Seeking Aerospace Mentorship

[KilgoreSnout]

Hey everyone,
I have prior military experience in aviation. I've sought some advice here and elsewhere but am approaching some tough decision points and would like some specific guidance if anyone's willing.

As I start to pursue medical school, I know I want to stay in the aviation community and become an (Air Force) flight surgeon. Beyond that, things get less clear as it seems to stovepipe pretty significantly between choosing a normal residency / Aerospace residency / Pilot Physician Program. Also some questions regarding USUHS vs other schools if I know I want to end up in aerospace.

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[DrMetal]

Hey everyone,
I have prior military experience in aviation. I've sought some advice here and elsewhere but am approaching some tough decision points and would like some specific guidance if anyone's willing.

As I start to pursue medical school, I know I want to stay in the aviation community and become an (Air Force) flight surgeon. Beyond that, things get less clear as it seems to stovepipe pretty significantly between choosing a normal residency / Aerospace residency / Pilot Physician Program. Also some questions regarding USUHS vs other schools if I know I want to end up in aerospace.

Here's some mentorship for you: If you want to become a physician, your intention should be do a normal residency first (IM, FM, GS, Peds, Obgyn, Rads). Aerospace medicine (or any other occupational form of medicine, Dive, Flight, etc) should be done secondarily. And it's not that complicated nor glamorous. Knowing the FAA's guidelines regarding blood pressure is not that hard; knowing which medications to use (and how to titrate) in order to satisfy those guidelines, that's harder (and that requires a normal primary care residency, IM or FM).

And having done a normal residency, you'll be more employable, both in and out of the military.

 

[KilgoreSnout]

@DrMetal Thanks for the reply, I enjoy reading your advice on here. Do you think there's any reason to avoid a combined program? The reason I am tempted to go straight into aerospace or a combined residency is that remaining competitive for astronaut corps applications requires some youth. Only doing one residency also leaves a couple years for an MS in engineering or biomedical science.

ASMA site: "However, the Air Force does offer a combined program in Family Practice and Aerospace Medicine. It should also be noted that the Air Force requires applicants to have completed at least 2 years as an Air Force flight surgeon as prerequisite to applying to the Residency in Aerospace Medicine.

 

[DrMetal]

@DrMetal Thanks for the reply, I enjoy reading your advice on here. Do you think there's any reason to avoid a combined program?

If it's a combined program that includes some kind of primary residency (IM, FM, Peds, etc), then yes, that's a great idea. Go nuts.

 

[DeadCactus]

It really depends what you want to do with your career and how sure you are.

If you are 100% sure you want to use the MD/DO as a medical foundation to spend your career in the administrative, research, and policy world of military aerospace medicine then USUHS to a combined IM/RAM or FM/RAM program to the pilot-physician world is a solid plan (though be ready for clinicians to **** on it). I would be very hesitant to complete only the RAM program; it only shaves off 1 year and drastically reduces your career options and credibility.

If you want to be a clinician who takes care of pilots sometimes and flies, then you're better off finishing a traditional residency +/- fellowship and getting your fill for aerospace medicine as a flight surgeon and probably even better off doing it through a Reserve component.

There is a broad spectrum of what aerospace medicine can look like depending on how much of your career you want to dedicate to it.

 

[Gastrapathy]

It is impossible to give advice about the right strategy to become an astronaut. You might want to read the biographies of recent astronaut physicians. I quickly found Kim, Morgan and Menon who are all emergency physicians.

 

[SirGecko]

Not an astronaut, just someone who has applied a couple of times and looked into this. I think most people associated with the astronaut corps will tell you it’s a fools errand to try to structure your career around the astronaut application. If you just look at the odds you have a better chance of being struck by lightning. If doing aerospace medicine admin is something you actually think will be fulfilling to you by all means do a combined residency, just don’t do it because you think the astronaut corps cares.

 

[Tenbusu]

Not an astronaut, just someone who has applied a couple of times and looked into this. I think most people associated with the astronaut corps will tell you it’s a fools errand to try to structure your career around the astronaut application. If you just look at the odds you have a better chance of being struck by lightning. If doing aerospace medicine admin is something you actually think will be fulfilling to you by all means do a combined residency, just don’t do it because you think the astronaut corps cares.

Not to mention who knows what will happen in the coming years with much astronautery (hopefully) shifting to the civilian side. I would think that devoting yourself to a challenging career like medicine (with FM/IM/ER res) and intellectual pursuits like engineering would be a good strategy, but you'll also have to be an interesting person (stories to tell) and good at networking. RAM is more for career AF Flight docs shooting for higher levels of Aerospace Med. Definitely checks the networking box, and a good career if you want to retire from the AF, but not the most challenging path.

Doing a combined residency may pigeon hole you into operational/aerospace med and make it hard to practice clinically to get all the experience you need to become a good doc. And any program that offers dual-anything in the same amount of time will probably sell one of the specialties short.

 

[KilgoreSnout]

Not to mention who knows what will happen in the coming years with much astronautery (hopefully) shifting to the civilian side. I would think that devoting yourself to a challenging career like medicine (with FM/IM/ER res) and intellectual pursuits like engineering would be a good strategy, but you'll also have to be an interesting person (stories to tell) and good at networking. RAM is more for career AF Flight docs shooting for higher levels of Aerospace Med. Definitely checks the networking box, and a good career if you want to retire from the AF, but not the most challenging path.

Doing a combined residency may pigeon hole you into operational/aerospace med and make it hard to practice clinically to get all the experience you need to become a good doc. And any program that offers dual-anything in the same amount of time will probably sell one of the specialties short.

Thank you guys for the responses. If I’m understanding you and @SirGecko correctly, it sounds like RAM (combined residency or RAM only) is going to result in a lot more board rooms and policy discussion and very little clinical experience?

I’m doing my best to not put the cart before the horse regarding astronaut stuff. I think my profile will fit the bill eventually, but I’m making my target to be a good flight surgeon with some years of patient care. From there applying to be a NASA flight surgeon, and applying to the astronaut corps until they tell me to stop.

 

[DeadCactus]

In general, the RAM makes sense for people who want to focus their career on aerospace medicine which typically means a lot of administrative and policy work +/- taking care of pilots. There are many physicians active in the realm of aviation and space medicine who are not RAM trained but they are generally in the research or consulting realm. If your goal is specifically to take care of astronauts, you'll want to complete an FM, EM, or IM residency and RAM program either in combination or in series.*

If I was a medical student today and certain I wanted to spend my career as a flight surgeon in the space industry, I would apply to UTMB's combined program.

* There are a number of space medicine fellowships that started this last year who knows if this will become an alternative or preferred training route.

 

[armytrainingsir]

I have an buddy who is a AF pilot physician. He is ER doc as well. And 0-2 for astronaut selection
Funny, I had a similar discussion with him recently and pertinent points from that.

Aerospace med guys are medical policy and physiology research oriented.
Pilot-physician guys are more operational SME when medicine and aviation collide in the field. For example when the AF had a recent human problem in the cockpit of the F35, they sought a PP to help solve it, not the aerospace guys.

His stories about the astronaut application were fun to hear. Basically, you are in a room of a few dozen superstars from varied corners of aviation. No one knows what NASA wants any particular year. Successful guys have been candidates multiple times. It is the ultimate right place at the right time lottery. But even being an astronaut doesnt mean you will ever fly in space. Now more than ever as Elon's SpaceX and BlueBezos are leading the way to space.

Personally, I think if someone has a desire to be both a physician and in aviation, I would suggest MD>AF PP>ER>possible aerospace, possible astronaut. You get to fly, you get board cert in the perfect part time specialty, can moonlight to keep skills up (buddy told me the AF is allowing or in the process of allowing, 4 days per month of moonlighting with something like little/no command approval needed), and have a post mil career path to a decent living. Or, if staying 30, or you like the admin side of things, adding aerospace gets you into command/policy circles as well.

IMO, USELESS, aka USUHS, impresses career mil types and folk that drink the milmed Koolaid 10x more than normal physicians. Its just another med school IMO.

Your career aspirations are not for everyone, but certainly are a path to a legit, interesting and rare career.

Good luck.

 

[DrMetal]

Personally, I think if someone has a desire to be both a physician and in aviation,

Let's take it a step further: If you're interested in medicine, go become a regular doctor. Apply what you know to aviation.

"Aviation Aerospace super-duper medicine" need not exist as a specialty. Nor should "Dive" medicine. What next? "Railroad" medicine, "Industrial Lithium battery exposure" medicine???

If you're interested in the cardiovascular / pulmonary effects that these occupations may have on a patient, go become a cardiologist or pulmonary physician. Interested in the psychiatric or neurological effects? go become a psychiatrist or a neurologist.

 

[backrow]

IMO, USELESS, aka USUHS,
.

Really?

 

[MillertimeUSNA]

Really?

Second. While to his point USU may put out more mil-career oriented physicians who then pursue RAM or the pilot/physician program, this factoid has more to do with USUs student cohort being a higher percentage of prior military as well as likely more gung-ho about mil-related things in general.

All of that has nothing to do with the quality of USU or its graduates. I, and I am sure may others on this forum would appreciate avoiding careless and nonspecific slandering of any particular university unless you have SPECIFIC things you wish to address. Which can be brought up in your own thread, thank you.

 

[armytrainingsir]

lol. Hit a nerve with USELESS it seems.

Seriously, have y’all never heard it referred to as that ?

 

[backrow]

Seriously, have y’all never heard it referred to as that ?

Yes, I’ve heard it before and anytime I hear it I call it out because it serves no purpose.

You can even go through my post history on here and see where I called it out several years ago as well.

 

[Atlas Shrugged]

I’ll echo the sentiment. USUHS is one of the shining gems of military medicine. There’s a lot to complain about, but it isn’t one comparatively.

 

[KilgoreSnout]

@SirGecko @DeadCactus @Atlas Shrugged 6 months later, now with my med school applications all prepped and ready to go. If I'm interested in aerospace/ operational medicine, what are your thoughts on USU vs. a top civilian program? In a way, it seems silly to go without pay at a civilian school for 4 years, just to end up back on active duty down the road if that's the best way to be an operational doc/ pilot physician.

I'm still under initial obligation with the reserves, so there's some fear I won't even be able to get command release into USU, but I could theoretically do civilian med school while maintaining my one weekend a month, graduating without any active commitment. I know of at least one guy who is unofficially a pilot physician for his unit the reserves currently. My fear with being a reserve doc is that my mil opportunities will always be second rate when compared to active duty units. E.g. waiting years to get to flight surgeon training, less chance to go TDY for trainings. Not sure if this fear is valid.

While I'm not banking on being an astronaut, it's interesting to me that LCDR Jonny Kim (and presumably plenty of other mil docs) chose to go to the big name school instead of USU, sacrificing a pretty clear-cut path as a mil physician and a lot of financial comfort while in school+residency. I understand these are all personal decisions but they're interesting to me nonetheless since so I so often here that almost all MD degrees are treated equally, especially in the military

 

[militaryPHYS]

It will be a lot of paperwork, but most prior service obligations allow for conditional release if you are accepted to USUHS. I was Navy enlisted reserve (prior USMC enlisted reserve) before accepting a Navy USUHS direct commission. My previous contract went bye-bye because USUHS commitment will trump anything you previously had (except Academy time). Can be trickier with prior service obligations from another branch and/or minimally manned jobs.

The reason to pick USUHS is if you plan to be in the Military for another decade and a half anyway. If after medical school you still want to pursue flight/operational/space etc. you would apply and hope to get accepted. If there is a more direct pathway to your final destination I would take it. Just remember, around 75% of medical students change their choice of specialty by the time they apply for residency. A lot of unknowns so stick with what you can control now.

Also, shout-out to @Atlas Shrugged @backrow and @MillertimeUSNA for pushing back on the USUHS slander. Not sure how I missed this thread. USUHS is an incredible asset that MilMed retains and its ability to expose future MilMed docs to the environment they will be facing in the future (good or bad) is invaluable.

 

[SirGecko]

USUHS is a great school. I doubt that location of medical school (unless it’s like a Caribbean school or something) would be the make or break astronaut selection, so I would not base your life decisions on that. I think I may have said this already in this thread before but the chances of getting selected as an astronaut are really small no matter how qualified you are. Don’t base you life around such an astronomically (hah) small chance. It might be your plan A but you are almost guaranteed to go with plan B or C or D (etc) so make sure you are happy with what those look like.

The difference of seven vs four years payback is significant even if you know you are going to be in the military for 20 years so make sure you take that into account. You don’t actually know how life will change your goals but barring that you can’t sign a retention bonus till you’ve paid off your education obligation. (So that could be a difference of 30-100k per year later depending on specialty) That said the pay during med school can be a significant boon as well depending on your situation.

 

[KilgoreSnout]

@SirGecko I agree. I'll just be happy to combine aviation and medicine wherever I go. Anything after that will be gravy.

I appreciate your point on some of the money "lost" from not going to USU can come back in the form of retention bonuses. Hadn't thought much about that. I could also imagine a scenario wherein HPSP keeps me on active duty for a good mil residency + just long enough to get the training and experiences I desire, and then allows me to transfer to the reserves 3 years earlier. As always, I really appreciate having folks on here give me new perspectives!

 

[DeadCactus]

To me USUHS makes sense for people committed to a military career who don't have super specific career goals. They want to do their 20, they want to do some cool stuff, but they can roll with a 3 year command tour in Minot if that's what gets thrown at them.

People who really have a specific thing they are trying to get out of the military are probably better off with HPSP so they can bail if it's not working out.

People who have really specific professional goals that can be met outside of the military or who just want to get to serve and do some military things are best off in the Reserve or Guard.

For what it's worth, my experience with the Guard has been that my opportunity to go to trainings, deployments, TDY's, etc is limited more by the time I can take away from professional and family obligations than by the opportunities available. The Guard and Reserve experience are highly branch and unit dependent though, so I'm sure other people have the opposite experience.

Edit: Something I try to push back against is the premed idea that you have to join the military to get cool opportunities when the reality is a civilian career is often a more direct and guaranteed route those goals. There are 100% things you can really only do in the military but the freedom and significantly higher income of civilian practice open up a lot of opportunities. The question for you is if the military aspect of your goal is so important it's worth the risk and loss of control that comes with a military obligation. This means spending a lot of time reflecting on what your real goal is at a granular level and what the most important aspects of it are.

 

[DrMetal]

People who have really specific professional goals that can be met outside of the military or who just want to get to serve and do some military things are best off in the Reserve or Guard.

The more time I spent in the AD MC, the more I'm convince that most of us should be reservists. And the MC should be a predominant reserve corps. There's just enough work for all of us to do on active duty.
[Of course, some would claim to be aghast at hearing me say that . . . I would challenge them to define 'busy'. Seeing 8 patients a day is hardly 'busy' by civilian standards. And mindless emails and Teams meetings don't count.]

And when you're looking towards 'civilian partnerships' to maintain your skills, you're clearly not that well employed on active duty.

 

[DeadCactus]

The more time I spent in the AD MC, the more I'm convince that most of us should be reservists. And the MC should be a predominant reserve corps. There's just enough work for all of us to do on active duty.
[Of course, some would claim to be aghast at hearing me say that . . . I would challenge them to define 'busy'. Seeing 8 patients a day is hardly 'busy' by civilian standards. And mindless emails and Teams meetings don't count.]

And when you're looking towards 'civilian partnerships' to maintain your skills, you're clearly not that well employed on active duty.

It sounds like military medicine was great when it still did retirement and dependent care. My understanding is we pulled those out and doomed military medicine because it was politically favorable to spend that money under the VA's name instead of as part of the "military budget". But I agree, in the current system a large reserve component makes a lot more sense.

 

[armytrainingsir]

It sounds like military medicine was great when it still did retirement and dependent care.

Trust me. I was there. It really was great.

 

[Gastrapathy]

@DeadCactus not the VA budget, Medicare.