9 min read

I tend to draw many corollaries between medicine and aviation. This is likely a result of the fact that I completed my private pilot training at the same time as my surgical residency. Both professions require an enormous amount of commitment, sacrifice and training. With discipline and professional execution both yield astounding accomplishment while complacency and inattentiveness can yield disastrous outcomes. A famous surgeon once said, “The only defense the unconscious patient can yield upon the incompetent surgeon is hemorrhage.”

The bulk of my thought about this topic came from thinking about what one does after training and before mastering a profession. In aviation, a newly minted private pilot is given some of the same responsibilities and authorizations shared by their 30,000 hour ATP counterparts. I see many similarities to the newly graduated surgeon working among his more seasoned peers with 20 years of experience and thousands of operations under their belts. The day after graduating residency, young surgeons are handed a scalpel and go off to work. Does that make the young surgeon, or aviator for that matter, less able to perform the task at hand? Everybody wants the gray-haired guy with decades of experience to operate on them, but that’s not always the reality.

There exists a great chasm of time that occurs after the acquisition of skill and mastery of the profession. For pilots, much like surgeons, there is no way to rush gaining experience. Experience takes time, and more importantly, an attentive pupil. As a trauma surgeon, I do not operate as frequently as the average general surgeon but am often called upon in the most difficult of cases.


You can’t rush experience, in the cockpit or the operating room.

As an example, a friend of mine who does bread and butter general surgery does 500-600 surgeries a year. I usually perform about a quarter of this volume. As an emergency general surgeon, I’m often the guy who gets the worst cases in the middle of the night. I’m talking about the abdomens that look like a bomb went off in them. The cases that present acutely are often much more difficult than those that are elective. I feel as competent as any other surgeon to take care of the issue at hand.

It may be a similar task to asking the average instrument rated private pilot to fly a category 3 approach at night in a Cherokee. The young surgeon, much like the young pilot, must find a way to safely navigate their way owning knowledge without the lessons taught by experience. With time and patience, one hopes for wisdom.

In the world of aviation, there is an interesting quirk that does not exist anywhere else in the professional world. When it comes to piloting and building airplanes, there is a litany of amateur associations, clubs and airplanes. As far as I know, there is no amateur surgical association. If there were, I could see the ad in Barnstormers: “Local amateur surgeon seeks other like-minded individuals to get together on weekends to perform appendectomies and hernia repairs.”

The benefits of the club would be camaraderie and fellowship, as well as reduced cost by sharing expenses! Everyone is looking for a way to cut health care costs, I mean, have you seen the price of arugula at Whole Foods recently? What I can say is that some of my most incredible experiences in aviation were spent at the controls of a homebuilt Pietenpol Aircamper and spending time with EAA Chapter 582 in Northwest Ohio.

Now, with all that being said, I am confident that experience makes one a better surgeon and likewise a better pilot. Flying and life, in general, have much to do with simply living long enough to learn your lessons and realize full potential. Early on we are all given wisdom that only becomes practical when coupled with experience, time and reflection. These mind nuggets of wisdom are planted deep in our cerebrum by our trainers, only to become evident when experience or situation requires their recall. I recently had the privilege of attending a talk that discussed improving single-pilot IFR operations. Mike Busch discussed the point that increased IFR errors (i.e. heading or altitude mistakes) do not necessarily correlate with the pilots’ experience. Complacency sometimes leads to the same errors as lack of experience.

I’m sure you professional pilots will scoff at this the same way a 60-year-old surgeon scoffs at the new graduate. Does that make me less qualified to take out an appendix? Less qualified to fly an approach? We’ve had the same training, passed the same test, hold the same certificate or degree.

Perhaps the most important quality of the young surgeon or aviator is a healthy degree of self-awareness and a respect for the task at hand. If the adverse attitude is a feeling of inadequacy, the antidote would be a never-ending quest for knowledge and skill rather than defensive posturing. With that in mind, I think that asking for help or an opinion is an incredible resource.

Pilot in cockpit with instructor

Asking a friend or mentor for help is a great way to accelerate learning.

We can rely on the experiences of our mentors until we develop our own. Reaching out to a mentor or colleague can often times be incredibly helpful and provide a different perspective that may not have been considered. Experience is neither bought nor awarded, it is earned slowly and carefully. Every proverbial journey starts with the first step; sometimes we need to be reminded to enjoy ourselves along the way.

New pilots are given the enormous responsibility to handle the lives of people when they are in an airplane. The good news is that they can only handle a small number of people at a time; for the most part some friends or family members. I suppose it would go the same for an ASA member, “Hey Mom, how about I perform a little liposuction on your thighs? My friend at ASA just got a new cannula and we are dying to try it out. I’ll go halfsies on the anesthesia.” Just as the newbie has to work up the nerve to fly in the clouds after getting an instrument rating, I suppose the new amateur surgeon would have this same case of butterflies. If this sounds bad, just imagine what his patient would feel like knowing that they were about to embark on this journey into exploratory surgery.

Experience, skill, and knowledge are the hallmarks of competency and one does not acquire them overnight, no matter what the endeavor. The first thing that needs to be acquired is a solid foundation upon which to learn and then add experience to. Unfortunately, this foundation is ignored or replaced by procedural compliance and as Rod Machado says, “A funny thing happened on the way to the practice area, we forgot how to fly.” Another misconception is that experience expressed in hours is a positive indication of performance, sort of like wealth is a virtue. A newly minted private pilot is usually less prone to error than one that has a few hundred hours under his/her belt (if he/she is wearing one of course).

One thing I know is absolutely true: experience does not equal proficiency. There are basic numbers expressed by regulation that define a minimum required. How comfortable would you be with a surgeon, or pilot for that matter, that hangs a sign on the wall, “We guarantee to have at least the minimum qualifications?”

So this brings up a question I have on experience: Who is the more experienced mechanic, one that has worked on only one model of car for years, or one that has worked on many models every year for the same period of time? An argument can be made for both. Transpose that question to pilots or surgeons. In other words, a license does not a pilot make. So how does one gain experience? On the surface, a more experienced person should be more qualified.

KLM crash

Experience wasn’t enough to save KLM 4805.

The problem with that is that aviation history is littered with contradiction to this concept. The biggest airplane crash in history was caused by an omniscient chief pilot at the controls of KLM 4805. Pardon my expression, but he made a private pilot mistake. I don’t mean to put down private pilots; what I am saying is that he should have been long past that at his experience level. His mistake was one in a series leading up to the accident. Air France 447 and the VSS Enterprise crashes are just a few more in a long string of experienced pilots, “screwing the pooch.” I agree it does come down to mentoring, again, “no matter what the sport.” If big time professional pilots can screw up, it stands to reason the 50-hour private pilot could save the day. The problem with this kind of thinking is it is like diving into a rabbit hole with no bottom – it can go on forever.

So the way I have seen it over the years is that experience is not the biggest asset. It takes years of experience (at least it used to) before you can fly a jet. The funny thing is flying a big jet is a cake walk compared to single-pilot IFR at night with no autopilot or copilot in a Beech 18 on one engine. The Beech is several orders of magnitude more demanding. Training nowadays has been replaced with procedural compliance and let me tell you, they are not the same. Mentoring, perhaps the single most important asset, is pretty much non-existent now. The idea that you can make a good pilot because you have certain instruments or equipment in an airplane is something a marketing department would try to sell you and I must say they are very successful at it.

In spite of all you and I have discussed, there still remains perhaps the most important element yet. There are things that can happen in an airplane, or in an operating room, that the best pilot or surgeon cannot handle. When all else has failed, we may rely on luck as our last resort.

The common phrase is, “It is better to be lucky than good;” however, luck favors the prepared. It has saved my posterior more than once while it wasn’t there in the last minutes for others. The element of luck may be just as important to the amateur weekend warrior surgeon trying to graduate from gallbladders to heart transplants. I know it works for pilots.

The author would like to thank Bill David for his significant contributions to this article.

Andrew Skattum
Latest posts by Andrew Skattum (see all)
10 replies
  1. Chris Schreiber
    Chris Schreiber says:

    What a fantastic and well written article. I am a veterinarian and instrument rated private pilot, and your correlations especially rang true for me. Thank you for the excellent write-up. I’m near Gulf Shores, AL. Please let me know if you ever get this way in business or pleasure. I’d love to hangar fly with you. I’ll buy the after flight hydration! (Friday fluid rounds in the veterinary world :)…)

  2. Richard Wyeroski
    Richard Wyeroski says:

    Intersting concept on flying airplanes. The human factor! It all comes down to actually common sense and handling an emergency when it happens.

    I like the advise given to pilots to never rush to do anything in an emergency except if the airplane is on fire!

    Your only as good as your last landing or the only difference between those that have landed gear up is that you did not do it yet.

    I am approaching the magic 50 years as a pilot without a violation or an accident. The FAA hands out a master pilot award to those that make it. I have to say I have seen a lot of wierd things in aviation over the years. It is a great past time and only a few out of out population of 330 million have experienced the joys of flight. Only in America and we have the best system still……..

    Great article


  3. Richard Wyeroski
    Richard Wyeroski says:

    BTW Doc, the AirFrance 447 accident was politics. Yes AirFrance lobbied the the government not to do an expensive Aiworthiness Directive until the aircraft was down for extensive maintnenance. The Pitot systems (3) were slated to be changed because in certain situations they would ice up. Well on this accident all three systems iced up and the auto-pilot shut down at night over the ocean and set off most of the alarms in the aircraft. The pilots were confused. The Captain was on break and got to the flight deck in time to hit the ocean in a stalled condition! Sounds unbelieveable and they blamed the accident on the crew even though there was a problem with the pitot systems. Politics!

    • William J David
      William J David says:

      Your statement about politics runs deeper than you think. In my opinion much of the AirBus design was driven by politics. The power levers don’t move, who’s idea was that? The control sticks don’t move together, must have been the same guy. I have flown hundreds of airplanes, including about eleven airliners and their variants, and the only ones to demonstrate this anomaly are the AirBuses. They are also the only one that I flew that had a green course to follow on the PFD, all the others are magenta.

      The pilots where what they called, “company babies.” They were ab initio products of Air Frances training department. Kind of like in breeding if you ask me. When I was hired I had more experience from multiple employers than both of the pilots at the wheel when they flew it into the ocean. Do you think any politics were in play with their training?

      I am certain that on the way down they were both trying to recall and employ procedures they learned in the simulator but it did no good, in spite of the fact that they had three functioning ADIs in front of them. All the FMSes, FCCs, A/Ps, all of that computerized technology in the cockpit didn’t help them on that flight.

      “ A funny thing happened on the way to the practice area,” comment is apropos. Better stick and rudder skills and not computer reliance would have payed big dividends for the passengers that night.

      Over the years I have tried to distill my many thoughts on this stuff and a while back I came up with two that I think should be taken to heart by all pilots.

      “When tragedy strikes, we seek relief through government and technology. Government and technology are usually the first to let us down.”

      and one more,

      “The politics of safety will be judged in the courtroom of physics, and common sense will be the jury.”

      Bill David

  4. Brent Dolphin
    Brent Dolphin says:

    Richard, the junior pilot on AF447 held the plane in a deep stall the whole way down. Rookie pilot mistake. The pitot tubes were clear and all the instruments working properly but the aircraft was still in alternate law allowing more latitude on the pilot inputs. When the captain was brought in he immediately recognized the situation but it was too late. The CVR transcript is pretty telling.

  5. Hunter Heath
    Hunter Heath says:

    Not intending to offend anyone– as a physician I think I can say this– one difference between surgery and aviation is stark: when a pilot screws up, he/she dies. When the surgeon screws up, the patient dies!

  6. Michael Bittles
    Michael Bittles says:

    Andrew, as a fellow surgeon and private pilot, I enjoyed your article very much! Please keep on flying and writing!

  7. Louis DiGiovanni
    Louis DiGiovanni says:

    As an adult reconstructive Orthopaedic surgeon with 34 years in practice I can certainly identify with this article. Very well written and very reminiscent of years of formal training coupled with a lifetime of continuing education and actual experience. The phrase used by Jason Schappert “a good pilot is always learning” rings true for many areas of life, some more than others, but very much so in medicine like flying. The sacrifice, study, and work to obtain your license in both arenas are more than compensated by the rewards we are privileged to enjoy in repayment.
    As a new private pilot with just under 200 hours and currently taking my instrument course I am constantly mindful that very seasoned pilots, thankfully rarely, have devastating catastrophes. If it can happen to them, who am I to be in the sky. It’s frightening and exciting to once again be on the beginning of the learning curve and this is in stark contrast to my professional life where the many years have me on the opposite end of that curve. The fact that Dr. Skattum was able to attend flight school and successfully become a pilot during his residency is no small feat and my hat is off to you. Five years without sleep is tiring even for the young!!
    Years of formal academic training forces us to develop rigorous study habits. Something that I have found very comforting is once again to be able to use those familiar habits in the study of aviation.When learning about aeronautical decision making I was struck by the fact that the logic is almost identical to that in surgical decision making. It may well be that this similarity is what draws many of us docs into flight.
    Thank you for a great article

  8. PAUL D
    PAUL D says:

    Andrew-Appreciate your insightful comments on doc/surgeon pilots. I am also a surgeon with a commercial helicopter rating obtained last year. The personality type that makes for a confident surgeon does overlap with pilots’ skill set. We all struggle with ‘knowing what we don’t know’ and that is the problem. Confidence and experience can fool us sometimes. Catastrophic mechanical failures are thankfully pretty rare. What gets us in trouble is not appreciating the reality in front of us or misunderstanding what we are seeing. This applies is the OR and while flying. A rigorous, systematic Aeronautical Decision Making type thought process has helped me many times. I assume nothing about any situation and work to a conclusion from the facts in front of me. This process is surely slower and not fully applicable to all circumstances, especially emergencies, but usually it helps clarify. CRM techniques used with fellow aircrew or operating room staff have many similarities and result in better outcomes for patients and our passengers. Finally, these Air Facts forums and AOPA videos are great for reading about others’ experiences and ways to improve. Agree with your comments about training, training, training.

  9. S. Ruppert
    S. Ruppert says:

    “….Training nowadays has been replaced with procedural compliance and let me tell you, they are not the same. Mentoring, perhaps the single most important asset, is pretty much non-existent now. The idea that you can make a good pilot because you have certain instruments or equipment in an airplane is something a marketing department would try to sell you and I must say they are very successful at it.”….

    This is SO true in terms of how certain airlines approach their own recurrent training … just get the procedure/terminology/sequence correct and everything will be AOK. Automation has led us down the road to an incredibly superficial way to train for when the bad stuff happens.

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