FAA Medical Certification and Alternatives
By Dr. Susan Northrup, FAA Federal Air Surgeon
Several years ago, my predecessor penned an article regarding the history of medical certification and an article on the process of certification. As he noted, the fundamental purpose of medical evaluation and certification is safety, yours and the public’s.
With this in mind, and with occasional direction from Congress, the FAA developed a set of standards that a pilot must meet to fly. As you might expect, these standards get more stringent as the potential risk to the public increases. A review of the medical certification process and alternatives is now timely.
Some aviation activities, including ultralights, gliders, and balloons, do not require a medical certificate at all. Ultralight pilots, under 14 CFR part 103, do not even need a pilot certificate. Sport pilots can fly with a driver’s license. In many states, you are allowed to drive with physical conditions that are incompatible with flight safety. Some of these conditions could contribute to higher fatal and non-fatal accident rates for light-sport aircraft than for the rest of general aviation.
BasicMed provides an alternate path to medical certification, although with limitations compared to a Class III medical. I support this program, as it has made it easier for many pilots to return to the cockpit. I understand the burden the special issuance (waiver) medical certification requirements can place on an individual. In fact, almost 30% of pilots using BasicMed had a special issuance (SI) at their last medical (compared to less than 5% for Class III medical certificate holders). We encourage BasicMed pilots to have frank and open discussions with their treating providers (hopefully the person signing their BasicMed Comprehensive Medical Examination Checklist (CMEC)) to ensure flight safety and appropriate treatment(s) to remain compatible with flight safety.
The FAA’s Office of Aerospace Medicine recently reviewed accident data for pilots flying under BasicMed. While the trend may show a slight increase in mishaps in BasicMed pilots compared to those who maintain a medical certificate, it did not reach statistical significance when comparing the number of accidents under BasicMed and Class III medical certificates. In other words, we cannot determine if this is a real difference or simply due to chance.
We will continue to monitor the trends in all categories of accident data, as we have done for decades. Please remember that changing from medical certification to BasicMed does not cure any underlying condition(s) you may have. We recommend continued follow-up with your personal physician and discussing any underlying health condition with someone knowledgeable in aviation medicine.
Traditionally, the FAA has issued Class I, II, and III medicals. Typically, these are needed for airline, commercial, and private aviation activities, respectively. The standards and duration of these medicals are governed by both your age at the time of the medical, as well as the class of medical requested.
When an individual meets the standards (derived from 14 CFR part 67) for a particular class of medical, Aerospace Medicine issues an unrestricted medical (no time limitations other than the regulatory duration). There are some conditions for which additional information must be provided to your Aviation Medical Examiner (AME), but these “Conditions AMEs Can Issue (CACI)” also qualify for an unrestricted medical.
In most cases, even when someone does not meet the standards, we can still issue a medical, with either a SODA (statement of demonstrated ability) or SI (special issuance). After an appropriate and successful evaluation, a SODA is issued for a condition that is expected to be stable. An SI, on the other hand, is issued when progression of a symptom or condition is likely and follow-up is required. A SODA generally has no expiration date, while an SI is time-limited.
As a reminder, all holders of a pilot certificate under 14 CFR part 61 are subject to the provisions of 14 CFR part 61.53 regardless of whether you require a medical certificate or chose either Sport Pilot or BasicMed.
The medical pathway you choose depends on your own medical history and what type of aircraft you want to fly. There are several paths available, but the end goal to all is safety.
Dr. Susan Northrup received a bachelor’s degree in chemistry and a medical degree from The Ohio State University, as well as a master’s degree in public health from the University of Texas. She is double board certified by the American Board of Preventive Medicine in Aerospace Medicine and Occupational Medicine. She is a retired U.S. Air Force colonel and a former regional medical director for Delta Air Lines. She is also an active private pilot.
