Going Direct: Does Your FAA Medical Mean Anything?

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I was talking on the phone yesterday with a friend who’s had the distinct non-pleasure of going back and forth with the FAA about his special issuance medical. In the spirit of full disclosure, he has two health issues the FAA is concerned about, one, atrial fibrillation, that’s arguably justly concerning, and the other, prostate cancer that’s been treated.

This isn’t about what a morass of bureaucracy the FAA’s medical division is, and it is. Want to talk to a live person? Good luck. Want to leave a voicemail for them to follow up on? Ha! My buddy after all this time finally got the paperwork from the FAA for his special issuance, and it took nine months to do so, only to be informed by the FAA that his medical clock started ticking when he started the process not when he finished it, so all this work was for three months of flying. Then he gets to start again.

My even bigger issue is that the FAA is concerned about his prostate cancer, which isn’t there any more. The heart issues I get. If someone has a stroke or a heart attack—and they can come without warning—while flying, then it could be game over for everybody onboard, that is if he could no longer fly the plane and if the person in the other pilot position couldn’t fly it either. It’s exceedingly rare when that happens, maybe a couple of times a year, maybe a few more times that are suspicious but can’t be proven. Still, I get their concern, even if the risks aren’t very high. I mean, every time we go flying the engine could quit over a landscape of water and alligators, but we do it anyways. There’s risk.

But the prostate cancer is another issue altogether. With this one, what is the FAA really worried about? This is the slowest spreading cancer, and if it goes bad and the person gets sick, you can bet he is not going to be out flying. In short, it’s an illness that doesn’t have a sudden onset component and that the pilots affected by it will self regulate. So why is the FAA getting involved? You got me. I have to assume it’s because they’re big and powerful, so they can.

Just how important are flight physicals to safety of flight? I think they have a really minor impact on it. In fact, I wonder if aviation would be safer if every pilot instead of getting a regular flight physical attended a three-hour long presentation on how to avoid in-flight loss of control. If the FAA were to do that, the accident rate might not drop precipitously, but it would save more lives that flight physicals do.

How do I know this? I don’t. But the evidence strongly suggests that safety education results in fewer accidents and fewer deaths. Although they don’t publicize it much, the airlines have achieved a nearly perfect safety record due to the innovative safety programs they’ve adopted, not to mention the requirement that airline pilots get checked every six months, as opposed to every two years for most of us, or even less, depending on your age and the type of medical certification you opt for.

Ideally, politics and medicine would be separate disciplines (admitting that the term “discipline” is generous when applied to politics). Medicine is a science, and while it’s practiced imperfectly, the idea has its roots in the scientific theory. In medicine that translates into treating patients with medications and procedures that the evidence shows work and have the fewest associated risks. So as researchers study the effect of particular treatments, doctors can then modify their practices in order to come up with better outcomes.

Another central tenant of medicine is to do no harm. This can be tougher to stick to than you might think. To do no harm might be to avoid doing a surgery when doing it gives the patient worse odds than not doing it. Again, evidence based care rules the day, and individual outcomes and overall survival rates almost always increase, sometimes dramatically, when doctors use best practices based on hard evidence.

So let’s get back to the FAA and the subject of medical certification. If the FAA requires pilots to get a medical certificate to go flying a certified airplane, and they do, shouldn’t there be an evidence-based model to justify that decision? Who is benefitting? How many lives are saved? How long should pilots go between flight physicals, and what evidence supports those intervals? The answer to all of these questions is, we don’t have supporting data on any of those practices. So if the FAA keeps a pilot out of the cockpit because they’re taking a medication that’s on the agency’s banned list, right or wrong that is  doing harm to the pilot, and if there isn’t any evidence showing that there’s an increased risk to the pilot or the public, then that’s unethical.

I don’t think it’s too much to ask for the FAA to provide supporting documentation for its medical determinations. After all, if the agency is making decisions based on what’s best for the public, it will be able to produce the evidence and that evidence will support those decisions, right?

In some cases, that’s certain to be the case. With pilots who’ve undergone major coronary surgery, the FAA would surely be able to find data to back up their determinations. The problem comes when they can’t find any supporting data or when the data they can find contradicts the FAA’s actual practices. In those cases, I think the agency should be required to amend their guidance to reflect the evidence.

BasicMed has proven a popular route to medical certification. It’s not as basic as I’d like, but when the FAA studies the safety implications of it, I’m guessing it will find that there’s been no loss of safety for pilots flying under BasicMed. That should be all the evidence it takes to make conventional certification a lot more basic itself.

 

11 thoughts on “Going Direct: Does Your FAA Medical Mean Anything?

  1. You’re 100% right! I wish everyone would think the way You do!
    Yes, that is talking (or writing) direct!

  2. The FAA medical process has absolutely nothing to do with health. It never has – it’s a self-licking ice cream cone that only serves to perpetuate a useless bureaucracy. There might’ve been a time where some of the contents were relevant to flight, but in this day & age, if you are healthy enough to hold a drivers license, you are healthy enough to fly.

    I agree that certain additional factors should be required when someone wants to fly an airliner with 300 pax on board, but otherwise, there should be NO need for any kind of FAA medical certification. Having said that, the FAA medical certification process doesn’t seem to prevent pilots of airliners from dropping dead of heart attacks during flight. The kind of arbitrary “determinations” the FAA makes with regards to health are discriminatory at best, and would very likely not be tolerated in any other capacity.

    BasicMed needs to be expanded to cover ALL non-commercial operations. Period.

  3. Exactly the reason that I quit flying. I had an indicator for a cancer. Didn’t have the cancer but had the indicator. Only 2% of those with the indicator ever got cancer. Went through the special issuance every year. Then one year had a very mild heart attack with no residual damage to the heart. Got some stents, then a year later was told that one of the stents was completely blocked. Took the stress test and was told by my cardiologist that I was in great condition even with the blocked artery. Collateral circulation goes around the blockage. Have my stress test every other year, same result so far. I could just see some doctor sitting at a desk, having never seen me, and totally freaking out thinking I would die immediately if I ever sat in a plane again. Better things to do than worry about dip wads in OKC.

  4. I had sleep Apnea and had prostrate cancel. A cyst in the upper right chamber of my heart that removed with no side effects. I have high blood pressure and the same prescription for ten years. I had cataract surgery. All these required multiple doctor visits and reports for doctors condition is rare and generally detected at death. I have high blood on my status. Did this for several years. Slowly the special issuance requirements reduce as my medical conditions improved. If was not for insurance coverage I would not be flying. When BASIC MED was approved, I jumped at the opportunity. I also have a deep seeded dislike for FAA medical overzealous grip on those how to want to fly, understand the responsibilities and would not put theirs of other lives at risk. In my case, the special issuance was good for six months. What on earth do those people do with their time? Are their electronics that outdated. Are they that paranoid? I would have kept my 3rd class, however, I don’t like running up all that expense against my insurance to appease FAA MEDICAL EXAMINATION BOARD ego.

  5. Outside of ATC service most all other units in the FAA are a disgrace to the Agency. Try to get something accomplished through a FSDO and you will agree. Something needs to change.

  6. As a government bureaucrat – virtually impossible to fire and whose pay grade is “empirically” based on “volume of items processed” (not time to resolution or the quality there of) and with no real accountability to the citizens they serve, it comes as no surprise that “no” and “give me more information” are the safest and smartest answers–keeps the paper work volume up (and pay grade rising), while mitigating risk (to the comfortably employed government worker).
    If reason and logic and data analysis prevailed, the strictest medical requirements would apply to drivers of private automobiles not pilots of private airplanes. Private Drives kill far more people far more frequently than Private Pilots-

  7. Outstanding analysis! Mr. Goyer just layed out such a clear, honest argument, that the FAA will surely feel threatened and circle their wagons in even tighter.

    I too have endured the FAA’s obscene bureaucracy. I am probably so tainted by the abuse I received, that I’m not even-handed on the subject. But Mr. Goyer does present such clear, fair logic; how could reasonable people dismiss his questions?

    Certainly the FAA isn’t even-handed.

  8. Amen brother, and while you are at it write an essay on the insurance industries practices finding ways to force pilots to get a third class because they do not like their age. It happened to me. Passed Basic Med only to have them declare no coverage for my flying club without a third class medical.

  9. This gentleman has said it all. The DOs at the FAA should concern themselves with Medical Issues that can effect people suddenly not ones that give Ample Warning. Besides, I firmly believe my life and My health is primarily of Highest Concern to me, even my wife, son / daughter can and will leave me to take care of it on my own, once the going gets tough. When the FAA tells me they are the guardians of my Life and Health, it is BS!

  10. I gave up on the why. I now hire a company with an office down the street from the FAA who speaks their language. My last 7 medicals have been WAY faster and generally painless. Their website is leftseat.com. They also smoothed out the BasicMed process for a friend. Basic works fine for some but it jacks-up insurance and it’s not likely to apply to ATP’s anytime soon.

  11. The FAA is unethical. You are correct in that assumption. A pilot refusing to take medication that may benefit them to appease the FAA god is wrong and wasted money over the years is wrong!

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