@BigRhinoGuy your original post clearly demonstrates that you have done your homework and put a lot of thought into this. Way more than I did at your stage as my only goal was to be a fighter pilot. I’m sorry it took so long to write this, but it was a full day which included academics, a couple of flights and followed up by family time.
I will admit that people frequently ask me if I am going for astronaut. What you need to understand, with your ultimate goal of being an astronaut, is that as a physician pilot you would be hired as a mission specialist and not a pilot.
The reason is two fold: 1) We don’t “fly” anything in space right now and 2) Even if we did fly something, you are likely not a current test pilot type guy so you are more valuable as a doc on long space flight missions (moon base set up, Mars, etc).
The background as a fighter pilot shows NASA that you can handle intense situations that aren’t just medically related and increases your value to a mission as you can do other things too.
The status of the Air Force Pilot Physician program is more robust than they Navy Aeromedical Dual Designator (AMDD) one. They have multiple spots each year to put physicians through flight school. They are not filling those spots for a variety of reasons. The Navy has not put a physician though pilot training for over 15 years now I think. They did put an Aerospace Experimental Psychologist through recently. There is growing desire to rectify this, but desire does not equal reality.
@Gastrapathy is correct, if you want to do both at once then your options limit you to Aerospace Medicine, Family Medicine and Emergency Medicine; maybe Internal Medicine too. Coincidentally those would also be the most desirable specialties for an astronaut physician. So you kind of limit yourself in medicine with the goal of astronaut anyway.
You don’t NEED to be doing both at the same time. I’m not even sure it would help, but I don’t think it would hurt. This allows for options 1 and 2a pretty easily. But as you pointed out, you go to medical school in your mid 30s like I did, but others did as well. If you want to stay flying in the mil then it works with option 2b as well.
The problem with doing medicine first and then doing flight training is the break in medicine. The pathway is generally taking an internship only trained flight doc with one tour and putting them through flight school. But you don’t know how well they will do. Will they even make it through or attrite? Will they be good enough for the platform the program wants them to be in? There are targeted goals, usually, so if a doc doesn’t get the goal platform, they just may have wasted a couple of years where that doc could have been in residency or in another flight doc tour. It isn’t a bad concept, but it isn’t perfect. Even if you make it through training and earn your wings you are now going to do a full tour out of medicine as a pilot. By the time you finish that you are close to 7 years out of internship and about five out of practicing medicine all together. Meanwhile, you still need a residency. EM is a no go as you can’t be out of training for more than 36 months or you have to repeat internship. So this further limits your options. Again, not the end of the world, but something you need to understand. If you were to choose a specialty other than the ones I mentioned then your have essentially made yourself a hospital doc. It just won’t work; you just pretty much ended being a pilot physician. And then why did you bother with the flight training?
The problem with doing it the option 1 or 2 way, which is how I did it, is that you can’t get out of your aviation contract to go to medical school. They own you. So most guys who do this just give up the flying and go be a regular type of doc. I know orthopods, anesthesia, neurology, family, etc. Some did fly while as a flight doc, but none since residency except the family guy. The rest haven’t flown since they went to medical school. I am proof, along with my FM friend (we actually did flight school together), but you have to want to make it happen and carve out opportunities for yourself. The Air Force Pilot Physician program is trying to get it set up so pilots can go to medical school after their first tour and roll the remainder of their aviation contract into the medical service. But cleaning up prereqs and taking the MCAT while a front line aviator is going to be very hard, never mind making interviews and such during the 1.5 year long process that is medical school application.
I will say that the respective schools in Aerospace Medicine do frequently have sub specialists and surgeons on staff so that is a way to stay active with aviation, get flight doc flight time, but you won’t likely be acting as a pilot as well. You can make the jump to NASA on that path, but more as a ground doc and less likely as an astronaut.
Logistically your option 3 would be incredibly difficult. I won’t say impossible because I hate being a naysayer, but it probably is.
If you want to go to medical school first then do it via the Air Force (I’m vomiting while typing this) because their program is more robust to get docs into flight training. But my recommendation is to be a pilot first then be ready to go to medical school as soon as your contract is up. Try to be a test pilot in the military as it will probably look better for the astronaut application later and definitely would play well with the pilot physician or AMDD programs if you choose to be a doc in the military.
Being a fighter pilot is more of a young man’s game. You can do it well as you age, but you need to stay healthy and fit. The other thing to understand is that if you are doing both at the same time, you can’t be a front line fighter and a doc at the same time. The level of time necessary to do both at the proper level just isn’t there. But if you do pilot first, you can leverage your past experience as a pilot to do the dual role as a more basic instructor, adversary, specialty test, transport, and the like because they are more “simple” forms of flying compared to what a front line fighter needs to be doing and studying on a daily basis.
As for
@pgg ’s comments, that is the subject of an entirely different conversation.
I do think there is value to the military with pilot physicians, but it is limited and niche. We don’t need hundreds for sure.