Who’s Who in the Office of Aerospace Medicine
A Behind-the-Scenes Look at the FAA’s Aerospace Medicine Decision Makers
By Tom Hoffmann, FAA Safety Briefing Magazine
While pilots may not regard airman medical certification as the pinnacle of the aeronautical journey, “the medical” is a critical part of that process. For most pilots, getting a medical typically involves a visit with their aviation medical examiner (AME), some online paperwork and, provided you meet the requirements, voilá — you have a certificate authorizing you to fly within the parameters of your class or type of medical certificate. For others, the process may require a few additional steps to complete. In either case, rest assured that the FAA is focused on issuing a medical certificate to every airman who applies, provided it does not pose an undue hazard or risk to the National Airspace System.
Making the process as efficient and seamless as possible requires a lot of behind-the-scenes work. Whether it’s processing medical applications, reviewing appeals, updating the conditions an AME can issue (CACI) list, reviewing new medications and vaccines, or even training the AME you regularly visit, the FAA’s Office of Aerospace Medicine (AAM) has a number of tasks to help you get your medical while contributing to maintaining the world’s safest airspace system. Let’s meet a few members of this dynamic team and learn about the many ways they are working to help you.
Rules of the Game
Like all agencies, the FAA is bound by the Code of Federal Regulations (CFR). The ones specific to medical certification are laid out in 14 CFR part 67. It lists all of the medical standards an airman must meet for a given class of medical certificate and all the certification procedures. You can think of part 67 as the rules of the game — regulations that guide AAM in developing policies and procedures.
Now let’s look at how AAM is structured. There are four main sections: the headquarters office in Washington, D.C., the Civil Aerospace Medical Institute (CAMI) in Oklahoma City, the regional medical divisions across the country, and the drug abatement program, which is a hybrid between HQ and three field offices.
Leading the team is Federal Air Surgeon (FAS) Dr. Susan Northrup, who took the position in January 2021. Dr. Northrup authors the Safety Briefing magazine’s Aeromedical Advisory department. Reporting to her are Deputy FAS Dr. Brett Wyrick and CAMI Director Dr. Melchor Antunano. These two doctors oversee AAM’s eight divisions and nine regions.
It’s a big organization, but for purposes of this article, we narrow the focus to three areas that pertain most to the medical certification process: the Aerospace Medical Certification Division (AMCD), the Medical Specialties Division, and the Regional Flight Surgeon Divisions.
Before that, though, let’s acknowledge that the AME is where the rubber hits the runway for most pilots. AMEs are physicians whom the FAA has designated to act on its behalf to grant medical certification to pilots in certain circumstances. They receive specialized initial and recurrent training from AAM’s Aerospace Medical Education Division. An applicant for a medical certificate works with an AME to approve his or her application. This interaction is usually a straightforward process that results in the AME issuing an FAA medical certificate. That’s precisely how the FAA wants it to work.
In some cases, though, an AME may not be able to grant the medical clearance. Don’t panic! There is likely to be a delay in getting your certificate, but the delay does not necessarily lead to denial. When an AME is unsure how to handle a specific case, they may defer the decision to the FAA and transmit the application and examination. In this case, the file goes to either the Regional Medical Office or the AMCD for review. The AME may also call the Regional Flight Surgeon or the AMCD to discuss the case. Let’s take a closer look at both.
The Regional Medical Offices
A Regional Flight Surgeon (RFS) heads each of the nine Regional Medical Offices. Larger regions also have a Deputy RFS. All Regions have staff to help with designee, airman certification, and air traffic controller medical issues. The RFS has the authority to issue or deny most medical certificates. In addition, the RFS and their staff can often provide a more personalized level of help to both airmen and AMEs.
“This is sometimes an overlooked attribute of the regional offices,” says Northwest Mountain RFS Dr. Stephen Veronneau. “While COVID-related workload limitations may restrict a regional office’s ability to assist with as many cases as before, if the information is ready to go and fairly concise, the RFS office can speed up consideration of the case and have it set up for the RFS to review.” He explains that simply correcting an error or clarifying a misunderstanding can help move a case forward. On occasion, AMEs can also receive a real-time authorization by calling an RFS, or in some cases, via a pre-arranged agreement for the airman to comply with all information requests. This can cut down on the need to defer a certificate.
Regional medical offices also have the distinct advantage of being, well, regional. Many are proud to take active roles in their local areas, participating and answering questions at airshows, flight club meetings, trade shows, FAA Safety Team events, and more.
Go to bit.ly/RFScontacts to find contact information for each regional medical office.
Aerospace Medical Certification Division
Located at the Mike Monroney Aeronautical Center in Oklahoma City, the AMCD shoulders the bulk of work with the national airman medical certification program, reviewing approximately 380,000 airman medical applications per year. This number includes 34,000 Special Issuances — certificates for airmen with disqualifying medical conditions who have obtained appropriate health care and risk mitigation acceptable to the FAS for flight duties. AMCD is also responsible for managing the information systems (MedXPress, the Aerospace Medical Certification Subsystem, the Document Imaging Workflow System) and a database that supports medical certification.
The AMCD works with the RFS offices to help identify a path forward for airmen with disqualifying conditions whose cases are referred by an AME. AMCD provides written notification to such airmen along with instructions for reconsideration or further review. According to AMCD Manager Dr. David O’Brien, most cases they review receive a Special Issuance. “When we find a pilot with a potentially disqualifying medical condition, our goal is to get to ‘yes’ on their medical application by ensuring the pilot is seeking appropriate care and minimizing any opportunity for sudden or subtle incapacitation,” says O’Brien. In addition, O’Brien notes that they work extensively with AMEs, medical specialists, and the airman medical applicants to find a pathway to approving a Special Issuance. This might involve the use of new treatments or medications as well as technological advances. “While getting to yes is not always possible, one way an airman can help is to provide complete and detailed answers during a flight physical and timely responses to any medical information requests.”
Medical Specialties Division
So what happens in the rare case where the medical certificate is denied? An airman may elect to appeal through the AMCD. Wherever possible, the AMCD works with the airman by requesting additional information or reviewing alternative treatment options. If they can’t reach an agreement, the airman may further appeal through AAM’s Medical Specialties Division. This division administers the medical policies and standards that the AMCD and regional offices carry out. The Medical Specialties Division will thoroughly review the case and work with the FAS to resolve it.
The Medical Specialties Division is behind many efforts to help airmen get to yes on their medical. Its work includes managing the Conditions an AME Can Issue (CACI) process, a way for pilots with certain common conditions to be certificated without FAA involvement. “The CACI process is a way of pushing down to the lowest level the ability to certificate airmen and minimize the hassle factor,” says Deputy Director Dr. James DeVoll. There are currently 20 conditions eligible for CACI, and the agency is actively researching more to add to that list.
Over the last several years, Medical Specialties has expanded its role to be a leading resource for behavioral health questions, including reviewing medical denials for individuals with psychiatric or mental health conditions. Medical Specialties manages the Selective Serotonin Reuptake Inhibitor (SSRI) program for allowable antidepressant medications and the Human Intervention Motivational Study (HIMS), a substance abuse treatment program. The division also has a new doctor of clinical pharmacy, who has been instrumental in helping AAM review new medications and develop policies on whether they are safe to use in the aviation environment. This asset has been invaluable, especially during the pandemic.
As the arbiters of aerospace medical policy for the agency, the Medical Specialties Division is eagerly awaiting the final development of a new OneGuide information system that will consolidate and streamline protocols and processes for handling certain cases. “OneGuide will provide a single data set that pilots, AMEs, and FAA employees can access to see information that is useful to them,” says Dr. DeVoll. For example, a guidance change made for migraines could be updated in a single place and be funneled down to all end users. “It’s one guide that will unify what we do for given medical conditions both internally and externally to ensure we’re all on the same page.”
Keeping it in the Family
As shown by the many initiatives described here, AAM is focused squarely on its commitment to get as many medical certificates in pilots’ hands as safely and expeditiously as possible. It’s reassuring to know that a good majority of the FAA’s medical decision-makers are active or former pilots who are sensitive to the needs of the flying community. That applies to no less than the FAS herself, an active pilot who flies a Stearman biplane and a T-6 Texan. “While my primary objective as FAS is to ensure that we have the safest National Airspace System in the world, I remain firmly committed to the policy of getting as many airmen into the air as safely as possible,” says Dr. Northrup. “I truly understand just how important a medical is to most pilots.”
Tom Hoffmann is the managing editor of FAA Safety Briefing. He is a commercial pilot and holds an A&P certificate.