AINsight: When Pilots Change Aviation Medical Examiners

Once a stable long-term relationship with an aviation medical examiner (AME) has been established, pilots are reluctant to change. I have had similar experiences.

I was sent by my flight school to an AME for an initial student pilot certificate in about 1975 (back in ancient times when the AME issued a combination medical/student pilot certificate). After that, I completed the next 30-plus years of private and professional flying with just two AMEs. I was fortunate in that regard.

If a pilot has some medical conditions that take time and creativity on the part of the AME to maintain their medical certification, there is understandable reluctance to make any changes.

When a pilot receives an unexpected letter from their AME’s office, it is opened with trepidation. A dreaded introduction may follow, with wording such as, “After 35 years as an AME, I have made the difficult decision to retire from practice…” The blood having drained from the pilot’s face, the rest of the letter is read without remembering anything but that first line.

The pilot’s first thought is usually, “What about me?” Soon, however, once the shock has worn off, celebratory congratulations and thanks for years of service will be expressed to the retiring AME. In most cases, the AME will help smooth the transition to a new AME for a pilot who has complicated medical issues.

How can a pilot be prepared for a first visit with a new AME? Notice that I used “prepared” in that last sentence. That is the key: be prepared. 

If a pilot has challenging medical conditions, it is a good idea to communicate with the new AME in advance. Most AMEs will welcome these initial introductions because they save time and stress during that first examination. Perhaps the retiring AME can give an explanatory heads-up to the new AME, facilitating the transition.

Many pilots have known medical conditions that the FAA has approved. OK, so far so good.

However, any such approval may come with requirements to provide follow-up documentation at periodic intervals. These requirements are stated in formal letters sent to the pilot.

As I have discussed previously, these FAA letters typically begin by stating all of the FAR and CFR standards that the pilot does not meet. At first, the pilot is terrified. But read on. Next, the FAA states that the documentation previously submitted is favorable, grants a continued approval status, and outlines what documentation is going to be needed for the pilot’s subsequent examinations.

Do not lose these letters—they are the pilot’s personal Ops Specs. Any FAA requirement in these letters is regulatory. Nothing is optional.

Even if the pilot’s continuity providers do not feel as though the requirements are clinically necessary, said evaluations must be completed. The FAA will not approve the pilot without them.

I have seen FAA letters specifically state that, as medically necessary or not the pilot’s personal providers consider the testing to be, for FAA purposes, they are not optional.

Make a copy of any relevant FAA letters available to the AME (a good copy, in printed form—not in a cellphone screenshot, please).

Read these letters. While there is plenty of unintelligible government medicolegal gobbledygook in these letters, there are parts that a layperson can understand. If it says you need a medical evaluation, blood testing, and perhaps a formal study such as a cardiac stress test, that is pretty simple to understand.

That said, the pilot is not expected to understand every nuance of the requirements, which is why the letter should be forwarded both to continuity providers and the AME. The continuity providers can figure out how to order the proper tests, and the AME will be able to coordinate how the documentation needs to be presented to streamline the follow-up FAA review process.

Some FAA follow-up requirements (if there are any) may be stated to the pilot in an eligibility or clearance letter. These are simple and straightforward.

I have discussed the various other protocols the FAA places on a pilot, including the Conditions the AME Can Issue (CACI) and the AME Assisted Special Issuance (AASI) programs. Somewhat stricter formal special issuance considerations have also been discussed in prior AIN blogs.

Do not make the mistake of assuming the new AME will handle things precisely as the former one might have. While there are clear and measurable standards to the FAA examination, along with increasingly useful protocols and checklists for AMEs (and pilots and their providers), there is always some art to medicine.

All AMEs, no different than all continuity care or specialty physicians, have their own individual practice philosophies when working with patients, evaluating their medical data, and—in the case of pilots—presenting the case to the FAA to justify why the AME issued the medical certificate or what the reasoning was in deciding not to issue it.

All FAA medical applications must now be completed, in advance, by the pilot via the MedXpress platform. This has been a requirement for more than a decade. Therefore, every pilot reading this blog has labored through MedXpress before.

99.9% of the time, the AME will expect that the pilot has completed MedXpress and has their confirmation number readily available. Do not make the mistake of forgetting where in your phone the email confirmation number might be accessed. Ensure that the confirmation number is immediately available for the AME office.

If possible, print out a copy of the application. This way, should the internet or the FAA website itself be inaccessible, the AME can at least review the pilot’s data entries.

Do not wait until just a few hours before the FAA examination to complete MedXpress. Do it at least a few days in advance, so that there is additional time available should the pilot be unable to access the internet temporarily.

It is very important that all items that had previously been checked “yes” on the MedXpress are checked “yes” in future applications. It adds confusion to the FAA and AME alike if there are inconsistencies.

Save yourself the stress of receiving the dreaded “nastygram” from the FAA by simply making sure you do not omit entries that have been previously reported. Also important is to clearly enter any new medical condition(s) that may have occurred since the prior FAA examination was completed.

When there are significant new conditions to report, a proactive call to the AME may be very useful to prevent certification delays that might have been dealt with in advance of the next FAA medical examination.

An unforeseen change in AMEs can be a bit traumatizing at first. However, the take-home message is to breathe and realize that, with some preparation, all will be well.

Be prepared and proactive. Have all required documentation available at the time of the next FAA examination. Complete MedXpress and have the confirmation number readily available.

If there are new medical conditions or medications to report, contact the AME in advance to streamline the certification process, thereby reducing the risk of unfortunate certification delays. 

FAA medical examinations themselves, let alone if a new AME is involved, can be stressful for pilots, just like periodic simulator training events. With a bit of preparation, things will usually go smoothly. Hopefully, in time, the pilot will develop a comfortable rapport with their new AME.