Reviewing the Medical Process
By Dr. Susan Northrup, FAA Federal Air Surgeon
Happily, the recent uptick in student pilot applications has reversed the downward trend in pilot numbers seen over the past few years. However, this has both the training environment and the FAA’s Office of Aerospace Medicine working hard to keep pace. Not only are we seeing an increase in the total number of applicants, but many of the initial applicants have an underlying medical condition that requires further evaluation. Moreover, this is now true even for younger pilots. Let’s review the certification process and what you can do to expedite your medical application.
First, a brief history lesson. Medical certification actually began in World War I because more pilots were lost in accidents secondary to medical conditions than were lost in combat. Once standards were put in place, the accident rate dropped precipitously. These military standards formed the basis for the initial civilian standards, which were developed in the 1930s. Our current FAA regulations, found in 14 CFR part 67, evolved from these. Initially, these regulations were very restrictive. However, we now grant a special issuance (waiver) for many conditions that were previously disqualifying. These include many cardiac conditions, insulin-treated diabetes mellitus, substance use disorder, etc.
When we consider medical certification, our fundamental concern is the safety of the National Airspace System (NAS). We focus on the risk of sudden or subtle incapacitation for the duration of the medical certificate. As such, we sometimes allow certification even if a condition does not meet current medical guidelines — examples include hypertension and elevated lipids. Conversely, if a significant medical condition is present, the need to mitigate the risk to public safety drives the requirement for some of the additional testing and observation times that we request. The standards that we use are found in part 67. These provide a basis for the AME Guide that we provide to aviation medical examiners (AMEs).
Even if a pilot does not meet all the criteria in part 67, we recognize that many pilots can safely fly after appropriate evaluation, treatment, and mitigation of the condition which determine there is not an increased risk to the NAS. In these cases, we have a number of options for medical certification. For relatively straightforward conditions, we allow the AME to determine that the condition is appropriately managed. The AME can issue a certificate based on some conditions simply by following the disposition tables in the AME Guide. There are 22 Conditions that an AME Can Issue (CACI) if the pilot brings the necessary paperwork to their appointment and everything is acceptable. Pilots with some static conditions are issued a statement of demonstrated ability (SODA). More serious and/or progressive conditions may warrant a special issuance (SI), which is time-limited and has specific follow-up criteria. For these, the AME (or other representative) sends the information to the FAA for review prior to issuance of the medical certificate. After the initial SI is granted for some conditions, we allow the AME to issue a medical certificate if the information is favorable, but the AME still sends all documentation to the FAA for review. These are called AME-assisted SIs (AASIs). Again, these are time-limited with specific follow-up requirements (see the Learn More link for additional info). For those interested in the regulatory basis, you can find this in 14 CFR section 67.401.
Many of you have experienced or heard that there can be delays for some pilots in receiving their medical certificates. While this is true in some cases, it’s worth noting that more than 90% of applicants for a medical certificate leave the AME’s office with their medical certificate in hand. Of the 10% who do not, most receive a medical certificate through one of the above pathways. Of the 1% who are ultimately denied, it is mostly because they failed to submit the requested information. Nonetheless, this 10% is the group where the delays occur. In the next issue, we will look further into some reasons for delays and what you can do to help avoid them.
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Dr. Susan Northrup received a bachelor’s degree in chemistry, a medical degree from The Ohio State University, and 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.
