Flying Physicians Favor Medical Reform

The Flying Physicians Association (FPA) recently polled its members and found that the flying docs overwhelmingly support the bills in Congress to reform the third class medical system.

As I’m sure you know, the General Aviation Pilot Protection Act introduced in both the House and Senate would allow pilots to fly most piston airplanes, including twins and retractables, using a driver’s license as evidence of medical fitness.

Over 81 percent of the FPA members responding to the query support implementation of the new policy. Interestingly, of the 18 or so percent of the doctors who disagree 9 percent of those don’t believe the proposed law goes far enough. Specifically that group of doctors want to see IFR flying allowed while the bill in Congress would limit pilots flying with a driver’s license to VFR only.

Add it up and 90 percent of the flying doctors in the FPA survey believe the third class medical system as it exists is not necessary, does not add to safety, and can be eliminated for private flying.

The FPA is 60 years old and is dedicated to promoting safety, education and research. The group has also worked hard to promote the use of aircraft in support of medical services and emergencies.

Like all of general aviation activity FPA membership has declined in recent years. However, new invigorated leadership has reversed the membership drop and now more doctors are joining than departing.

I’ve been fortunate to be invited to speak at several FPA events over the years and it is always a gratifying experience. The flying docs are very serious about their aviating as well as their medical practice. Despite the old saw about doctors and Bonanzas they fly a huge variety of airplanes.

A significant number of FPA members are also AMEs. When the topic of the medical certificate comes up the FPA members that I have spoken with usually split along the lines of AMEs supporting the requirement while the other flying docs do not.

The easy target to ridicule within the FAA medical system is the concept of sudden incapacitation. The idea that a third class exam assures that a pilot will not only survive, but be healthy, for the next two years is ludicrous. When I ask non-AME doctors how long they “guarantee” their patients will live they usually say something like “I think they can make it to the parking lot.”

But the thoughtful AMEs–and there are many–also discount the effectiveness of the medical certification in avoiding a sudden pilot incapacitation event. They know the entire medical industry is not capable of predicting who will be struck by a sudden illness so the third class medical exam essentially has no chance of succeeding.

But what does worry every AME who is an FPA member that I have chatted with is changes in a pilot’s cognitive ability and overall physical functioning capability, particularly as we age. Who will be there to tell us when it’s time to close our logbooks if there is no regular exam and no required visit with a medical professional?

That is a valid concern. Families face that same question when it comes time to decide if elderly parents are still fit to drive. And those decisions on how long an aging parent should drive seldom revolve around specific medical conditions as the FAA medical certification system does.

But, FPA members are all pilots and are all physicians and the huge majority reach the same conclusions about the third class medical as the rest of us who are pilots but not docs. Doctors who fly agree that the third class medical is adding a burden with very little benefit.

It will be interesting to see how the FAA defends its medical certification procedures when even a big majority of doctor-pilots don’t believe they work.

As for the really tough decision about when to close the hangar door for the last time, well, that should be made by those of us who fly with the help of people we know and trust.



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23 Responses to Flying Physicians Favor Medical Reform

  1. stan sanders says:

    Indeed, cardiovascular disease does not tend to result in a fatal accident in high capacity, two-pilot commercial passenger-carrying operations. In the period 1980 to 1996, no fatal accidents anywhere in the world for commercial air transport operations above 5,700 kg occurred in which cardiovascular incapacitation of the crew was cited as a cause

  2. stan sanders says:

    The majority of pilot incapacitation events recorded by the ATSB do not involve a chronic or pre-existing medical condition. That is, they are largely unforeseeable events, often involving acute illnesses or injury. Many are not in themselves life threatening, but are capable of impairing a pilot’s performance to the extent that safe operation of the aircraft may be adversely affected. This study also confirms the findings from other international reports that gastrointestinal illness is the most common cause of in-flight incapacitation in the pilot population.

  3. TedK says:

    I think Mac hit the nail on the head. The real question is when to hang up one’s spurs, not only in the cockpit but with the car. Frankly, I have been more concerned about some aged aviators making it safely to the airport due to momentary lapses in attention than I have been in their ability to fly VFR. I think this come back to a larger and more threatening issue of aged drivers and the when and how of retiring their Drivers Licenses.

    • Jeff Boatright says:

      I have similar concerns, Ken. I’ve seen a couple of older friends do just fine flying low and slow around the pattern on an easy Saturday morning – and that’s all they’re interested in doing, but somehow their cars have more and more dings…and their “war stories” mainly involve what happened to them on the way to the airport than what happened in the “wild” blue yonder.

  4. Boyd says:

    Hi Mack,

    In my 33 years as a flight deck crewmember for a major airline, I walked out of the AME’s office with a fresh medical certificate time after time….but could have dropped dead driving home. “Self certification” for medical fitness is an on-going process which must be assessed before each flight….and each drive!

  5. Ken K. says:

    Yup it’s the obvious answer.. a person’s ability to fly safely does indeed degrade over time (come on guys, it’s only natural, be honest about it). The problem with the aviator’s medical is it does not examine the pilot for the symptoms that are in fact a detriment to flying safely – factors such as reaction times, spacial (dis)orientation, balance, attention deficit, visual perceptiveness, hearing, etc etc. Instead it looks at factors such as, for example, blood pressure. Now, we all know we shouldn’t walk around with high blood pressure, but blood pressure (high or not) has absolutely nothing to do with flying safely.

    The problem isn’t so much that there is a medical exam we must pass, but rather with the nature of what is being examined.

    • Warren Graef says:

      Then there is diabetes. If the diabetes is treated and the person has not had any kind of episode, he is safe to drive his car, why isn’t he safe to fly a plane VFR. I have had diabetes for 10 years and been on insulin for 6 years and have never had any kind of incident. Yet, the AME wants to see a sleep test, a Pulmonary Function Test, a Stress Test and an A-1c below 7. I drive a pick up in construction and oil field consulting sometimes 12 hours because I can’t simply fly there any more. I think it is time to change the rules.

  6. JC5404L says:

    This is great news – that the flying MD’s see this issue the same way Joe-Pilot does. I’m pleasantly surprised. As one who’s been caught in the Special Issuance nightmare I’m watching progress on this issue like a hawk (yes, the eyes still work that well). Greatly appreciate the additional support thrown behind the effort. Let’s hope the FAA and/or Congress acts soon. Long overdue in my humble opinion.

    • Sarah A says:

      Take note that according to the anacdotal evidence that the only flying doctors who do not support the roll back of the 3rd class were the ones that were AME’s. It is purely a matter of money to them and they want to keep getting those payments for the 3rd class medicals they administer. My feeling is if a docotr has a financial stake in the outcome, they are not qualified to comment on the congressional action to pass the GAPPA. The comments are only valid and unbiased when they come from doctors who will not be losing business.

      • Mac says:

        Sorry, Sarah. That’s a fiction. Few AMEs make money doing FAA exams. In fact many probably even lose a little because their time would be more valuable performing other exams and procedures.
        For example, the equipment used by the FAA for the EKG exam is essentially obsolete and not used for other “normal” patient tests, but AMEs have to buy and use this expensive equipment only to perform FAA exams.
        We can disagree with AMEs, but I refuse to doubt their motives are anything but a sincere belief that they are helping to promote safety, and also helping to keep pilots flying under the rules that exist.
        Mac Mc

        • Sarah A says:

          OK so lets take this a little further. You contend that these flying Docs are performing FAA medicals as a service to their fellow pilots. I will buy that argument since without a medical you cannot fly above the LSA level so they are a necessary evil for the moment and those who can pass the FAA criteria need someone to administer the test. So what is it that these Pilot-AME’s know that the non-AME flying docs do not know which makes them feel that continuing the 3rd class is a good idea ? Are they routinly grounding pilots and keeping the skies safe ? Why do they have a different view point that is not related to a financial stake in keeping their appointment books full. And the argument about the EKG for the 1st class does not fit here, we are talking 3rd class where no such requirement applies. You are the one that has the contacts so please enlighten us as to what they are saying in defenese of the 3rd class.

          • Donald DeLong says:

            I must agree with Sarah. Additionally as a veterinarian I am somewhat aware of EKG machines. I would love to know why the FAA would allow data from an older possibly less accurate machine , as stated by Mac, and not accept the findings from a more modern ” usefull” machine.

        • Rob says:

          Mac: If the difference between non-AME physicians and AME-physicians who support dropping the Class III is statistically significant (and the reports I have seen suggest that the contrast is stark), we are obligated to explain the variance.

          For that explanation to be rooted in science, we would have to have answers to the empirical questions: (a) what is the *distinctive* contribution of the Class III Medical to the prediction of health-caused non-commercial GA accidents, (b) how does ‘a’ compare to the proposed alternative (i.e., DL, self-certification, and required recurrent training), and (c) does the margin between ‘a’ and ‘b’ (should it turn out to be positive, which is unlikely), justify the aggregate cost of maintaining the Class III system.

          Since AMEs do not have answers to these questions, their support of the current system must rest on other considerations. It may be that their experiences have led them to think (without objective evidence) that their activities are contributing to safety. However, it is also possible, and quite likely in my opinion, that personal incentives are at play as well, perhaps unconsciously. One AME friend tells me that the work is very profitable. He lines pilots up in mass every other Thursday and his PA runs through 5-6 per hour for the full day, while he is seeing other patients. His face time with each pilot averages 2-3 minutes.

          Getting back to the real questions, we now have 10 years of LSA data. Is there a single accident that would have been prevented by a distinctive contribution of a Class III? I am not aware of any.

  7. Eric7 says:

    When to hang it up…that’s the big issue. I have a friend who’s flown for most of his life but, increasingly, he’s not up to the task. He blames his airplanes and has now changed airplanes twice, thinking that would solve the problem. I watch him fly and it’s got nothing to do with the airplane and everything to do with him.

    Personally, I would welcome some sort of testing that would help me assess my ability to continue to fly competently. Why? Clearly, we are notoriously poor judges of our own abilities when it comes to flying.

  8. Josh Johnson says:

    I think we already have the process in place to decide when one must ‘retire’ their wings – it’s the flight review. Perhaps some additional training to flight instructors would satisfy this requirement – even adding medical awareness to the items required in a flight review might solve the whole issue of pilot self-assessment training in lieu of a third class medical.

    • Mac says:

      Good point, Josh. The biennial flight review is a chance for a CFI to see a pilot in action. But as you know, the flight review is not a pass-fail event like a checkride. It would take some rules adjustment to allow a CFI to “ground” a pilot and prohibit him from flying based on the flight review. But it would make more sense than the medical certification because at least the review is performance based in an airplane.
      Mac Mc

      • Jim O says:

        TECHNICALLY correct, but since the PASS is required to continue flying, a NON-PASS does effectively ground the pilot (after his current review expires and he finds someone to pass him).

    • Sarah A says:

      An interesting concept that provides a better look at a pilots true ability to continue flying. Not that CFI’s are qualified to make medical decisions but it puts an independant observer in the cockpit with a pilot while accessing their ability to peroform normal flight duties.

  9. Donald DeLong says:

    Josh, I think you have the best answer yet. I would suggest changing the flight review to a pass , fail event. In the case of a fail, I propose the pilot must pass a check ride with a designated examiner to reinstate his or her pilot privileges.

  10. Josh Johnson says:

    The idea of a reinstatement ride with a DE is interesting. Along these lines, I have always wished we could approve a flight review limited to solo privileges only. Take for example, the pilot who hasn’t flown in 20 years. We either sign off the whole enchilada – they get full VFR pilot privileges back, or no sign off at all, and the pilot cannot fly without an instructor in the cockpit. It seems to me that allowing this pilot to solo a few hours into his or her recurrent training would make sense, while limiting their exposure to that of a student pilot. This might also be a step for the pilot who might be approaching the end of their career due to age or other medical reasons – no passengers unless the passenger is a rated pilot.

  11. Jim Whiteley says:

    I feel the real obstacle is the manufactures of the LSA airplanes which sells for 125,000.00 plus. Most of us would you rather have a Cessna 177B or a Piper Comanche for one third of that price. Others like my self could just keep flying our own planes.

    • Sarah A says:

      I would say that the manufacturers of those SLSA aircraft are not on or friends list in trying to get the GAPPA passed. I am not sure if the data exists but I would bet that the great majority of these high priced but limited performance aircraft are people like me who have regular licenses but no medical to go with it. That explanins the elaborate instrument panels and luxary interiors that have become the norm for what was supposed to be a basic class of aircraft for the begining pilot to use as a stepping stone to higher ratings. With the passage of GAPPA the SLSA market will significantly dry up and while the aircraft designs could be moved to the EAB catagory and made more rational (i.e. get rid of huge wings and increase the GW) they cannot be sold as an off-the-shelf complete aircraft. That still leaves the option for builder “Assistance” programs so common to the high end EAB aircraft but that is still not the same as writing a check and flying away with a new aircraft. I have not heard much comment from these aircraft manufactures but I would bet they are silently working against GAPPA for their own sakes. At lesat that is my own assessment of the situation and others might feel differently.

  12. Mike Berg says:

    There are some us (ahem) who are on the plus side of 70 that have chosen to fly a Aeronca, Taylorcraft, J-Piper, etc. rather than jump through the FAA 3rd class medical hoops. Safety wise a 172, Cherokee, etc. would be much better in nasty cross wind landing rather than a quirky tailwheel on hard surface not to mention being able to travel in a bit more comfort with better radio and navigation equipment. Paying $125,000+ for a LS toy just doesn’t make common sense and that’s probably why they aren’t selling well. My choice, if I could afford it, would be a RV12 but that’s also a $80,000 machine plus having to build it.

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