Flying Physicians

Part I

The idea for the last series of articles on high altitude sickness popped into my head after a conversation in the surgeons’ lounge with a couple of other doctor-pilots.

Another popular topic that always seems to come up during these chats is that age-old question of whether doctors are dangerous pilots. The urban legend that docs are bad pilots dates back over 50 years to September 1966 when the FAA released a report authored by Stanley Mohler (who was himself a physician and the FAA Chief of Aviation Medicine) entitled “Physician Flight Accidents.” The report detailed a run of 30 physician fatalities from 1964 to 1965 and documented that doctors were four times more likely to kill themselves in GA aircraft crashes than the general pilot population. Mohler examined the circumstances of each incident and, not surprisingly, found nothing unique about how MDs crashed, only the number involved. There were the usual non-instrument pilots flying into IFR conditions, docs flying into adverse weather without weather reports or avoidance equipment, overloaded and unbalanced airplanes, substance abuse, and fuel exhaustion. There were also a few flat-out stupid (and fatal) decisions like taking off at night in the rain on a short, unlit runway with only a “friend’s car headlights” illuminating the airstrip. The debate in the docs’ lounge is whether this is still going on and also why, at least back then, so many docs did so many dumb things.

The answer to the first question, if it’s still going on, is hard to know from current accident reports. One thing for sure is that accidents involving doctor-pilots get a lot of attention in social media and the press. If you put the topic into your favorite search engine you’ll get thousands of hits on physicians dying in GA accidents, but the relative numbers are hard to glean from official statistics since the occupations of the pilots aren’t usually documented in the NTSB accident reports. The FAA did try to answer the question with a follow-up study to the 1966 report, published in March 1971. They stated that over the next six years physician-pilot deaths had declined and ranged from 12-18 per year. That was still a little above average for general aviation accidents back then but much improved. Neither study took into account flight hours, only occupation, so the numbers, if controlled for flight time, might be even worse since it’s likely, with busy schedules, docs flew fewer hours than most GA pilots. Dr. Mohler had at least a partial answer to the issue of why so many docs were involved in these accidents. “Risk-taking attitudes and judgments appear to be the key underlying thread uniting the major variables studied. For the most part, the flights were undertaken for a purely recreational purpose. The premium physicians place on their relatively restricted opportunities for recreation is highlighted.”

Although much later than the Mohler days, the tragic death of one of America’s most prominent physicians is a typical, but sad, example, of just this point. Andreas Grüntzig, MD, was a Swiss-born cardiologist practicing in Atlanta and renowned as the father and inventor of “balloon angioplasty,” a needle-and-catheter-based treatment to relieve blocked arteries. His breakthrough technology to treat coronary artery disease, called “per-cutaneous coronary angioplasty (PTCA),” translated to “through the skin coronary artery dilatation” and totally revolutionized the entire treatment of atherosclerotic vascular disease. PTCA turned the previous treatment of coronary disease that had required a major invasive surgical procedure with large incisions and a week of hospitalization into a needle stick technique that, in selected patients, can be an outpatient cure.

In October 1985, Hurricane Isabel had just come through Florida and Hurricane Juan was churning in the Gulf of Mexico off the Florida coast. It reached its peak storm force on October 26. Grüntzig and his wife, also a physician at Emory Hospital, were at their vacation home on St. Simons Island (KSSI), Georgia, and planned to fly his newly acquired Beach Baron, N583AM, back home to Atlanta (KPDK). Although Juan was centered in the eastern gulf, the system spread over Florida and Georgia and the meteorological conditions were obviously terrible for a GA flight. Regardless, on October 27, 1985, Grüntzig and his wife took off to try to return to their home base. They never made it and crashed near Forsyth, Georgia; neither he nor his wife survived. It’s unclear why he made the decision to fly that day; speculation was that he “had to get there” because of multiple pending clinical commitments. His obituary read, in part, “He, so careful with his patients, yet so sure of his own invincibility that he took off against all advice into adverse weather in his new multi-engine aircraft.” Almost exactly as Dr. Mohler had described.

The Mohler report and the Grüntzig accident are descriptive of the nature of these crashes but don’t help us understand why docs, in particular, took these risks. Dissecting the statistics of that terrible year in 1966 yields another part of the answer to the question. The majority of these crashes had to do with the type of airplanes that docs died in. MDs were fortunate, at that time anyway, to be in a lucrative profession that could generate the income to purchase top of the line, expensive airplanes. In the early 1960s, Beech started to manufacture the flashy Bonanza, which quickly rose to the top in the class of elite, personal airplanes to own. A lot of professionals bought and flew the new fast, attractive models. The Bonanza was a huge step up in performance, system complexity, and instrumentation from older GA airframes, so to fly it safely demanded an equivalent increase in pilot training, skills, and above all, judgment. Although lots of other professionals like lawyers, entrepreneurs, and investors bought the Bonanza too, it soon earned the unfortunate nickname, “The Fork-Tailed Doctor Killer.”

The early Bonanza fatality rate in 1966 was not too different from the first years of other high-performance airframes like the Cessna 310, which had a horrible accident rate early on. The same jump in fatal accidents happened when the technically advanced Cirrus aircraft first rolled off the production line. Cirrus was among the first OEMs to engineer advanced, glass-paneled electronic bells and whistles and even a parachute into their new airframe. Many tech-loving pilots quickly bought up the attractive new planes but were not adequately prepared to fly them safely, and along came another unfortunate nickname, “The Geek Killer.” The common thread between all these incremental systems and performance advances and the additional training needed to operate them safely becomes obvious. Eventually, the industry figured out how necessary it was to teach people to safely fly these airplanes. It paid off and with more diligent and mandatory flight instruction matching the technically advanced airframes, the accident rate dropped off.

It’s still not clear why docs, and other high achievers, elected to fly these airplanes under unsafe conditions and without adequate preparation. A number of my flying doctor friends have offered their ideas on this. Next month I’ll tell you what I’ve heard, but in the meantime I’d really like to hear what you folks out there think and I’ll include your ideas in the follow-up article next month. Till then, noodle on this issue and let me know what you come up with and above all—fly smart and stay safe!

Kenneth Stahl, MD, FACS

Kenneth Stahl, MD, FACS is an expert in principles of aviation safety and has adapted those lessons to healthcare and industry for maximizing patient safety and minimizing human error. He also writes and teaches pilot and patient safety principles and error avoidance. He is triple board-certified in cardiac surgery, trauma surgery/surgical critical care and general surgery. Dr. Stahl holds an active ATP certification and a 25-year member of the AOPA with thousands of hours as pilot in command in multiple airframes. He serves on the AOPA Board of Aviation Medical Advisors and is a published author with numerous peer reviewed journal and medical textbook contributions. Dr. Stahl practices surgery and is active in writing and industry consulting. He can be reached at [email protected].

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