AINsight: Preparing for FAA Medical Exams

 - April 12, 2019, 10:23 AM

Being prepared for an FAA medical exam can often prevent unexpected delays in certification and reduce the associated stress involved. Certainly, for many healthy pilots the FAA medical exam can seem to be so routine that they never have concerns. For other pilots, however, there are medical conditions that make the exam a bit more worrying.

Even if the requirement for these periodic exams seems like yet another obligatory governmental intrusion, the plain fact is that a pilot can’t go to work without having a current and valid medical certificate. It is no different than a required aircraft recurrent training event, and taking the process of obtaining an FAA medical certificate seriously can improve the experience.

Being prepared for an FAA medical exam is also something that the AME greatly appreciates. In the talks I give to pilot groups, I have a section about being prepared for the exam, which may go a long way to making things easier for both the pilot and AME.

First and foremost, arrive on time. This sounds self-explanatory, but a reminder is in order. I had a pilot arrive 45 minutes late recently who told me that it wasn’t a problem since he “sets aside the whole day” when he needs to get his medical certificate renewed. I reminded him that I can’t set aside my whole day for him and that I also pride myself in running on time at my office. Traffic is a daily hassle, but it’s unfortunately part of the deal in modern society. Leave yourself enough time to get to the AME’s office on time. Your blood pressure will appreciate the on-time arrival, too!

Situational awareness is something emphasized in all CFIT discussions during training events. I have pilots getting lost coming to my office with greater frequency than you might imagine. The usual reason? They are following GPS apps on their phones to incorrect locations. I had a pilot recently who had been to my office countless times previously get lost by following a new GPS program on his phone. As humorist Dave Barry would say, “I am not making this up.” Would you follow GPS into a mountainside while flying? Situational awareness is important on the ground, too.

Remember to do MedXpress well in advance of heading to the AME’s office. The FAA system for filling out the exam form online before the FAA exam itself has become more reliable and more user-friendly over the years. However, no electronic system is infallible. Please don’t wait until the morning of the FAA exam to do MedXpress, just in case it’s “down” that morning. It doesn’t fail that often, but on rare occasion it does. Complete the exam form at least several days in advance if at all possible. My assistant provides a reminder in all exam confirmation emails in regard to completing  MedXpress in advance. Even so, a few times weekly a pilot arrives for his/her exam having completely forgotten to do MedXpress. Please have the confirmation number with you and, if possible, a printout of your application form.

If you have experienced a new medical condition of interest since the issuance of your last medical certificate, give the AME a heads-up to the situation. The AME can give advice as to whether documentation will be required at the time of your next medical exam and whether or not a “special issuance” might be required. Getting on top of potential documentation requirements proactively could potentially save weeks to months of unanticipated “grounding.” As I have mentioned before, please respect that AMEs are busy in the months between your exams. However, most AMEs would want to know, in advance, if a new medical condition has arisen that might create challenges at the pilot’s next exam. A bit of proactive guidance might streamline the process.

Once medical conditions have been reported, if ongoing documentation is going to be required, the FAA sends a letter so stating. Sometimes this is under the special issuance program, which also results in a time-limit being specifically stated on the medical certificate itself. At other times this is done through a simpler letter of eligibility.

In any case, if documentation is going to be required at a subsequent medical exam, there is no provision for the AME to issue without having the precise documentation the FAA has requested. There have been many times that a pilot arrived at my office without the entire documentation package, stating that their physician didn’t think the required testing was medically necessary. I agree that perhaps it’s not always “medically” necessary, but if the FAA requires it, it’s mandatory if the pilot wants to walk out of the office with a medical certificate in hand. If the FAA asks for it, it’s required. 

Copies of FAA letters should be given to treating physicians so that they can see exactly what the FAA is requiring. Both the proper testing and how the documentation is to be presented are equally important. I appreciate that at times it can seem maddening to comply with the FAA’s documentation requirements, but nothing they request is optional.

The FAA has to act from the stance of respecting medical necessity but also from the conservative position of “protecting the national airspace.” The agency clearly states at times that some of the required testing might not be covered by insurance, and therefore the pilot could incur “out of pocket” expenses. Again, the FAA’s primary responsibility is to protect the safety of flight. More often than not, however, the data the FAA requires aligns pretty well with appropriate medical indications.

When documentation is required, there are circumstances when the information must be sent to the FAA well in advance. This is for conditions that are potentially a bit more critical, and hence the FAA wants the opportunity to review the data before giving the authorization for issuance of a medical certificate. In those cases, a pilot must plan very carefully to ensure the data arrives at the FAA in time for a review prior to the expiration of the pilot’s current medical certificate.

Usually that works fine, but we all know that sometimes the FAA gets behind in reviews (I’m sure you’re aghast in surprise). In such cases, a pilot indeed could be grounded for a short period of time. I wish I could prevent this from ever happening, but it’s impossible to do so. This is, without question, one of the more frustrating events for pilots. They feel they have done everything they were asked to do, and yet they got grounded anyway.

There are mechanisms to occasionally obtain an expedited review when a pilot is on the verge of getting grounded due to delays in FAA review of their documentation. Often, well-meaning aviation consultants tell pilots “the AME can just call for a verbal authorization to issue.” This sounds simple, doesn’t it? In practice, it’s just not that easy.

There is typically only one FAA physician available for all such calls, and usually this does not include Tuesdays (and, of course, never includes weekends or government holidays). So, this technique might lead to the AME wasting half a day calling, leaving messages, and awaiting a return call. While the FAA physicians really do want to help expedite reviews, we all need to understand that we can’t expedite everyone. And, for each pilot we expedite, that means someone else waits just that much longer. 

Before a pilot asks an AME to drop everything to call the FAA, which then requires the FAA physician to drop everything to review the case, that pilot must consider why their case is worthy of doing so. My heart bleeds for every pilot sweating out a delay in certification, but sometimes it’s just not feasible to make FAA approval magic happen as quickly as would be desirable.

The FAA staff and physicians love to help out when they can—I am also not making this up. Calling the “doc of the day” for a verbal authorization sometimes works great, other times not. However, such calls are not meant to include cardiac or diabetic renewals. 

For cases that do not include the requirement for any kind of “panel” or outside consultation review (as is typical for initial reviews after cardiac treatments, for example), going through the regional flight surgeon office could result in a more timely approval. Check first with the AME before sending data to an FAA office other than in Oklahoma City.

Scheduling tips: all corporate pilots should do their best to schedule with their AME as early in the month as possible. That way, there are options to move the exam to a date later in the month should a “pop up” trip arise when the FAA exam was originally scheduled. All pilots should do their best not to schedule an exam the day before heading out on a trip that overlaps the transition to the following month. If the FAA system or the AME’s internet goes down, there is no provision to issue a medical certificate other than by waiting for the system to return to service.

Proactive scheduling also reduces the risk of delays should either the pilot or AME have a family issue or minor illness at the time of the scheduled exam. Most airline pilots get their schedules well in advance of the due month. Consider family and training events first, of course, but then proactively get in touch with the AME. Those who are proactive often get to pick which date and time they want their exams. Those who wait until well into the due month to schedule might run out of options when contacting a busy AME.

There are many other tips, but the point is clear. Be proactive, and at times patient. I’d like for pilots to have the tedious process of renewing their medical certificates become a bit less complicated and stressful. I want pilots to avoid getting grounded for simple logistical considerations, as much as is possible.

Sometimes a pilot will indeed get grounded, but preparing documentation in advance might reduce the time period that they are unable to go to work. It is neither the FAA’s nor AME’s fault that a pilot developed a new medical condition (nor did the AME write the FAA protocols and rules for dealing with such problems), but working proactively together as a team can bring about a satisfactory result without undue delays.

Dr. Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a Senior AME since 1993 and is appointed as AME Consultant to the Federal Air Surgeon.