hilariously incorrect.

 

[FiremedicMike]

Job is more intense than being in the ER??? 😛 😛 😛 😛 LOLOL.

That's funny.

I've flown for a year as a resident. Always relaxing, a lot of downtime of doing nothing, several days of NO transportation and literally just watching cable and hanging out. It was a nice break between real work at the ER.

Now an ER shift on the other hand..... you see 2 patients an hour, not two patients a day. You also are the first to stabilize the said sick patient that the flight crew flies for you, often times after you've done the initial stabilization while running a busy department and seeing many more patients.

Think about it... Is having one sick patient for 20-30 minutes harder or having multiple sick patients with multiple non acute patients harder?

The dirty secret about working on a helicopter is the majority of your patients are boring.. ER to ER with a stable STEMI. ER to ER with a stable stroke alert. Scene to ER with a “mechanism of injury”..

Yes, you’ll get some sick patients, yes you’ll occasionally get to save the day, and of course flying on a helicopter is cool.. With that said, the patient care is usually pretty lame..

 

[deleted109597]

At least in the ER, if the equipment doesn't work only the patient dies.

 

[PsychPop]

Haha I no doubt knew I would sound foolish one way or another but that's fine lol I am in fact speaking from no experience. That being said I have been volunteering at my local hospital twice a week in the ER and from what I see most patients are druggies, elderly, and illegals taking advantage of medicare for the simplest of reasons. As an ER physician, how deep do you get to go when it comes to actually touch and administer treatment with the patient? At what point does a surgeon take over? To me, it seems like they mostly talk with the patient briefly and then charts. I have shadowed a family medicine doc and the same seems to be true apart from let's say a wart or skin tag removal. My question to any of you would be, Would you go into EM again if you could start all over and why? (I am aware they work less than a surgeon has to which is nice)

Thanks for your thoughts!

 

[alpinism]

Being on the helicopter is definitely not as glamorous as on television.

The other thing you have to realize is most patients are inter-facility transports without any immediate life threatening emergency.

 

[Arcan57]

Being on the helicopter is definitely not as glamorous as on television.

The other thing you have to realize is most patients are inter-facility transports without any immediate life threatening emergency.

Or if they’re not stable, they’re hosed in ways you can’t fix in the air. Malfunctioning LVADs, type A dissections, etc.

 

[cyanide12345678]

Being a flight nurse or medic is probably one of the cushiest jobs actually. 80 percent downtime at least of doing nothing. It's glorified for no reason. Like has been mentioned above, even the transports most of the time are relatively stable. Few transports involve truly unstable patients. But even the longest flights for us would be 30-35 minutes. Average flight was 20-22 minutes in the air. Most of the times you can keep people alive for 30 minutes with enough pressors, fluids/blood products

 

[cyanide12345678]

Haha I no doubt knew I would sound foolish one way or another but that's fine lol I am in fact speaking from no experience. That being said I have been volunteering at my local hospital twice a week in the ER and from what I see most patients are druggies, elderly, and illegals taking advantage of medicare for the simplest of reasons. As an ER physician, how deep do you get to go when it comes to actually touch and administer treatment with the patient? At what point does a surgeon take over? To me, it seems like they mostly talk with the patient briefly and then charts. I have shadowed a family medicine doc and the same seems to be true apart from let's say a wart or skin tag removal. My question to any of you would be, Would you go into EM again if you could start all over and why? (I am aware they work less than a surgeon has to which is nice)

Thanks for your thoughts!

I'm pretty happy with EM, but I've only been an attending for two months (moonlighting for another year before that). There are moments i feel new attending Jitters on the job, sometimes i walk into work and see 15 patients in 3 hours on a busy day. That can be stressful as a new attending i feel.

I would go either into EM or anesthesia if i had to do it again.

Surgeons help with maybe 3-5 percent of my patients? You know when organs actually have to come out of the body, then a surgeon is needed. But out of a 100 ED patients, i think only 3-5 people truly have a surgical diagnosis maybe. 80 percent i would just send home after doing whatever that needs to be done, 15-17 percent will get admitted to the medical hospitalist.

 

[RuralEDDoc]

Being a flight nurse or medic is probably one of the cushiest jobs actually. 80 percent downtime at least of doing nothing. It's glorified for no reason. Like has been mentioned above, even the transports most of the time are relatively stable. Few transports involve truly unstable patients. But even the longest flights for us would be 30-35 minutes. Average flight was 20-22 minutes in the air. Most of the times you can keep people alive for 30 minutes with enough pressors, fluids/blood products

Agreed. Fairly chill job with the occasional moments of terror. A little riskier than average (due to the risk of crashing) but that is still relatively low.

 

[cyanide12345678]

Agreed. Fairly chill job with the occasional moments of terror. A little riskier than average (due to the risk of crashing) but that is still relatively low.

Depends what sort of a place you work for. The big commercial companies are flying single engine aircrafts with no IFR capabilities and the companies put pressure on pilots from saying no due to weather. The aircrafts run by big University centers usually are twin engine, packed with redundancy safety features which are very safe. Almost all helicopter crashes have been with single engine aircrafts. Still the risk isn't 0, but it's fairly safe as long as you are in a twin engine aircraft.

 

[FiremedicMike]

Depends what sort of a place you work for. The big commercial companies are flying single engine aircrafts with no IFR capabilities and the companies put pressure on pilots from saying no due to weather. The aircrafts run by big University centers usually are twin engine, packed with redundancy safety features which are very safe. Almost all helicopter crashes have been with single engine aircrafts. Still the risk isn't 0, but it's fairly safe as long as you are in a twin engine aircraft.

Not to turn this into a helicopter debate, but helicopter crashes are nearly always due to bad decisions and I can’t think of a single incident where a second engine would have changed things..

Now, management pressure is another story and I agree there are far too many dead flight crews due to pressure to fly. I recently lost a friend when he and his crew accepted a flight which had been turned down by everyone else in the area due to weather..

 

[Apollyon]

Not to turn this into a helicopter debate, but helicopter crashes are nearly always due to bad decisions and I can’t think of a single incident where a second engine would have changed things..

Now, management pressure is another story and I agree there are far too many dead flight crews due to pressure to fly. I recently lost a friend when he and his crew accepted a flight which had been turned down by everyone else in the area due to weather..

The president of my group was in a feet wet emergency more than 30 years ago, over Lake Erie. I don't recall the specifics, but the aircraft was a two jet engine ship. Eurocopter, maybe? I don't know. He told me that one jet engine failed (birdstrike, maybe), and the pilot had to overpower the second engine to make feet dry. This destroyed the second engine, making the aircraft a total loss. Apparently, the airframe ain't worth that much.

 

[FiremedicMike]

The president of my group was in a feet wet emergency more than 30 years ago, over Lake Erie. I don't recall the specifics, but the aircraft was a two jet engine ship. Eurocopter, maybe? I don't know. He told me that one jet engine failed (birdstrike, maybe), and the pilot had to overpower the second engine to make feet dry. This destroyed the second engine, making the aircraft a total loss. Apparently, the airframe ain't worth that much.

Now that you say that there was a bird strike in Tennessee within the last few years that destroyed the engine and killed the crew.

But the fact remains that HEMS crashes are usually pilots driving them into the ground, either because they can’t see or they make some other poor choice. 30 engines won’t stop that from happening..

 

[Birdstrike]

22 year old pre-med: "Being a full time air ambulance doc would be great!"

42 year old EM doc: "No ----ing way I'd take that job."

 

[PsychPop]

I'm pretty happy with EM, but I've only been an attending for two months (moonlighting for another year before that). There are moments i feel new attending Jitters on the job, sometimes i walk into work and see 15 patients in 3 hours on a busy day. That can be stressful as a new attending i feel.

I would go either into EM or anesthesia if i had to do it again.

Surgeons help with maybe 3-5 percent of my patients? You know when organs actually have to come out of the body, then a surgeon is needed. But out of a 100 ED patients, i think only 3-5 people truly have a surgical diagnosis maybe. 80 percent i would just send home after doing whatever that needs to be done, 15-17 percent will get admitted to the medical hospitalist.

That's great to hear!
I too am interested in Anesthesia as it seems like you get to see all types of patients going through surgeries.

 

[Birdstrike]

One day I show up for the 7 a.m. shift. The charge nurse says to me, "By the way, if you need to call the chopper today, don't bother. They can't find it. It's all ground transport today."

Not sure what was going on, I ask, "What the hell do you mean they can't 'find' it?"

Dead serious, the charge nurse says, "It means exactly what you think it means."

It turns out later they did find it...sort of. They found a charge mess of ashes burrowed into the ground in a forest, with a part of the tail sticking up out of the ground. It had dropped off a patient and was headed back to home base at the airport. There was a storm heading towards the area, the pilot was notified, but decided they could beat the storm. He gambled wrong. The pilot, a young nurse married with kids, and a paramedic, were all killed.

 

[PsychPop]

One day I show up for the 7 a.m. shift. The charge nurse says to me, "By the way, if you need to call the chopper today, don't bother. They can't find it. It's all ground transport today."

Not sure what was going on, I asked, "What the hell do you mean they can't 'find' it?"

Dead serious, the charge nurse responded, "It means exactly what you think it means."

It turns out later they did find it...sort of. They found a charge mess of ashes burrowed into the ground in a forest, with a part of the tail sticking up out of the ground. It had dropped off a patient and was headed back to home base at the airport. There was a storm heading towards the area, the pilot was notified, but decided they could beat the storm. He gambled wrong. The pilot, a young nurse married with kids, and a paramedic, were all killed.

Wow, well that sounds awful... I was already turned off on the idea, but when the time comes to do a rotation and I am offered a ride, im still gonna take it

 

[Birdstrike]

Wow, well that sounds awful... I was already turned off on the idea, but when the time comes to do a rotation and I am offered a ride, im still gonna take it

The flip side is that most of the flights go safely, it can be a great learning experience and you may save some lives in the process.

 

[cyanide12345678]

Not to turn this into a helicopter debate, but helicopter crashes are nearly always due to bad decisions and I can’t think of a single incident where a second engine would have changed things..

Now, management pressure is another story and I agree there are far too many dead flight crews due to pressure to fly. I recently lost a friend when he and his crew accepted a flight which had been turned down by everyone else in the area due to weather..

Agreed, culture matters a lot. It's absolutely unacceptable for a crew to fly when several other crews have said no. The pilots I've flown with, the moment they heard that two others have turned down the flight, they would automatically turn it down.

The culture of 3 to go and one to say no existed within our organization as well. Which is probably one of the most important aspects.

Though don't discount the aircraft features. If crap weather hits, an aircraft with IFR does not require any visual clues and it can be flown solely with instruments. Cheaper helicopters don't have those features.

 

[thegenius]

The dirty secret about working on a helicopter is the majority of your patients are boring.. ER to ER with a stable STEMI. ER to ER with a stable stroke alert. Scene to ER with a “mechanism of injury”..

stable STEMI? 🤔

 

[Apollyon]

Agreed, culture matters a lot. It's absolutely unacceptable for a crew to fly when several other crews have said no. The pilots I've flown with, the moment they heard that two others have turned down the flight, they would automatically turn it down.

The culture of 3 to go and one to say no existed within our organization as well. Which is probably one of the most important aspects.

Yeah, that reminds me of something from a little over 20 years ago. Hunter with isolated leg injury, but in a very remote location. Mercy Flight declines, due to weather. Starflight declines, due to weather. Mercy Flight Central says, "We'll take it".

Yep. Pilot, patient, paramedic, all deceased.

 

[FiremedicMike]

stable STEMI? 🤔

I.e. 70 year old woman with generalized weakness for several days, slight elevation and a positive troponin, awake and alert, still only complains of being a little weaker than normal.

Cardiologist has the cath lab booked for later this afternoon.

Yes, I’ve had that flight.. numerous times..

 

[FiremedicMike]

Though don't discount the aircraft features. If crap weather hits, an aircraft with IFR does not require any visual clues and it can be flown solely with instruments. Cheaper helicopters don't have those features.

Totally agree about autopilot and glass cockpits, just never really bought the whole single engine arguments.

 

[alpinism]

stable STEMI? 🤔

Probably meant stable vital signs.

Believe it or not but most STEMI patients would actually survive without treatment. PCI is very effective but it only decreases 30 day mortality from about 15% to 5% depending on the study.

 

[BoardingDoc]

Though don't discount the aircraft features. If crap weather hits, an aircraft with IFR does not require any visual clues and it can be flown solely with instruments. Cheaper helicopters don't have those features.

Assuming that the pilot is instrument only certified, which many are not.

 

[Tenk]

Agreed, culture matters a lot. It's absolutely unacceptable for a crew to fly when several other crews have said no. The pilots I've flown with, the moment they heard that two others have turned down the flight, they would automatically turn it down.

The culture of 3 to go and one to say no existed within our organization as well. Which is probably one of the most important aspects.

Though don't discount the aircraft features. If crap weather hits, an aircraft with IFR does not require any visual clues and it can be flown solely with instruments. Cheaper helicopters don't have those features.

Yeah and the autopilot on those newer birds is insane. When I was doing flight in residency my pilot was like watch this and the bird circled around and flew straight down the entire runway just several yards in the air all on its own. **** was scarier than Six Flags or Cedar Point.

 

[NSLDX]

Haha I no doubt knew I would sound foolish one way or another but that's fine lol I am in fact speaking from no experience. That being said I have been volunteering at my local hospital twice a week in the ER and from what I see most patients are druggies, elderly, and illegals taking advantage of medicare for the simplest of reasons. As an ER physician, how deep do you get to go when it comes to actually touch and administer treatment with the patient? At what point does a surgeon take over? To me, it seems like they mostly talk with the patient briefly and then charts. I have shadowed a family medicine doc and the same seems to be true apart from let's say a wart or skin tag removal. My question to any of you would be, Would you go into EM again if you could start all over and why? (I am aware they work less than a surgeon has to which is nice)

Thanks for your thoughts!

You have a great attitude, keep that no matter what and I am sure you could find a job doing almost anything! It just might not pay super well...