Blog: A Look at the FAA's Medical Certification Process

What scares a pilot? An engine failure on takeoff? A minimums approach to an icy runway? Or is it his or her upcoming FAA (Federal Aviation Administration) medical exam?

Many pilots admit to trepidation about FAA exams (those who claim to have no concerns probably aren’t being honest). That’s understandable and nothing to be ashamed of. Many aspects of FAA operational and medical regulations are worrisome due to “jeopardy” considerations regarding the ability to go to work or simply to enjoy the avocation of flying. Few careers or hobbies get as deeply integrated into a person’s inner being as does flying. 

Flying is a labor of love more than logic, which is why pilots protect that privilege at nearly all costs—at times avoiding reason in doing so.

My goal in these blogs will be to demystify the protocols of FAA medical certification, and to restore some reason to this intimidating process. Pilots are reluctant to research answers to their questions and concerns due to apprehension that “no good deed goes unpunished” when disclosing confidential information to a government entity.

I do not work for the FAA. I am a former airline pilot (having worried about my own FAA medical exams until I better understood the process) who worked simultaneously as a pilot and senior AME (Aviation Medical Examiner) for much of my adult life. I appreciate your concerns. I understand aviation from the left seat of the airplane, and not just from the earpieces of a stethoscope. I will strive to explain the FAA medical process, including the “why” and “how” we get pilots through the seemingly impossible maze it presents.

A statistic worth considering is that more than 99.9 percent of pilots applying for FAA medical certification ultimately get approved. Of the 0.1 percent who don’t get approved, some elect to abandon the certification process when it becomes overly burdensome or expensive. While infrequent, that outcome is truly unfortunate. Overall, therefore, less than one out of one thousand are permanently disqualified medically.

Given that statistic, is it reasonable to avoid obtaining appropriate medical care, worrying about opening the proverbial “can of worms” with the FAA? Remember, it’s easier to keep you flying if you are still alive. Seek appropriate medical care, and through the guidance of an experienced AME you will probably retain or regain your FAA medical approval.

In my upcoming blogs, I will discuss everything from routine medical certification to the “special issuance” process, which returns pilots to the cockpit who have disqualifying medical conditions (once treated and stabilized, of course). 

Regarding reporting requirements, pilots ask, “Why does the FAA care about my kidney stone, DUI history, medications, or that teensy little stroke?” I will discuss why the FAA does care and how we get pilots back into the cockpit after conditions such as those are properly evaluated. Once medical conditions are approved in a formal authorization letter, any follow-up considerations become regulatory and mandatory. In essence, they become the pilot’s personal ops specs.

While the AME can provide important guidance to a pilot, the AME’s decision is only regulatory at the time of the actual FAA exam. Between FAA exams, however, things are often somewhat different. While seeking counsel from the AME is usually a good idea after a significant medical event has taken place, the ultimate decision about returning to the cockpit may rest transiently on the pilot himself (until such time that the FAA has provided formal input). This is outlined, quite nebulously, in FAR 61.53. I’ll also later discuss the ramifications of this FAR, why it must be written somewhat vaguely, and why it’s important enough that the FAA puts reference to it on the Conditions of Issuance part of the medical certificate. 

There are certain medical conditions that warrant immediate grounding, regardless of any theoretical validity period remaining for the medical certificate. For many of these specifically disqualifying conditions, once treated, a special issuance authorization often returns the pilot to the cockpit.

I look forward to making the FAA medical certification process a bit less daunting for you. The system may be an unwieldy beast at times, but for the most part FAA medical recertification is possible after medical conditions have stabilized.

Dr. Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a senior AME since 1993 and is appointed as AME consultant to the federal air surgeon.