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Smooth is Fast

How to Speed Up Your Medical Certification

FAA Safety Briefing
Cleared for Takeoff
11 min readDec 30, 2021


By James Williams, FAA Safety Briefing Magazine

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There is an idiom that says, “Slow is smooth. Smooth is fast.” The expression was made famous by special operations soldiers to emphasize that slowing down to smooth out the process will paradoxically often lead to a faster end result. As Tolkien said, “the hasty stroke oft goes astray.” Both sayings are very relevant to our medical certification. So by rushing the process, you may find yourself in a far more frustrating ordeal than is necessary. In fact, the vast majority of medical certificate applications that are not issued are based on a lack of response from the airman with the requested information, not a denial by the FAA. So, in a very real way, taking some time to slow down and ensure a smooth process could make a huge difference.

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Smoothing Out the Process

“There are some very simple things a pilot can do to streamline the process,” explains Federal Air Surgeon Dr. Susan Northrup. “First, make sure any documents you submit to the FAA are legible and have your name, a date, and any identification numbers that you may have on them.” She continued, “Make sure all letters, including summaries from physicians, are signed and dated. Ensure that your package includes all information requested by the FAA and keep a copy of what you’ve submitted for your records. Also, make sure your contact information is current in MedXPress.” These tips help any pilot looking for a medical, whether for a renewal or an initial application (for more on what to expect from your first medical exam, see the article “What to Expect From an FAA Medical Exam”).

Guiding Your Path

Dr. Northrup also has another piece of good advice. “The Guide for Aviation Medical Examiners (AME) is a great resource for pilots to see what the FAA requires to certify a pilot with any given condition.” The Guide for Aviation Medical Examiners is the AME’s manual for the medical certification of pilots. While the AME Guide was written for doctors, it is available to anyone online. So if you want to know what your AME is going to be looking for, the guide is a great place to start.

“If you have any questions, or need more help, reach out to your AME, Regional Flight Surgeon (RFS), or one of the pilot advocacy groups that can provide more information,” said Dr. Northrup. If you have a condition listed in the AME guide, you can work with your primary care doctor to make sure that you have current copies of all of the reports and test results. It’s also essential to ensure that any tests ordered are correct, and in the format the FAA needs for certification. When in doubt, your doctor may contact your AME or RFS’s office. This ensures that you don’t have to repeat tests and are ready to be certificated when you walk into your AME’s office. But what if you don’t meet the medical standards?

Regardless of what certification path you end up taking, slowing down to ensure a smooth process will likely deliver the best results.


If you haven’t had a medical certificate before or haven’t had one in a while, you probably don’t know what a CACI is.

A table of CACI conditions.

Conditions AMEs Can Issue (CACI) is a program that allows AMEs to issue medical certificates to pilots that would usually have to be deferred to the FAA so long as they meet specific requirements. That means that you walk out of your AME’s office with a medical certificate without having to wait for the FAA to review and approve your medical. Also, these are regular medical certificates, not Special Issuance certificates, that usually come with limited durations or additional requirements. These conditions include arthritis, asthma, hypertension, migraines, pre-diabetes, several forms of cancer, and more. For a complete list of conditions and the applicable worksheets, visit

Special Issuance, SODAs, and More

If you don’t meet the regular medical standards, there are a few other options. The most common would be a Special Issuance (SI). Broadly, SIs are performed when a pilot doesn’t meet the medical standards. Still, through some alternate means like additional documentation, shorter duration certificates, additional monitoring, or other mitigations, the FAA can issue an SI so the pilot can fly. Unlike a CACI, these medical exams must be initially deferred to the FAA and reviewed by the Aerospace Medical Certification Division (AMCD). Under the AME Assisted Special Issuance (AASI) program, some SI renewals may be handled by selected AMEs without first deferring to the AMCD, assuming specific criteria are met. AASI saves time by not processing on the front end and gets you back to flying status faster. Please see our Jan/Feb 2009 issue for the article “Getting your Special Issuance Medical” (PDF download) for a more detailed look at the SI process.

Photo of doctor.

A Statement of Demonstrated Ability (SODA) is a process that allows a pilot with a static, non-progressive condition that might otherwise be disqualifying to demonstrate that they are capable of operating an aircraft safely despite the disqualifying condition. The scope for a SODA is more limited than an SI, as the condition must be static but is valid until the condition changes or is revoked by the FAA. This process may require a special medical test flight (this might not actually include a flight) to determine that the pilot can operate safely and what, if any, limitations must be placed on the medical certificate. These tests are requested by the AMCD or RFS and generally carried out by the local Flight Standards District Office (FSDO).

Other means of medical compliance include BasicMed, Sport Pilot, and aircraft operations that don’t require a medical certificate. Each of those categories is an article in its own right, but it’s important to remember that Title 14 Code of Federal Regulations (14 CFR) section 61.53 still applies. This means that you must still ensure that you are fit for flight as pilot in command before each flight.

Image of eye test.

Regardless of what certification path you end up taking, slowing down to ensure a smooth process will likely deliver the best results. If you think you may have difficulty with the process, check the AME guide to see what the FAA needs. This is especially true if you have a CACI condition. Work with your personal doctor and AME to make sure everything is in hand, and be sure that’s what the FAA needs to see. If you have questions, ask your AME or RFS. Also, consider contacting a pilot advocacy group. Many have excellent advice for navigating the process.

Remember your medical exam doesn’t start until the AME pulls up the MedXPress application at your office visit, so there’s no penalty for asking questions before that process begins. Hopefully, by knowing what to expect and being ready with any additional information, you can reduce a maddening waiting game of frustration to an easy visit to your AME that ends with a medical certificate in your hand. Even if that isn’t possible, having that additional information in hand and ready to send to the AMCD should reduce the need for time-consuming back and forth. This is where a good AME can make a big difference. For more on finding a good AME, see “Building the Right Team” (PDF download) on page 5 of our Sep/Oct 2018 issue.

A smooth and fast certification process is what everyone wants, and hopefully, this helps you get there.

5 Tips to Fast-Track Your Medical

By Dr. Leo Hattrup, FAA Medical Officer

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Due to advances in treatment, medical follow-up, and FAA medical programs and protocols, the FAA now allows pilots to be issued medical certificates with medical diagnoses and/or medications that were previously considered grounding. However, pilots (and the FAA) still want the process to be as fast as possible.

The key is to come prepared for your Aviation Medical Examiner (AME) appointment.

In many cases, your AME will have all of the information needed to issue a certificate at your appointment. Still, if any item is missing or a question is unanswered, your medical (if deferred) will take longer. Here are five tips that can help speed things along.

1. List ALL Your Medical Conditions, Including Any Physician Visits Since Your Last Medical

A common mistake that applicants make is not including a complete medical history on their application. The FAA requires a complete list of your current medical conditions and history, so be sure to make a list of everything, including events that happened years ago and those you reported on previous applications. This list will also help you fill out your Application for Airman Medical in MedXPress (Form 8500–8) and give you a starting point to review what information the FAA will need for each of your conditions. (Remember, the instructions state “Have you ever in your life …”)

Many pilots find it helpful to maintain a list of all doctors visited, including names, contact information, and specialty, along with the treatment received and the condition or reason for the visit. Keep in mind that after you have made an initial report, further reports can be very brief (e.g., “appendectomy, 2003, fully recovered”).

2. What Documents Do I Need to Bring to My Appointment?

Take a look at the AME Guide to find out what documents and information your AME will need to see for each of your medical conditions at your appointment. It will also give you a starting point to help you fill out your MedXPress application.

A helpful tip is to use the CTRL-F key search function within the PDF file to find requirements for a specific condition. The disposition tables for each condition in the AME Guide will indicate what documents you need to provide. You should see this under the Evaluation Data section of each table. Watch this AME Minute video explaining disposition tables.

Your condition may require your AME to follow the Conditions an AME Can Issue (CACI) worksheet, so be familiar with this document. Many pilots find it helpful to bring the CACI worksheets or disposition tables to their treating physician(s) to help them create a note or clinic summary that the FAA can use to make an aeromedical decision.

If your condition requires you to provide a “current status report,” please note that we are looking for a copy of the detailed clinical progress notes (actual clinical records) from your treating provider that should address each of the following topics:

  • Diagnosis
  • Treatment and Follow-up Plan
  • Prognosis
  • Specific Items on the Disposition Table

Caution: A “Patient After Care Summary” is easily accessible on many Electronic Medical Records, but this DOES NOT contain what the FAA needs to make a medical certification decision. The FAA requires a copy of the actual clinical treatment records. Also, the FAA does not need a separate letter or note from your provider. It is just more work for the provider and usually does not include all the information that the FAA needs.

3. Help Your Physician Understand Airman Medical Certification

There’s a very good chance that the physician who takes great care of you and your medical conditions has no experience in airman medical certification. Here’s a few things that will help them help you:

  • Explain that the FAA makes medical determinations based on the Code of Federal Regulations, which focuses on public safety.
  • Let them know what information the clinical records must contain and that an FAA physician may review it.
  • Bring a copy of the CACI worksheet for each of your conditions. Let your physician know that you need each item addressed in the clinical records.
  • If the FAA specifically asks for an evaluation by your physician, make sure the clinical records are officially reviewed and signed by your physician and not just a clinical extender (e.g., nurse, nurse practitioner, physician assistant, etc.).

4. Work With Your AME

Unlike most physicians, AMEs are specifically trained by the FAA to know when to issue or defer a medical certificate. When a pilot has a condition requiring the AME to defer (such as a heart attack or stroke), your AME can help you understand which documents the FAA will need to review. Remember, while both your physician and the FAA are concerned about your health, the FAA also focuses on public safety. For that reason, we sometimes require testing beyond what is necessary just for patient care.

If you have a condition that requires a Special Issuance, in some cases, your AME will be able to issue a follow-up certificate. The FAA has a sub-set (30 conditions, so far, for all classes) for which the AME can issue a renewal of the Special Issuance. These are called AME Assisted Special Issuances, or AASI, though the FAA will still review the evaluation. Assuming the evaluation is favorable, the pilot can walk out of the office with a certificate in hand rather than waiting for the FAA to complete the review. In the past few months, we added a group of the most common cardiac conditions to the list.

5. Don’t Forget to Submit Your Information to the FAA Within 14 days of Your Exam

Due to the volume of documents received by the FAA, if at all possible, send your documents within the 14-day window that AMEs are allowed for submitting examinations. Also, note whether you or your AME will be sending in documents, and ensure your AME gets a copy. Advise the FAA of any delay beyond 14 days.

Approach your medical certification the same way you prepare for a flight. Be prepared, use a checklist, and have all the tools and supplies that you need on hand to fast-track your medical to a smooth landing.

James Williams is FAA Safety Briefing’s associate editor and photo editor. He is also a pilot and ground instructor.Dr. Leo M. Hattrup, M.D., received a bachelor’s degree from Wichita State University, a master’s in public health from Harvard University, and a doctorate from Vanderbilt University. He is retired from the U.S. Air Force in which he spent the majority of his career in aerospace medicine. He is board certified in aerospace and occupational medicine. He is a certificated flight instructor and enjoys flying airplanes, helicopters, and gliders.
This article was originally published in the January/February 2022 issue of FAA Safety Briefing magazine.
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Cleared for Takeoff

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