The Army RAM Career

The young Army physician who desires a rewarding career as a valued team player on the command staff and making a significant impact on unit health and fighting strength is usually attracted to the duties and responsibilities of a flight surgeon. That young Army physician starts his operationally oriented career at Fort Rucker, AL. There, he attends the Army Flight Surgeon Primary Course (AFSPC) conducted at the US Army School of Aviation Medicine. This service specific six-week course culminates in the designation as an Army Flight Surgeon and the award of the Army Flight Surgeon badge. The course prepares graduates for duty as Aviation Battalion Surgeons and covers aerospace physiology, aeromedical evacuation, mishap prevention and investigation, aeromedical policy and administration, and brigade medical planning and support. The six-week course does have a modular design that permits medical students, National Guard, and Reserve Soldiers to complete it in blocks.

Ideally (and this has been the past paradigm), the new flight surgeon would then serve a utilization tour with an aviation battalion. It is at this level that strong professional bonds form with the unit command structure and social networking bonds with the aircrew members that last his career. The new flight surgeon gains invaluable first hand experiences executing his duties as battalion flight surgeon. He/she is the medical authority in remote and austere environments. He/she supervises a few medics and an aeromedical physician assistant. Relying on his organizational and problem solving skills, the flight surgeon and his medical team trouble shoot medical issues affecting the unit. Many flight surgeons have reflected fondly on their experiences and often desire to serve again at that level. Leadership development, however, dictates that the flight surgeon is trained to assume duties with higher responsibilities and perspectives that are more global.

Aerospace Medicine is a medical specialty of the American Board of Preventive Medicine (ABPM originally incorporated in 1948). It has been a recognized medical specialty since 1953, almost two and a half years before Occupational Medicine and almost 8 years before General Preventive Medicine gained specialty status. The Army conducts joint training with the Navy at the Naval Operational Medicine Institute in Pensacola, Florida. The Navy Residency in Aerospace Medicine (RAM) Program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Prospective residents in aerospace medicine (RAMs) must first complete a clinical internship at an Allopathic or Osteopathic approved program. While applications for the RAM Program are for PGY-2 positions, there is a categorical RAM intern positions at Eisenhower Army Medical Center in Augusta, GA. The current paradigm is that the Army GME Office expects those interns to directly rollover into the specialty specific ACGME training (vs. a GMO utilization tour). Those selected begin their PGY-2 year by attending the University of Texas Medical Branch in Galveston, Texas for a fully funded Masters in Public Health (MPH). Upon completion of the MPH, the resident proceeds to Pensacola Naval Air Station for the PGY-3 year — Aerospace Medicine Practicum.

The PGY-3 year consists of approximately five months of aeromedical clinical rotations. The resident must also complete: the Aviation Safety Officer Course, Joint Aviation/Aerospace Medicine, Space Medicine, Civil Aviation Medicine, Travel / Tropical Medicine, Strategic and Tactical Medical Evacuation, and enhanced Flight Training. Flight training utilizes a combination of resources, to include civil flight training and courses and flights with Training Wing 5 and 6. Upon completion of the PGY-3 year, the resident is eligible to sit for the specialty board in Aerospace Medicine.

Residents who have previously completed a residency will go on their utilization tour immediately following the PGY-3 year. Those residents who are doing the RAM as their first residency will remain in Pensacola and complete a PGY-4 year. The PGY-4 year provides a structured clinical year. Approximately eight months of primary and urgent care, two months of preventive and occupational medicine, and two months of electives. The purpose of the PGY-4 year is to ensure the resident is competent and confident in his/her role as a primary care physician — the Army flight surgeon is the primary care physician for his/her aviation unit.

The RAM then serves a utilization tour typically as an aviation brigade flight surgeon. Not only does he advise the aviation brigade commander on medical issues, but also he also medically supervises 3-6 battalion level flight surgeons and aeromedical physician assistants. As such, and in concert with the centralized aeromedical authority, he ensures aeromedical standards are enforced. Other operationally related duties include service in the Surgeon Sections of the various Special Operations Groups. Clinically related duties include acting as Regional Aerospace Medicine Consultant to various Medical Centers and Community Hospitals whose mission is to provide area medical support to units that include MTOE aviation related assets. The RAM is typically assigned as Department Head or Chief of an aviation or physical exam clinic in the medical treatment facility.

The new RAM graduate could also serve in aeromedical research, aeromedical academia, or aeromedical policy promulgation. Most all of these functions are at Fort Rucker, AL, the Home of Army Aviation. In aeromedical research, the new RAM serves as a bench level research flight surgeon and/or as project manager of research efforts in Aircrew Protection or Aircrew Health and Performance. He can later advance to higher responsibilities in aeromedical research program management, thereby having a major influence in the development of technologies that give the soldier/aviator the combat edge. Ultimately, he can advance to Division Director and Commander of the USA Aeromedical Research Laboratory.

In aeromedical academia, the new RAM graduate starts his tenure as the AFSPC Director. He is singularly responsible for training and graduating the Army FS cadre. Later, he can then advance to Chief of the Academic Standards and is responsible for overseeing standards consistency in the training of flight surgeons, aeromedical physician assistants, flight medics, and aviation psychologists, as well as the tactical medical evacuation, Joint En Route Care, and aeromedical physiology courses. He also assists as the medical inspector of Army-wide Aviation Resource Management inspections. To round out his/her career, the RAM can serve as the Army Associate Director to the Navy RAM Program, where his job is to ensure that, within the ACGME Guidelines, Army specific training is addressed and to serve as a full staff member to the Navy RAM Program. To top off his scholarly career, the RAM can advance to be the Dean of the USA School of Aviation Medicine.

Regarding aeromedical policy promulgation, the new RAM graduate serves as the centralized aeromedical authority on waivers and reviews. The execution of his/her duties has a major impact on the health and fitness of the Army-wide air crewmember population. His focus is to ensure that all crewmembers meet published aeromedical standards and if they don’t, is lead in determining whether the medical condition should be considered waiverable. Later, the RAM advances to be the Chief of the USA Aeromedical Activity (USAAMA) where his duties include liaison with the aviation line commanders, Army Human Resource Center, and sister services in establishing joint aeromedical standards and policy. The Chief of USAAMA also ensures that the Army Aeromedical Standards and Policies are based on scientific data, as applied to the appropriate occupational environment.

The RAM’s career choice is not limited to the aforementioned. Although not aerospace specific, the RAM competes well against other physicians for duty as a Division Surgeon, MACOM Surgeon, and Centers of Excellence. Examples include duty in CENTCOM’s Surgeon Office and service as the Army’s Combat Readiness Center (aka Safety Center) Surgeon. The RAM’s operational experiences also make him/her an ideal candidate for a JTF Surgeon, supporting NORTHCOM’s Defense Support to Civil Authorities mission. On the strategic level, the TRANSCOM Surgeon (an Army RAM) is working on creating an Army RAM billet in the Validating Surgeon’s Office. The RAM can compete against other physicians for Deputy Commander for Clinical Services, Clinic Commander, and Hospital Commander positions. The pinnacle, and certainly aerospace medicine related, is serving as the Aviation Medicine Consultant to the Surgeon General.

Hence, the RAM career covers the functional areas of clinical, operational, academic, research, and standards promulgation. He can track down one functional area, thus becoming a subject matter expert in an area, or he can transition across the functional areas, thereby bringing to each functional area a new and fresh insight. In both ways, the Army aeromedical community benefits by building on past knowledge and leveraging individual strengths that allow improvement to the Aviation Medicine Program and service to our customers.