As the Wall Street Journal reported, there’s a growing shortage of qualified pilots in the US, driven by both economic reality and federal policy.

Pilots typically start their professional careers at small, regional airlines — airlines that pay, approximately, fast-food wages. Less than that, really — for for the hours they work, many pilots make less than minimum wage.  After a few years, these pilots have enough flight time and experience to try to get jobs with the big carriers, for a substantial increase in salary. Once the promotion to captain of a commercial jet comes through, pilots can make $200,000 or more a year.

But the system is getting wobbly. The two-tiered payment system relies too heavily on a steady influx of new, fresh-faced pilots eager to fly at any income. And new federal regulations require that starting pilots have 1,500 hours of flying experience, up from 250 hours — meaning even more debt for young flyers.

In other words: Long training for an eventually good salary isn’t likely to continue to attract enough talent. Does this remind you of any other industry?

It’s expensive to train a pilot, and it’s expensive to train a doctor. We typically spend 4 years as undergrads, 4 years in medical school, then at least 3 years at a less-than-minimum wage job (residency) just to qualify as primary care providers in internal medicine, pediatrics, or family medicine. If we want to make the big bucks, that’s another several years for fellowship or surgical training.

Meanwhile, there’s a push to get more people insured — more people who will want to see a doctor. As with pilots, a doctor shortage looms.

Some people are suggesting an expanded role for non-doctors: nurse practitioners, physician’s assistants, pharmacists, and others to take a larger role, perhaps to “lead the health care team.” It’s unclear what the effect of such a change will be on the quality of health care delivery, but that hasn’t stopped many health care systems from relying more on these lower-cost providers. Most of the time, with most patients, that works out fine.

I suppose we could also rely more on low-cost “pilot assistants” or “flying practitioners” as well. Most of the time, that would work out fine, too. But I don’t think most people would be happy to ride a plane piloted by a non-pilot. When people fly, they expect a real pilot to be in charge: Someone with both the experience and the training not only to handle the routine stuff, but someone who can handle the rare emergencies or unexpected complications. Someone who can land any plane safely, even when things go wrong.

Physician extenders and other mid-levels can safely and effectively handle most medical questions. But the trick is knowing which patients really would do better with a physician. We don’t necessarily know ahead of time (just like we don’t know which flights will have emergencies.) Co-pilots and navigators and other assistants can be a valuable part of the cockpit team, but who will you turn to when something goes wrong?

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.