I have been thoroughly blessed to serve as an active member of the USAF Pilot Physician Program (PPP) officially since 2008 but unofficially since 2002, when I entered pilot training as a “former flight surgeon”. Although the USAF Pilot Physician Program was officially created in 1954, the legacy of medical professionals serving as pilots dates back to the earliest days in aviation.
HISTORY OF THE USAF PILOT-PHYSICIAN PROGRAM
Physicians were intimately involved with aviation from the earliest days of lighter-than-air balloon flight. An American physician, John Jeffries, was on a maiden voyage in a hot-air balloon accompanied by a French balloonist on November 13, 1784. Although he had loyalties to the British during the American Revolution, he made history as the first air mail carrier by dropping a note to a friend while aloft. Later, an Italian medical officer, Lieutenant Luigi Falchi, was the first known military pilot-physician of heavier-than-air aircraft. In 1911 he participated in an expedition against Libya acting primarily as a pilot and was awarded the Bronze Medal of Military Valor. Falchi’s medical activities are vague, but some aeromedical descriptions from this time period such as “fainting in the air” (perhaps an early description of G-induced Loss of Consciousness – GLOC), and aviator “staleness” have occasionally been attributed to him.
In World War I, Major (Dr.) Ralph N. Greene, a neuropsychiatrist from Florida, was the first US Army medical officer known to receive orders as a military aviator. He served on the Mexican border as part of the Third Aero Squadron. Although he was the first, others followed. After WWI, most of these physician aviators returned to private medical practice, but on 25 April 1919, the Army Surgeon General (SG) published a letter requesting that medical officers serve as flight surgeons with an opportunity to become pilots. This was the first documented instance of an official military order for personnel to serve as both pilot and doctor. It is considered by some the origin of the Pilot-Physician (PP). Two of the earliest PP’s, Captain Charles V. Hart and Captain Alexander Mileau, were trained and then stationed at Brooks Field in Texas. The earliest PP’s were doctor-aviators motivated only by their desire to fly rather than by compensation or medical credentials. It has been my experience that modern pilot-physicians are similarly motivated purely for their love for flight.
From the conclusion of WWI to the onset of World War II, flight surgeons also trained as pilots became rarer and nearly ceased entirely as the war’s demand for combat aviators increased. Physicians, who wished to serve as pilots, had to resign from the medical corps and become strictly line officers.
There is a general consensus that the father of the modern USAF Pilot-Physician Program is Dr. Harry G. Armstrong, who became the USAF Surgeon General in 1949. As early as 1946, he considered returning physicians to the cockpits in order to fully appreciate the associated physiologic risks and problems of flight. As aircraft improved in maneuverability and performance, Dr. Armstrong decided to train several physicians as pilots to help solve physiological and psychological problems associated with advances in aviation technology. In 2010 my unique skill-set was used just as Armstrong had intended when I was tasked to become the first F-22 Raptor pilot-physician in order to find the aeromedical cause for a rash of physiological episodes plaguing many pilots flying the new stealth aircraft.
During his career, Dr. Armstrong continued to oversee the program personally, sending qualified flight surgeons to pilot training with cooperation from the USAF Director of Operations. Years later in 1954, the program was formalized by regulation, which authorized 25 positions for PP’s, and delegated authority and assignment management to the USAF Surgeon General. From 1954 to roughly 1964, qualified applicants were primarily WWII pilots who later went to medical school and then came back to service for dual qualification. Because participants were older than their peers, Air Staff began allocating two pilot training slots to qualified and highly motivated flight surgeons in 1964. Our current program revitalized this concept in 2011 and graduated the first flight surgeon from undergraduate flying training (UFT), Captain (Dr.) William Smith, in November 2014. This tradition of sending flight surgeons through UFT (sometimes known as UPT) continues today and is a vital part of the program.
The current USAF Surgeon General, Lieutenant General Thomas Travis, is the most senior ranking pilot-physician on active duty. In total, there are currently 14 of us (many of these exceptional pilot-physicians’ photos and short biographies are featured throughout this article below) representing the spectrum of the aircraft operated by the USAF. Being a member of the USAF Pilot-Physician Program has been an absolute pleasure, and having the opportunity to fly in high performance military fighter aircraft has never seemed like work to me!
FLIGHT SURGEON TO STUDENT PILOT
My personal journey to the Pilot Physician Program was somewhat atypical. I entered the US Air Force to pay for medical school with no previous exposure to USAF aircraft. I started as a pediatric resident at Keesler AFB in Mississippi, but realized during internship that I didn’t want to commit my entire career to pediatrics. I took the advice of a friend of mine and joined him in becoming a flight surgeon, not really knowing what that exactly entailed. The following summer I began my journey into aviation medicine with the USAF flight surgeon training called Aerospace Medicine Primary Course (AMP) at Brooks AFB, TX (in 2011, AMP and the USAF School of Aerospace Medicine moved to Wright Patt AFB in Dayton, OH where it currently resides).
During AMP, we experienced one incentive sortie in a T-37 Tweet trhttps://www.aangfs.com/wp-content/uploads/2012/10/AFI11-405-Pilot-Physician-Program.pdfainer aircraft and I can honestly say, I was 100% hooked. I loved every bit of it and from that point on began a quest to see if flight docs could fly from the “front seat”. My research led me to discover the PPP and I called the program director at the time to learn how I could get my pilot wings. He said the typical route was for pilots who had gone to medical school to reenter service to become dual-qualified. He also shared that no one had gone the “opposite” direction in recent times. Although I continued service as a flight surgeon, I kept in frequent contact with the director.
During my second assignment as a flight doc, I learned from the same director that another flight surgeon had applied for, and was accepted to the active duty pilot training board. The veil had been lifted and I intended to follow suit. I applied to become a pilot during my third year as a flight surgeon. Age requirements had increased to 30 years old, and I had celebrated my 30th birthday 6 months prior to the application deadlines. Hey, why not apply for an age waiver? That’s what I did…and my waiver was approved. I started pilot training in class 03-07 at Moody AFB, GA, in the new T-6 Texan II trainer. What a great airplane!
At that time, I was forced to officially resign from the medical corps and “swore” in as a line of the Air Force (LAF) officer. Because of the transfer from the medical corps to the LAF, my date of rank changed from a 1997 Captain to a 2001 Captain. Despite the four-year loss of rank, I was incredibly excited to start pilot training. Like many of my classmates in pilot training, I wanted to get matched to a fighter jet. Unlike many of them, however, I refused to accept anything else and worked my butt off! In fact, I went to pilot training with a singular goal in mind – the premium air-to-air fighter aircraft, the F-15C Eagle! My persistence and efforts paid off as I earned a transition to the T-38A Talon trainer and was destined for the ‘fighter track’. Following the T-38 transition, I was fortunate to earn the only F-15C slot in my pilot training class. After graduation and officially earning my pilot wings, I headed off to learn basic fighter skills in the Introduction to Fighter Fundamentals (IFF) course flying the T-38C. All throughout training I maintained contact with the PP program director. I made it clear that doing both was my ultimate goal. Now the real fun began!
The courses for young USAF pilots who are learning to fly their specific airframes is called the Basic-course, “B-course” for short. Tyndall AFB in Panama City, Florida was the schoolhouse location for active duty Eagle driver training and what a special location it remains to this day. The white sugar sand beaches and crystal clear emerald coast waters were a perfect place to learn to fly the “mighty-mighty” as the F-15C is affectionately known by Eagle drivers. Again, fortune smiled on me when I was told my first operational assignment as an F-15C pilot would be at Royal Air Force (RAF) Base Lakenheath in England. And so May 2004 was the beginning of my fighter pilot career – an incredible European adventure with some of the best flying in the world.
WHY NOT BOTH? – AVIATION AND MEDICINE
During my time at Lakenheath I started to explore options to combine medicine with aviation, even though I was not yet an official PP. I made an appointment with the chief of staff of the hospital and we discussed options to get re-credentialed in flight medicine, as I hadn’t practiced medicine in over 18 months. My USAF career specialty code defining me as a flight surgeon still remained on my record so I was able to work with the flight medicine flight commander to develop a “phased-in” credentialing program while remaining fully mission capable as an F-15C Eagle driver. In the squadron, I maintained normal duties such as scheduler, life support officer, and later, even served as flight commander. I could tell right away that having medical credentials was going to be a huge benefit to my fellow squadron mates as time would present itself for frequent “consults” while walking the squadron halls or completing my additional duties.
During deployments or temporary duty tours (TDY), I officially maintained “pilot” status, but I was able to perform both duties when time permitted. This was especially valuable when the squadron was unable to take our normally assigned flight surgeon. This is just one of the benefits of being a dual-qualified asset. My contact with the PP program director proved invaluable and he recommended I start filling out the application as required by the official regulation defining the USAF Pilot Physician Program (Air Force Instruction 11-405).
Following this memorable time in England, I returned to the United States. I was assigned to the 434th Fighter Training Squadron as as an instructor pilot flying the T-38CIFF for the Introduction to Fighter Fundamentals (IFF) course. Being an instructor pilot was the highlight of my aviation career to date. It is truly rewarding to see the proverbial “light-bulb” illuminate in a young fighter pilot’s mind when he/she comprehends a concept you’re trying to teach. And it was even better to see student pilots implement the lessons as instructed! That is a rare opportunity. During the time at IFF, I maintained frequent contact with the PP program director and in December 2008, I finally completed the formal application process to transition back to the medical corps and attain the AF specialty code (AFSC) for a USAF Pilot-Physician, 48Vx. The whole process from start to finish took 6 full years!
THE UNIQUE VALUE OF THE PILOT-PHYSICIAN
It was during the time I was an IFF Instructor Pilot that the newest fighter in the USAF, the fifth-generation stealth F-22 Raptor, began reporting abnormal physiological events initially described as hypoxia (described more fully in another post here). Every aircraft, including commercial airliners, are at risk of exposing passengers and aircrew to hypoxia. However, the high number of events recently reported in the Raptor, combined with notable differences in tactics and employment of the airframe, made these reports extraordinary and highly concerning. This troubling trend encouraged the PPP director to facilitate an opportunity to send me back to Tyndall in 2009 with the prospects of getting a PP qualified in the F-22. This was the first single seat aircraft that lacked an aeromedical professional with first-hand knowledge of flying the aircraft. I entered the F-22 transition course in December 2010 (following a non-flying deployment) and in May 2011, the entire fleet of F-22’s was indefinitely grounded. That is when my “real work” started.
Tactically, the F-22 is a truly unique airframe and unlike legacy (4th generation fighters like the F-15, F-16, F-18) platforms in a number of important ways. And by design, the life support system is also unlike any other fighter aircraft. This brings me to another strength that the PP brings to the U.S. Department of Defense. We have the innate ability to truly speak “both languages”. Through military aviation training we can speak “tactically and mechanically” and through our clinical training, we are able to speak “medically”.
We are able to define and articulate the human factors and perceived biological sensations that result from interpreting aircraft sensor manipulation, weapons selection, and real-time hands-on-throttle and stick (HOTAS) management during “tape” review as well as during personal interviews with pilots that had experienced physiologic symptoms. In other words, I was able to evaluate the tactical decisions made during missions when pilots reported symptoms and then associate them with attributable human factors and/or perceived biological changes. Being able to bridge the two disciplines is truly one of our greatest assets to the individual flying squadron and the entire USAF.
During my investigation into the hypoxia-like events plaguing the F-22, I was able to distinguish and translate physical symptoms that I personally experienced from flying the aircraft into a hybrid medical language understood both by the medical professionals and aircraft operators. This allowed the distinctive ability to communicate this critical message to the entire F-22 fleet, the aeromedical community, some of the highest ranking USAF leaders, and concerned civilian legislators in the U.S. Congress. Congress had become keenly interested in the investigation that had culminated in a four-month grounding of one of the most expensive U.S. military assets and the world’s premier tactical fighter. For the full story for the cause of the F-22’s hypoxia like events, see here.
In addition to speaking both languages, pilot-physicians offer a unique perspective in the man-machine interface during development of aviation equipment and supplies. In fact, the full coverage anti-G suit, known as ATAGS, (For more info on Pulling G’s and how the Anti-G Strain Maneuver works, see previous posts) worn in the Raptor and other legacy aircraft was developed with the help of a very successful pilot-physician – current USAF Surgeon General Lt Gen Thomas Travis. PP’s were also integral to the development of the F-35 helmet mounted display system and aircrew ensemble (fight suit). Lastly, PP’s have been extremely active in developing aeromedical standards for USAF service requirements.
Finally, and in my opinion, most importantly, pilot-physicians provide the squadron with a trusted medical agent that has walked the same walk, completely understands the mission, and knows the importance of getting back in the air. What I believe the most difficult hurdle of our program to overcome, however, is explaining to line Air Force commanders that we truly can support whatever they need for their unit in the traditional role as a pilot. If they need an instructor pilot that can also perform Assistant Director of Operations (ADO) roles, we can do that. If they need a squadron or wing flight safety officer, we are perfectly suited. If they need a “SNACKO” we are even happy to clean the bar and stock the eats! We can fill any unit function that our peers are occupying while at the same time offer a unique skill-set not found in the standard squadron flyer. This is not a detriment, but a force multiplier. Even so, it still seems foreign and seemingly “impossible” to most flying unit commanders despite the fact that we’ve been doing it that way since before WWII. Once this concept is understood, our program will flourish particularly in the single-seat community.
Our biggest limiting factor currently is maintaining a large number of strong applicants for the USAF Pilot Physician Program – We NEED YOU!
PILOT PHYSICIAN HOPEFUL, CAPT ANDREW PELLEGRIN, ON THE PPP
I would like to credit Major (Dr.) Thomas Koritz, an F-15E Strike Eagle Pilot-Physician for much of the information recited in the historical recounts of the Pilot Physician Program above. He authored a paper for the USAF School of Aerospace Medicine in July 1989, titled USAF Pilot/Physician Program: History, Current Program, and Proposals For The Future. Dr. Koritz is the only PP in modern times to have given the ultimate sacrifice in service to his nation when his aircraft was shot down on the second night of the first Gulf War, January 17, 1991. It is with great reverence that I say, “Thanks Dr. Koritz!”
Maj Koritz was survived by his son, 2nd Lt. Jon Koritz, who followed in his father’s footsteps and graduated from Undergraduate Pilot Training in Aug 2013.
- Authored by Jay Flottmann and edited by Rocky Jedick of GoFlightMedicine.