AINsight: Why Pilots Want Thorough AME Exams

 - December 8, 2022, 12:18 AM
exam table in medical office
(Photo: Creative Commons/Stock photo)

Before you start posting comments on pilot forums that begin with the title, “Sancetta has totally lost his marbles,” please hear me out. A pilot’s main concern when going to their aviation medical examiner (AME) for their required FAA examinations is, understandably, to walk out of the AME’s office with their coveted medical certificate in hand—and with little fanfare along the way.

I get it. In addition to my medical practice, I was also a professional pilot for more than 30 years. I too am familiar with the trepidation of the potential outcomes of an FAA medical examination.

While pilots often find the FAA requirements for filling out the laborious MedXpress application and the extensive examination requirements as burdensome overkill, there is actually good reason for this process. Pilots may roll their eyes when I state this, but that reason is called “aviation safety.”

That said, it often appears to pilots that the FAA protocols go a bit overboard and beyond what is truly needed to determine aviation safety, with the system in place as it currently is. Unfortunately, there’s the Code of Federal Regulations (CFR) that very carefully outlines not only the aviation medical safety standards the FAA must uphold, but AMEs also take an oath to provide examinations of pilots that meet the standards as prescribed.

Most AMEs truly want to be advocates for their pilots. Don’t tell the FAA that I said that, as AMEs are expected to be “evaluators” more than “advocates.” In reality, within ethical bounds, AMEs can function effectively in both roles.

I want my pilots to exit my office with their medical certificates in their hands, but I must maintain faithfulness to the CFRs and the ramifications of both medical history and examination standards along the way. When a pilot clearly does not meet a standard, my policy is not to simply boot them out the door, stating, “Well, I can’t issue your medical today. Sometime in the next century the FAA will send you a letter outlining what documentation would be required to meet those standards, if at all possible. Then, after a brief period of about two additional years to review the documentation you provide, the FAA may issue a medical certificate to you. You do have a decent disability policy I presume?”

While I may have embellished a tad on that anecdote, the point is that I don’t leave a pilot without any direction if I can’t issue their medical certificate. In such cases I provide a list of documentation to the pilot that the FAA is likely going to request by letter so that they can get the process going expeditiously.

There are many minor medical conditions that, with a simple delay in submitting the medical application, the AME can issue the medical certificate and then just send the data to the FAA for final review. In certain cases, this is completely ethical to do and the FAA appreciates when we handle minor conditions in this manner.

For example, in the case of a pilot no longer meeting the vision standards, sometimes just telling the pilot to go to their eye specialist for simple vision correction might only lead to a delay of a week or so.

If there is a change in the required ECG for first-class medical applicants, instead of being grounded for six to 12 months, I can send the pilot to a cardiologist for the required evaluation. And if all of the results are favorable, issue the medical certificate and send the documentation to the FAA afterwards. This too might only result in a few weeks of delay.

For more significant medical problems—those that must be followed under a “special issuance authorization”—a proactive AME can be instrumental in assisting their pilot with the many details of the process, thereby potentially reducing the period of grounding that pilot may be forced to endure.

While AMEs try not to make a policy of bugging busy FAA physicians with authorizations for their individual pilot approvals, there are times when doing so is appropriate. The AME must make a decision in that asking for a verbal approval is “compelling,” as for every pilot we expedite then another pilot waits just that much longer.

For example, a pilot, perhaps one who has already waited several months for review and/or without a good sick leave or disability policy might be the type of case we try to get jump-started. Or a pilot who works for a small corporate operation without hoards of pilots “on reserve” if they are on sick list (often unpaid in the case of a contract corporate pilot) is a good case to ask the FAA for assistance in expediting an approval.

As heartless as pilots often feel the FAA is, in reality most of the agency’s staff and physicians do try their very best to be helpful whenever possible.

A good AME wants to help their pilots—again, within ethical bounds. I also want to give my pilot clients, in addition to their medical certificates, information that is useful for them on a long-term basis.

Sometimes, just by taking a careful listen to the lungs or heart sounds, an AME might catch a problem that can be dealt with before it manifests into a much bigger problem. A short period of grounding to deal with a new problem proactively and expeditiously might save that pilot an extensive period of grounding later—when a small medical problem has been given the time to evolve into a larger and more significant problem if not dealt with when discovered.

This is typical when heart valves are beginning to fail, diabetes might be developing, or even a cancer that can be detected with early screening if a problem is suspected (and the pilot properly indicates it on their MedXpress application).

A cliché that you have likely seen me write in previous blogs is that “it is easier to keep you flying if you are still alive.” Even if there is not a concerning exam finding, pilots are often reluctant to disclose a newly discovered medical problem to their AME, worrying that they are going to open the proverbial can of worms that might keep them grounded for an extended period of time.

Sometimes that does happen, and sometimes the FAA does require testing and documentation that might seem to be in great excess of what the pilot’s treating physician feels are medically indicated. The FAA reminds all of us that aviation safety is paramount, and to permit a pilot to strap a bunch of paying passengers into the airplane behind them, a certain degree of medical conservativeness is sometimes required.

A long delay in getting medically certified is a disappointment to the pilot and their AME, but sadly this outcome cannot always be avoided.

Rest assured that well over 99.9 percent of pilots who apply for an FAA medical certificate do ultimately receive that certificate, even if the process might drive all of us to distraction. Most of the time, however, when a medical problem is uncovered, FAA medical reinstatement takes place within a reasonable period of time.

You also might have heard about an AME in Florida, who, a few years ago, was subject to criminal action for entering fraudulent examination findings in FAA pilot medical records. These actions were apparently so egregious that the FAA required more than 3,000 pilots to obtain more thorough examinations that met the CFR standards.

That AME did not do any favors to either the involved pilots or the FAA by passing some pilots who actually had disqualifying medical conditions or examination findings. Fraudulently entering data did a disservice to the pilots, the FAA, and aviation safety in general.

Therefore, please don't begrudge an AME for doing a reasonably thorough history and physical examination. That’s the AME’s job, as stated clearly in the CFRs. Please also remember that most of the time pilots do indeed exit the AME’s office with their medical certificate in hand. In cases where that cannot be achieved at the time of the examination, a proactive AME can assist in minimizing any delay in getting that pilot back into the cockpit.

Another cliché I use, when doing a thorough examination, is that “my goal is not just to give the pilot only this medical certificate—I want to give the pilot their next 20 medical certificates.” Finding medical problems sooner rather than later, no different than with mechanical defects, often promotes the health and well-being of the pilot and keeps them flying for many more years than if the medical problem was brushed off or ignored entirely.

I want my pilot clients to have a safe and successful career, just as I want their families to have a spouse or parent for a very long time. Most AMEs have similar goals.