Exam Prep

I appreciated reader’s comments about “Unintended Consequences” last month.  The broad subject of the future of our health care delivery system is clearly one in which opinions are strong and passionate. Judging from some comments, readers may not have understood that I was simply suggesting “possible scenarios” that pilots might face under a government-managed health care system.  That was not an affirmation that our current system is running smoothly on all cylinders, nor was it necessarily an indictment of the health care legislation passed earlier this year. Regardless of which side of the argument one’s on, our current system, as good as it is, leaves much to be desired. Fraudulent Medicare claims payments and astronomical prescription drug prices are just two examples of some really low fruit that must be addressed, with or without a fundamental change in the way our nation’s health care is administered.

I heard from a couple of AME colleagues and that prompted me to comment on the valuable role of Aviation Medical Examiners in the medical certification process.  AMEs, much like Designated Pilot Examiners, are authorized by the FAA to perform airman medical examinations, and are under the supervision of their nine respective Regional Flight Surgeons around the country. The docs represent a diverse group of medical specialties such as Family Practice, ENT, Neurology, Cardiology, and Aerospace Medicine.  About 50% hold at least a Private Pilot certificate.  Many are full time private practice physicians who see patients all day and devote a few hours or more a week to performing FAA physical exams. 

The Medical Certification specialists in the Pilot Information Center are sometimes asked by members to recommend a “good” AME in the pilot’s local area.  We can’t really make recommendations, although I personally know a decent number of AMEs around the country, and if a pilot is in the general area of one of them, I will gladly suggest the pilot give them a call.  Of course, not all AMEs are created equally, so there are some really outstanding ones, some who are OK, and a small number who cause us to scratch our heads and wonder what were they thinking?

Finding an AME who “speaks airplane” and is willing to work with the pilot who has a medical certification issue is the ideal situation.  Word of mouth seems to be the mechanism by which most pilots find their medical examiners.  If you’re new to an area, hang out at the airport for a few hours on the weekend and it probably won’t take long to find out who the locals see for their flight physicals.  WWW.FAA.gov and www.aopa.org are two websites that can provide a database of aviation medical examiners.  On our AOPA site, you can use several different search parameters to locate an AME by his/her name, city, state, or zip code.  The list also identifies Sr. AMEs who can perform First Class physicals, and also lists their pilot credentials.

It’s important to consider that an FAA physical exam is not intended to replace a comprehensive work up with your own family doctor.  Some pilots’ AMEs also happen to be their treating physicians, and there are situations where that can be beneficial, and times when it isn’t.  The FAA generally suggests that your aviation medical examiner should be just your AME and not also your primary care doctor.  Placing the AME in the position of wearing both hats could create a conflict with physician/patient confidentiality and the AME’s responsibility as an FAA-designee. 

The encounter with an AME for a flight physical has two important elements that the examiner, and ultimately, the FAA, considers when issuing a medical certificate.  One is the medical history the pilot provides on the front side of the FAA Form 8500-8.  We pilots are responsible for the accuracy of the history part of the application, and for that reason AOPA developed TurboMedical as a pre-examination planning tool to help with the process. The other is the physical examination performed by the AME that could identify potential safety of flight issues such as an undetected inguinal hernia that could strangulate a loop of bowel, untreated high blood pressure, a significant change in visual acuity since the last exam, or a heart murmur that could suggest a failing valve. There are three, well actually, four choices for an AME when examining a pilot.  He can issue the medical, which we all hope for, hold the application for a couple of weeks and asks the pilot for some additional information before the certificate can be issued, defer the application to the FAA for a decision, which means the pilot leaves the office empty handed, or, even deny the application if the pilot clearly doesn’t meet the medical standards for the class of medical applied for. I’ll get into more details in future installments about the deferral process and how to avoid or deal with it when it happens.

Finding an AME who you can build a rapport with is like finding an A&P to do your annual inspection.  If the chemistry “clicks” and you feel comfortable in the relationship, stick with it as long as you can.

Gary Crump
Director, Medical Certification Services

AOPA Pilot Information Center  |  AOPA Medical Services Program

7 Responses to “Exam Prep”

  1. Dear Gary,
    As a pilot since 1965, an M.D. since 1968, Instrument Rated and Current since 1969, Contract AME at Oakland Air Route Traffic Control Center since 1993 and HIMS certified since 2010 I try to do everything I can for my airmen. The most important is to call OK City while I am doing the exam to try to get approval for issuance while they are in the exam room with me.
    Keep up the great work.
    Jim Simon, M.D.

  2. Gerald L. Marketos ,M.D. says:

    Good article, Gary
    As I’m sure you know, all AME’s must undergo recurrent training every three years. Until my recent attendance last March, AME’s were drilled to defer when in doubt. However, there has been a change, due mostly to FAA staffing cuts, I believe, but also, again my opinion, that the AME has better tools with which to make decisions.
    We are now encouraged to call our Regional Flight Surgeon or one of the duty MD’s at Oklahoma City while the applicant is in the office and see what we can do to issue a medical right away or what the airman must do further in hopes of qualification.
    Since last March, I have been able to certify several after a phone call.

    Also, your premise that the AME cannot substitute for a thorough annual medical exam is an excellent one.

    Gerald L. Marketos, M.D. FACA
    Senior Aviation Medical Examiner 14284
    Rome, NY (KRME)

  3. David Black says:

    How do you report an incompetent AME. I have been flying for 50 years without a problem with a physical. I move to MD two years ago. I had to get a special for my pacemaker. I found the name of an AME at a local airport and went to him. Based on AOPA medical information I had copies of all the necessary paperwork.

    This doctor totally messed up the paper work. By his standards I was color blind. He made me take a stress test ($250). There were other items that were incorrect. He then filled out the paperwork incorrectly. Needless to say, I got a long letter from the FAA and went back to square one.

    I went to my cardiologist (one of the best in the USA) who looked at the stress test and said that the machine the AME used was broken. He gave me a new accurate stress test. The eye doctor I went to said there was nothing wrong with my eyes. All the things the AME said were wrong were determine not wrong when I went to a specialist.

    How do we have AME like that still ripping off pilots. This doctor was just going after money.

    David Black
    Fairfax, VA

  4. air jordan says:

    Downright grateful for your posts. I have been looking around the page, as my colleagues mentioned that from them, and was thrilled when I can find it following a long period of time to find. I hope to demonstrate appropriate commentary grateful for your site, because it is a very inspiring thing, and many writers do not recognize the security they deserve. I believe I’ll be back, definitely a good friend sent me

  5. Norman says:

    I guess from the gyst of the article the author is engaged in hero worship, or is terribly smug. I think the internist I have used for several years knows me better than the AME I see once every two years. I guess my physician is incapable of finding that loop of intestine and only an AME could, then rip me off for $90.

    Third class medical is a sham in this era. I’ve decided that aviating is a rich man’s hobby and there are better things to do than sit around while some bozo and some government body full of bozos tells me I can’t enjoy my hobby because of some minor problem. Sorry we can’t all be Harrison Ford, Smilin’ Jack or Steve Canyon.

  6. Ron Young says:

    Sounds like I have been doing some of this wrong. For special issuance, this year my 2nd class took 3.5 months. That is a LONG time, and cost me a seasons work. If I had only known to try and hook up with a Regional Flight Surgeon, might have saved the season.
    Also, I recommend everyone read latest ‘how to’ page here on AOPA site before going for any special issuance exams.

  7. Donald Hobel says:

    Survey link for Woody Cahall did not come up
    Requesting assistance thru Jo Ann Wilson to get my medical thru FAA bureaucracy
    AME aparently determined to keep me grounded by refering her faulty hearing check to OK city
    FAA Spec calls for conversational speech audio level.
    She did not do that, but went to electronic test which she did not approve
    Then sent to independent lab
    FAA allows for 70% hearing level
    Test came back 84% & 88%
    AME Insisted had to go to OK City so time is wasting as good weather goes by.
    My Pilot ID 2050267 Towing gliders is all I need medical for

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