Just as a pilot may see a biennial flight review as an obstacle or an opportunity, the anticipation of meeting aviation medical standards during a flight physical may cause confusion, anxiety and frustration.
The process of obtaining an FAA Airman Medical Certificate is fraught with misconceptions, suspicions, and in some cases, misinformation from pilots, pilot advocacy organizations, and even Aviation Medical Examiners themselves.
The mandated flight standards are intended to ensure a pilots fitness to fly and ultimately the safety of the airman and their passengers. Although there are occasional accounts of pilots becoming incapacitated at the controls because of hidden medical conditions, the fact that there are not more underscores the fact that the process works – although not always efficiently.
Aviation medicine became part of the regulatory environment in the 1920s with the passage of the Air Commerce Act. Within the Aeronautics branch of the Commerce Department, Dr. Louis Hopewell Bauer was appointed the first medical director of aeronautics. He has often been accorded the honor of being the founder of civil aviation medicine in the United States.
Bauer was the first commandant of the Army School of Aviation Medicine at Mitchell Field, N.Y. In 1919 he wrote the first American textbook on aviation medicine, and as his first order of business wrote the physical standards that would govern the medical certification of civil pilots for their fitness to fly. He set out to create an examination system that would give meaning to the physical standards and make them an effective tool in aviation safety.
Bauer and other medical experts considered certain conditions disqualifying because they could cause sudden incapacitation or death while at the aircraft controls, or could otherwise affect a pilots ability to operate an aircraft safely. From the start, there were three levels of physical qualification that today are called Class I, Class II, and Class III.
The plan, then as now, was to rely on a group of specially designated physicians who were knowledgeable in the environmental factors of flight. They would be delegated with the authority to conduct physical examinations of pilots and issue and deny certification as determined by the written standards.
Designated aviation medical examiners, or AMEs as the examiners are now known, were to be appointed at examining centers throughout the country in proportion to the need in a particular geographic region. While some of the physical standards have been modified, the system established by Bauer is, for the most part, still intact.
Choosing an AME
One of the most difficult questions to answer is how a pilot should choose their AME. In my opinion, the key is to find an individual who will be a resource throughout the year, not just someone with whom to trivialize medical problems to get through the evaluation.
Ideally, your AME should have the ability to balance their responsibility for certifying pilots who meet a strict physical standard with that of pilot advocacy. While the AME should work to make your flying legal, you should also work with your AME to make your flying safe.
Some pilots attempt to hide important medical history they think (or know) will make them ineligible for a medical certificate. Often they dont ask the AME about suspect conditions because they dont want to admit to something that may ground them. While many AMEs will engage in hypothetical discussions, dont be surprised if they start focusing on your welfare instead of your license.
There will always be stories of physicians who perform the six-foot pilot exam, which deviates on a theme of looking at the pilot from the doorway, nodding and signing off on a certificate. While many of these stories are greatly exaggerated, you should be wary if you are not carefully examined and your medical history reviewed in detail by your AME.
If you pick a CFI who pencil-whips your biennial flight review, what confidence do you have in your ability to handle the airplane? Likewise, if your AME signs off your medical application after only a cursory look, youve missed a chance to have an expert evaluate your fitness for flight.
Obviously, the most important consideration is that an incapacitating illness or injury, or an undesirable drug action, will be missed – with grave consequences for the pilot. There are also the legal ramifications. Failure to report medical illnesses or injuries on your Form 8500-8 is illegal and may come back to haunt you if an untoward event occurs while you are flying.
After a crash, investigators will subpoena the pilots medical records from all sources, as well as the medical information reported on the Form 8500-8. If a discrepancy is identified, insurers or plaintiff attorneys may argue that the medical certificate is invalid, which could make insurance policies void and the damages sought from the pilot or the pilots estate.
If you choose to make your AME a partner in monitoring your flying fitness, ensure he or she has the expertise to do so. Your AME should have a knowledge of the aeromedical certification process, certainly, but should also be familiar with basic aviation medicine including the physiology associated with flying at altitude, what medications could be potentially disqualifying by the FAA, and how to report illnesses or injuries encountered between the expiration dates of a particular certificate.
Since most pilots will encounter some medical condition in their flying careers that could potentially affect their flying eligibility, it is also important that your AME have an infrastructure in place for expedient referrals to subspecialists, as well as the ability to coordinate and organize all the supplemental data in support of your application.
This is especially important when coordinating data to support a special issuance claim, for instance, after coronary artery bypass surgery. An application that is deferred to the Aeromedical Certification Division will have its best chance of a quick resolution if all supporting documents are submitted at one time and under one cover letter. Whats more, your AME should understand what testing is required by Special Issuance reviewers and help you to arrange those procedures in order to speed up the process.
Medical Certification Goes Hi-Tech
Since late 1999 AMEs have been required to submit the information you provide on the Form 8500-8 to the FAA electronically via a Web-based format on the Internet. While this will undoubtedly save time in the future, the process of matching paper-based supplemental material with the initial electronic application form has been challenging and has created delays in the evaluation and certification of many pilots.
In our recent practice experience, if an injury or illness is being deferred to the Aeromedical Certification Division of the FAA in Oklahoma City, the pilot should plan on at least a two-month wait before receiving a determination letter. Therefore, if you have a medical condition that your AME plans to defer for final determination because he or she is unsure of whether it is disqualifying, it is advisable to contact the Regional Flight Surgeon for your area to clarify the question and possibly make a recommendation over the telephone.
The process of aeromedical certification can be frustrating, especially when confusion exists regarding what the examination should accomplish. You should identify an AME with whom you feel comfortable and who will be a resource for all your medical certification questions.
-by Clayton T. Cowl
Clayton T. Cowl is a senior Aviation Medical Examiner and chief of the Section of Aviation Medicine at the Mayo Clinic in Rochester, Minn.