"Off the Record Q & A with a Local A.M.E."
I think one of the greatest concerns for pilots, and a major reason for their not disclosing everything they should to their AME, is their fear of loss of license.
Can you tell us what events will cause a pilot to permanently lose their medical?
On the other side of that coin, if a pilot fails an item on the test—high blood pressure, eye-site, ECG, etc.,—what happens?
Do you report the event to the FAA? Or do you enable the pilot to do what it takes to pass the medical?
Pilots are the most passionate of anyone having control of a motorized vehicle, so of course their great fear is loss of license. Commercial pilots are also at risk for loss of income. Even though far less than 1% of all medical exams result in a denial, everyone seems to have heard a story about the pilot who went in feeling fine and ended up losing their license. In reality, the majority of those who have their license denied are due to “failure to provide” requested information.
Per our Regional Flight Surgeon, most pilots are surprised that over 90% of all airman walk out of their FAA exam with their medical certificate. This is compatible with my 30 plus years of experience although more than 95% leave with certificate in hand.
While few, the medical problems which can cause loss of license are significant. Examples include a stroke with or without a significant neurologic deficit, or a diabetic requiring insulin who requests a First or Second class medical. (Third class applicants however can fly with insulin under a Special Issuance). There is also a short list of other disorders which may result in denials. Even within this group, many have the possibility for Special Issuance, such as returning to flight status following a heart attack.
A bigger issue for both pilot and examiner occurs when something presents during the exam, such as an abnormal ECG, failing of the visual exam, or a medication is listed which is not compatible with flying. At these times, the AME has some decisions to make, and these should be made in concert with the airman.
Most problems that come up typically require further explanation and perhaps a medical report from the treating physician (eg, hypertension, hypothyroidism, kidney stones, and DUI). One option open to the AME is the ability to put “on-hold” an application while the airman gathers the necessary records. The AME has only a limited number of days before they must submit the completed form; between 7 to 10 days maximum. During this time an airman is not typically grounded. If the pilot is proactive and has the reports when they come in for their exam, these health concerns can often be dealt with on the spot by a knowledgeable AME or by the AME contacting the Regional Flight Surgeon for clearance. The proactive pilot will then be in the best position for not losing any time in the air due to lack of or delay in certification.
There likely will be times in a pilot’s career when they are faced with health issues that can potentially ground them. A broken leg or gallbladder surgery are examples. The Guide for Aviation Medical Examiners holds nearly all the protocols and dispositions the AME must follow. However, a trusted and knowledgeable AME has the ability and leeway to help a pilot navigate unforeseen turbulence, especially when the airman is willing to be proactive in their approach to their medical exams. For this reason, we advise all our pilots to call or email with flight related health questions anytime and especially before presenting for their medicals.
To your good health,
Advanced Senior AME
Heart Attack and Stroke Prevention
Family and Sports Medicine
Thank you Dr. Larry!
Please continue to send me your questions. Everything you wanted to know, but were afraid to ask.
Enjoy the Journey!