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.