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I Want to Fly

So Why Do I Need to Go to the Doctor?

Medical Certification Basics

Source: www.faa.gov/news/safety_briefing, By James Williams

Are you considering becoming a pilot? While the first stops on your new aviation adventure will likely include visits to local flight schools and maybe a pilot gear shop for the latest swag, a doctor’s office visit should also be at the top of your list. This might seem a bit incongruous at first glance, but medical fitness is an essential and sometimes overlooked part of aviation. In this article we’ll discuss what the aviation medical certification process is, how it works, and what you should know before you head into your medical exam. With the right information beforehand, the process can be a lot less daunting. And with the right Aviation Medical Examiner (AME) it can be a lot easier. We’ll cover both of these areas, but first you need to determine if you even need a medical certificate, and if you do, which type.

What Class Are You In?

When you go for a medical exam you will have three classes of medical certificates to choose from: first, second, or third. The requirements for each class of medical can be found in Title 14 Code of Federal Regulations (14 CFR) part 67. See also “The Right Stuff ” in the Jan/Feb 2013 issue of FAA Safety Briefing (www.faa.gov/news/safety_briefing/2013). Here’s a summary: First class has the most stringent requirements and the shortest life span, with second class being less restrictive, and third class even less so.

The medical exam is very similar for all three classes. Some of the key differences are the requirement for an electrocardiogram (EKG) for older airmen (once after turning 35 and on an annual basis after turning 40 for a first class) and vision standards (first and second class require vision correctable to 20/20 while third class only requires vision correctable to 20/40).

eye exam

For most general aviation (GA) pilots, a third class medical is sufficient. Medical certificate requirements are tied to the privileges an airman wishes to exercise, and not necessarily explicit to the certificate they hold. For example, if an Airline Transport Pilot (ATP) plans to conduct commercial operations, he or she would be required to hold at least a second class medical, and for a 121 or 135 air carrier operation, a first class medical would be required to act as pilot in command (PIC). When exercising private or recreational pilot privileges (or when providing flight instruction under subpart H) only a third class medical privilege would be necessary.

Can I Fly Without a Medical?

In some cases, yes. 14 CFR section 61.23(b) explains that both glider and balloon pilots are not required to hold a medical. Another viable option for fixed-wing aficionados is the sport pilot certificate, which offers some latitude in medical requirements. You don’t have to have an FAA-issued medical certificate to exercise sport pilot privileges, but you must hold and comply with any restrictions on a current driver’s license. (For more on operations requiring either a medical certificate or U.S. driver’s license, see 14 CFR section 61.23(c)). There is a caveat here though. If you’ve ever held an FAA medical certificate, it must not have been suspended, revoked, or denied. Also, if you’ve started an FAA medical exam, you must have had your medical issued; you can’t stop in the middle of an exam if you don’t like what you hear. But once you have a medical, you may allow it to expire and continue to operate under sport pilot rules so long as you hold a valid driver’s license and don’t know of any condition that would render you unsafe to operate an aircraft. For more information on the IMSAFE checklist for determining fitness for flight, see Aeromedical Advisory from our September/October 2014 issue (www.faa.gov/news/
safety_briefing/2014
).

medical staff

What if I Can’t Get a Medical?

If you don’t think you can pass an initial pilot medical exam, don’t give up just yet. One of the FAA’s Office of Aerospace Medicine’s top priorities is getting as many airmen into the sky as is safely possible. To that end, the FAA has aggressively pursued policies that will, with some safety mitigations, let an airman walk out of the AME’s office with a medical certificate in hand, despite having a previously disqualifying condition(s). In fact, our last full year of data (2014) shows that 96 percent of airmen walked out of the AME’s office in possession of a medical.

This is in large part due to the new Conditions AMEs Can Issue (CACI) policy. CACI allows AMEs to issue medical certificates for conditions that previously would have had to be denied or deferred to the FAA. So, with some additional information supplied by the airman, the AME simply follows the CACI procedure, which in many cases allows issuance of an unrestricted medical certificate on the spot. Currently there are 16 conditions that qualify for CACI. You can find the full list here: http://go.usa.gov/cuEvF. Federal Air Surgeon Dr. James Fraser has made it his goal to expand the CACI policy to as many conditions as is safely possible. For more information on CACI, stay tuned to the Aeromedical Advisory column in these pages. The last update was on page 5 of our July/August 2015 issue: www.faa.gov/news/safety_briefing/2015.

What if you don’t have one of the listed CACI conditions? Another option is the Special Issuance (SI) process. The process is covered in more depth on page 2 of our January/February 2009 issue (www.faa.gov/news/safety_briefing/2009), but it relies on additional requirements that enable the FAA to issue restricted medical certificates to airmen who would otherwise be disqualified. With the introduction of the AME Assisted Special Issuance (AASI), the process has become even more airman-friendly. Once you have completed your initial SI, and you meet the AASI criteria, your subsequent SIs may be issued by the AME, assuming you have all the required documentation. That means no more having to defer to the FAA for every exam; only the initial exam is deferred. This will save a significant amount of time in getting you certificated.

What is an AME and Where Do I Find One?

The AME is a doctor who is designated by the FAA’s Office of Aerospace Medicine to provide airman exams and issue medical certificates. The AME is the medical equivalent of a Designated Pilot Examiner (DPE), who evaluates airmen and issues pilot certificates on behalf of the FAA.

The FAA administers both initial and recurrent training that keeps AMEs up to speed with policy and guidance changes. So effectively an AME is a doctor trained on FAA policy. While it is perfectly acceptable to use your AME as a primary care physician if they are so qualified, most pilots choose to have a separate primary care doctor and AME. This is because when the AME is conducting your exam, he or she is actually working for the FAA and not for you as they would normally do with a routine physical.

The easiest way to find an AME is to go to the FAA website (www.faa.gov/licenses_certificates/medical_certification/) and click on “Locate an Aviation Medical Examiner.” Simply picking the closest or most convenient AME might seem like the way to go, but Dr. Fraser suggests that “Your best bet is to approach AME selection in the same way you approach looking for a good investment: ask around!” That’s because if you stay involved in aviation (in a capacity that requires a medical) you’re going to need a good AME rather than a convenient one. For more information on finding the right AME, see “AMEing for Excellence” on page 9 of our Jan/Feb 2013 issue (www.faa.gov/news/safety_briefing/2013).

So I’m Done Once I Leave the Office, Right?

Not quite. Even though you may be in possession of a brand new medical certificate, you are responsible for making sure that you continue to meet the standards of that certificate well after you leave the doctor’s office. While no one is expecting you to be perfect in adhering to the standards in part 67, you are expected to make sure you are ready for any given flight. Are you properly rested? Are you sick? Are you taking a medication that might interfere with your abilities?

The FAA understands that your medical condition can change over time. Given that, you are expected to ground yourself for any condition or medication consumed that might make you unable to fly safely. For circumstances like a cold or the flu, this would simply mean not flying until after you’ve recovered. For more significant health issues, like a heart attack or major surgery, it’s a good idea to talk to your AME about what you may have to report and how you should go about returning to flight status. Some conditions have waiting periods before an airman can reapply. A good AME can help you figure out what tests or reports need to be done to make the FAA process go more smoothly.

Another issue to pay attention to is medications and the waiting period after you stop taking them. Even common over the counter (OTC) drugs like diphenhydramine (Benadryl) can be potentially disqualifying. For more information on the use of medication see Aeromedical Advisory in this issue. While it varies from medication to medication, a good rule of thumb is to wait at least five times the dosing interval of the medication. So if you have a medication you are directed to take every six hours, you should wait at least 30 hours (5 x 6) after your last dose.

While it sounds like a lot, the medical certification process is actually pretty easy for most people. In review: Figure out what medical class you want; find an AME; upload your information into MedXPress; go to your exam. For 96 percent of airmen, that’s the end of it. Armed with the right information and a good AME, you should have no problem joining the ranks of medical certificate holding airmen.

James Williams is FAA Safety Briefing’s associate editor and photo editor. He is also a pilot and ground instructor.