Doctor, Doctor, Let Me Give You the News

How to Talk to Your Doctor about BasicMed

By James Williams
Source: FAA Safety Briefing, July/August 2017

By the time you read these words, one of the biggest-ever changes in pilot medical certification will have started. BasicMed is a shift in the way many pilots will meet their required medical qualification for conducting lower-risk, non-commercial flying.

If you are among those intending to use BasicMed, the first question in your mind may be “which doctor should I go see?” BasicMed offers new options you’ll want to consider.

There are two key factors here: who you wish to partner with, and who wishes to partner with you.

A Different Kind of Dance

In the pre-BasicMed world, things were pretty straightforward. If you needed a medical exam, you’d book an appointment with your chosen AME. The AME would conduct the exam. You’d walk out of the office with your new medical certificate (in the vast majority of cases). This system is still available to you should you choose it.

In the BasicMed world, the concept is to take the BasicMed checklist to your Primary Care Physician (PCP), who evaluates your condition for each item on the checklist, and signs off on your fitness for flight. But BasicMed gives you significantly more latitude regarding which physician you choose to use. “Any state-licensed physician may conduct a comprehensive examination for BasicMed,” explains John Linsenmeyer, the FAA Flight Standards Lead for BasicMed. “It’s obviously best to go to the physician who is the most acquainted with your overall health, but you can choose any other physician you’ve been to, or your AME, or even a physician who’s seeing you for the first time,” Linsenmeyer continued.

But for physicians, simply being qualified is only one part of the equation. BasicMed is opening up the door to thousands of physicians who now have the authority to sign an airman off as being medically eligible to fly recreationally in GA aircraft. At this point, quite a few of those physicians will be unaware that they now have this authority. In some cases, physicians who haven’t heard of BasicMed may have reservations about conducting these sorts of examinations. Under BasicMed, though, you still have plenty of options even if your PCP or AME has chosen not to participate.

Presentation is Key

In some cases, you may find yourself educating your doctor on BasicMed. Many physicians are aware of the FAA medical certification program, and may assume an FAA-approved doctor (an AME) must sign the comprehensive medical examination checklist (CMEC). Because they are unfamiliar with BasicMed, they may be hesitant to perform the comprehensive examination without further research.

When selecting a physician to conduct the BasicMed exam, be sure to inform the physician’s staff prior to the appointment. If they have questions about BasicMed, direct them to the FAA’s BasicMed website for more details. If your physician of choice elects not to offer BasicMed exams, ask them for a referral to a physician who offers the service.

Ideally, you would be able to find a doctor who is familiar with your history. Based on early anecdotal evidence from pilots who have completed BasicMed examinations, the physicians who seem the most willing to conduct BasicMed physicals are the ones who already conduct physical exams on a routine basis (such as physicians who perform annual preventative medicine physicals, physicals for clearance to play on sports teams, or to attend summer camp, or for certain occupational physical exams).

Be Prepared

The best way to prepare for the examination is to make sure you have thoroughly answered the questions in Section 2 of the CMEC and provided the necessary information for the physician to evaluate your medical history. Fortunately, many medical insurance companies offer online access to your medical records, which will help you to answer questions
about visits to health professionals and prescription medications. If you’ve held a FAA medical certificate in the past, with a special issuance authorization, you will want to share that information with your physician, as well as any recent tests that may provide insight as to your current medical status.

If your doctor has concerns, deal with them directly. This is where taking a page from the FAA process might be beneficial. During the special issuance process, the FAA often requests more information in order to mitigate a specific concern. If there is an issue that causes concern for your physician, ask them what further information about your health condition you could collect that would help them feel more comfortable about signing you off for BasicMed.

It might also help to note that while your doctor is examining each item on the checklist, he or she is not certifying that you meet the specific criteria of a traditional FAA medical certificate. “How you deal with any issue is between you and your doctor,” Linsenmeyer explains. “That means that any conditions that don’t fall under those specifically outlined in the regulation are up to you and your doctor to resolve. So, you certainly want to explore possible resolutions with your physician.” It’s worth noting that while the doctor is signing off on the form today, the obligation for determining your fitness for flight ultimately resides with you, as it always has.

Doctor’s Education

One of the main reasons doctors might be uncomfortable with BasicMed is that they might not have training or experience in aviation medicine. BasicMed doesn’t provide a medical “standard,” like part 67 does for medical certificates. BasicMed relies on the physician’s general medical training (and their own experience and discretion) to make the decision about whether the pilot has a health condition (or combination of conditions) that precludes them from operating under the limited recreational flying allowed under BasicMed.

In drafting the bill that created BasicMed, Congress gave this broad discretion to physicians to exercise their own medical discretion when conducting the physical exam. This means that much of the decision-making on what is, and is not acceptable, is left to the judgment of your own doctor, rather than a FAA-prescribed medical standard. This gives you and your doctor latitude in how they resolve any issues, and it also reinforces the same responsibility you have when flying using a medical certificate.

You must make a risk determination on your fitness for flight every single time you get in the cockpit, no matter when your most recent BasicMed physical or FAA medical certificate exam occurred. You need to remember to be realistic about any potential challenges in your medical fitness. By being realistic and honest about medical conditions, you can work toward finding a sensible solution with your doctor, including the possibility that you will need to do more work to address any troubling medical conditions before flying under BasicMed. It’s a good idea to have some suggestions ready as to how you might be able to mitigate those concerns when you go to your doctor for your BasicMed physical exam.

While we’ve always advocated a strong partnership to help with medical certification, BasicMed exists to provide another alternative to pilots. Whether you opt to operate under BasicMed, or continue to maintain a medical certificate, your objective should be the same — ensuring that you are healthy, and fit to fly.

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