DECEMBER 24, 2012
Surgeons are not pilots

I am sick of hearing that surgeons can be compared to pilots. Yes, there are some similarities and some things can be learned from the aviation industry. For example, I am a big fan of checklists, having used them in both the operating room and intensive care settings. Both a GS and an FP will have occasion to multitask and both need to have what is termed “situational awareness” or an understanding of where he is and what is going on around him. But let’s look at some of the differences between specifically, general surgeons (GS) and fighter pilots (FP).

The training of surgeons and pilots is remarkably different. This table illustrates some of the differences.

Total hours of training for a GS after medical school can be broken down as follows. Five years of residency training at 80 hours/week equals 20,800 hours. Allowing for 6 hours of sleep/night (Ha!) over five years would reduce the actual training time to 15,600 hours of which some 2000 hours would be spent in the operating room (about 1000 cases performed by the average graduating chief resident at about 2 hours/case).

Total hours of training for an FP entering the US Air Force are as follows. (Note: data are from a paper by a USAF colonel who is also a surgeon.) Once accepted to flight school, the neophyte first takes 50 hours of civilian flight training and becomes certified as a private pilot. Then he goes to Phase I or preflight training which apparently involves ground training, survival, navigation etc and no actual flying. Phase II is six months of flight training with 90 hours of flight time in a jet trainer. Phase III is another 6 months of training with 120 hours of flying in the aircraft to which they have been assigned. The entire package takes about two years at let’s say 10 hours per day or 5200 hours (50 hours/week x 52 weeks x 2years) of which some 260 hours is actually spent in the air.

To illustrate this point more clearly, someone once said, “I know a lot of doctors who became recreational pilots, but I don’t know one pilot who became a recreational doctor.”

If what Malcolm Gladwell says is true that one needs to spend 10,000 hours at a task before one can be considered an “expert”, I leave it to you to decide whether surgeons and pilots are experts.

Some thoughts on this from surgeons in the UK:

“If a pilot were to undertake all the roles required by a consultant surgeon, he/she would interview separately every potential passenger for every flight that he/she was responsible for. He would then have to determine for each passenger the optimum way of reaching their destination; it may well be that rail, road or sea travel would be better for that particular individual than air travel. [T]he captain would need to obtain informed consent from every passenger to ensure that they understood what flying involved, including the risk of infection in aircraft, the risks related to the type of ventilation being used for that particular flight, the risks of deep vein thrombosis and pulmonary embolism, the risks of a major air disaster, the risks of air turbulence, etc.” It goes on.

“When was the last time you talked to your pilot? Please let the analogy end.”

Coming soon: “Patients Are Not Airplanes”

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at and tweeting as @SkepticScalpel. His blog averages 800 page views per day, and he has over 4200 followers on Twitter.

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