Evolution of Medical and Flying Careers

A lot has changed over the past 50 years in both professions.

View out of airplane window
Grandson Clemens contemplates careers while gazing out of a Cessna CJ1.Dick Karl

A lot has happened to the two greatest careers imaginable (to me) since I fell in love with each of them. When I started medical school 53 years ago with the intent of becoming a surgeon, such a career promised interesting work, a middle-class income and a respected role in society. When I got certificate number 1782747 some 52 years ago, aviation was in a heady period of expansion. Though I wasn’t on track for an ­airline career, I remember Pan American World Airways coming to our undergraduate ­campus a few years earlier to recruit young (mostly) men to become pilots. Some of the applicants had never been in an airplane. By the time I got out of medical school, some of my college classmates were flying Boeing 707s around the globe.

These two great vocational romances have given shape to my life, and their ­similarities are not difficult to trace. I’ve had an abiding interest in both professions for years—the first piece published in this magazine under my name 21 years ago was about how the two seemed so alike. There’s the ground school and medical school, the initial flight training and surgical residency, and the first solo in both. Both ­professions require a certain modicum of industriousness, persistence and delayed satisfaction. Both call for technical knowledge, skill gained by repetition and a sense of confidence to be successful. Both have had a wild and unpredictable ride.

When I entered medical school in 1966, my classmates were mostly altruistic young college graduates with plans to help the poor by becoming family physicians in Harlem. By the time we graduated, many had set their sights on becoming dermatologists in Beverly Hills. Money had crept into the calculation. Soon we would be contemplating medical specialties that had unfathomable incomes.

Aviation changed too. The cyclical nature of the airline business gave pilots a career marked by furloughs, bankruptcies and lost retirement funds. Most of my friends and acquaintances in aviation have suffered more than one major setback. These days, pay is up and contracts are improved. Nonetheless, the thrill of international ­nonstop jet travel is necessarily diminished for the 56-year-old pilot when faced with five ­Miami-to-Madrid round trips this month—especially since she’s still a first officer.

The predictable and (hopefully) routine nature of airline flying has led to a ­certain sense of ennui. If it is Tuesday, this must be Tulsa, as the great aviation writer and Braniff captain Len Morgan once wrote. Most of my airline friends have a hard time remembering the thrill of takeoff or the edge-of-your-seat sense of wonder when the runway appears after an ILS to minimums. As the head of training at Southwest Airlines said to me when I had flown the head-up-display-equipped 737 simulator to a ridiculously low RVR, “Even the [kids] in scheduling can do this.”

Medicine has had an even more spirit-sapping effect on its practitioners. Electronic health care records, touted as a great way to collect data, save lives and send bills, have added hours of mind-addling clerical work to most everyone’s day. Most medical journals have multiple articles about burnout, depression, suicide and early retirement.

Yes, there are similarities, but in other ways there have been different trajectories for these two careers. They did diverge when it came to safety. When I was young, airline midair collisions, controlled flight into terrain, even running out of gas, were occasionally the lead stories on the evening news. Now fatalities are so rare—with the recent exception of the Boeing Max issues—that the only way to improve safety is to study near disasters via the NASA aviation safety reporting system.

Medical error is now the third most common cause of death in hospitals. Wrong-site surgery (even wrong-patient surgery), drug mistakes and hospital-­acquired infections have been resistant to the many committees and seminars devoted to improving things. There has been a reluctance to adopt proven aviation tools; they are dismissed as irrelevant. As one health care consultant told me, “That business of us killing a 747’s worth of people each week is tiresome and old hat—it doesn’t mean anything.”

There are no physical examinations required of doctors. Checklists are often mistaken for to-do lists and are usually executed by one person (without the benefit of challenge and response), if used at all. I never had a checkride in the operating room. Individuals, not systems, are blamed for mistakes. Errors are punished with monetary penalties and shame rather than mined for explanation and improvement.

Knowing personally how devastating it is to harm a patient by a mistake and having never met a caregiver who got up in the morning with the intent of doing so, I have to conclude that our current health care system contributes to the exhaustion of our doctors and nurses because it is so chaotic, unsafe and money-driven.

The social structure is different in these two careers. The quality of life for an airline pilot has a lot to do with the aviator’s seniority and the strength of their union. Surgeons don’t unionize, tend to be competitive and mostly aren’t as social with fellow surgeons as pilots are with one another. The reasons are obvious. A surgeon may spend 10 minutes talking to a fellow surgeon at the scrub sink complaining about the management, whereas two pilots can complain for eight hours straight as they sit inches from each other. Surgeons don’t go on overnights. The seniority system in airline flying removes a lot of politics. Pilots tend to be more fun in my experience.

So, then, why would anybody ever want to be a surgeon or a pilot? Luckily there is a cadre of young people willing to vault the considerable barriers of entry into both worlds.

Medical students today are not naive. They understand the time and effort, the missed Little League games, and reheated dinners that await them. But they also marvel at the precise talent that can grasp a scalpel and propose to set right what nature has allowed to go wrong. If they are truly built for this world, they will be equally buoyed by the faith that patients will place in them.

Those clamoring for entry-level ­aviation jobs are equally aware of what may lie ahead. The effort and cost to get an ATP rating and accrue the required hours are not lost on them. There may be a pilot shortage now, but there was demand before and it evaporated. Today’s beginners are well aware of this history.

I guess they too are driven by the ­majesty of an early morning takeoff, when you burst out on top into blinding sunlight and set course for a destination thousands of miles away with the absolute conviction that this seat, right here, is where you are ­supposed to be.