by Dr. Bill Blank, M.D.,Senior AME
Published in Midwest Flyer – April/May 2020 issue
I just returned from speaking at an FAA Aviation Medical Examiner (AME) refresher course in Nashville. AMEs are required to perform at least 10 flight physicals per year, attend a 2 ½ day refresher course every 3 years, and are graded on performance (i.e. the number of errors on exams). Too many errors can result in termination. There are approximately 2650 AMEs in the U.S., and this number has been gradually decreasing. Consequently, the FAA may need to start recruiting AMEs. Fewer new AMEs are pilots, so they have less understanding of the system and a pilot’s needs.
In federal year 2019, there were 393,789 medical applications. This works out to about 32,000 per month. Approximately 35,000 “special issuances” were authorized in 2019. The FAA policy is to certify as many airmen as can safely be certified. This is time consuming.
A major cause of certification delays is the obsolete system used. The major way the FAA receives medical records for special issuances is by paper copy mailed to them. Every page has to be scanned. That can take one to two weeks. No one looks at the records until they have been scanned into the computer system. There can easily be a one-month delay between the time the records have been scanned and mailed, and someone looks at them.
Technicians called legal instrument examiners (LIEs) review the records. In many cases, the LIEs have everything needed and can authorize issuance under the signature of an FAA physician. An internal email is sent to the typing pool where it can take between one and two weeks to get the letter in the mail.
If more information is needed, a request letter will be sent. There is no phone number or email address on the letter in case you have questions. Of course, you will need to gather the data, mail it to them and have it go through the same process of scanning, etc. Most of these cases will need to be reviewed by a physician who can either issue the certificate or ask for further information. When the physician is satisfied, an authorization is sent to the typing pool. There are less than 50 FAA physicians who review these applications. First and Second-Class Medicals have priority.
You can see why it takes so long. Amazon wouldn’t be where it is today with such a cumbersome system. Major hospital systems send millions of records daily at light speed, while the FAA is using the U.S. Postal Service.
What you can do to help speed up the medical certification process!
First, only submit information when it is absolutely necessary. The FAA prefers that AMEs certify as many airmen as possible. As I have previously written, when your AME enters your confirmation number in the FAA computer system and imports your application (Form 8500-8), the medical exam has started. Your AME is required to electronically submit your application within 14 days from the date of your examination. He has two choices – issue or defer. We are strongly advised to never deny.
You need to do your homework ahead of time. If you check YES to any of the questions on the 8500-8, your AME needs supporting information so that he/she can issue the certificate. If you reported a tonsillectomy when you were 5 years old and are now 46, nothing would be needed. Remember, though, that you need to report it on every exam. The question asks, “Have you ever?” I don’t have the space to explain the logic of this. If you plan to check YES to something, I would go to the AOPA or FAA websites to see what will be needed.
AMEs use an online publication called “The AME Guide.” It is available at http://www.faa.gov/go/ameguide. Go to “Decision Considerations.” You may not be a physician, but it is clear enough for you to have an idea of what you will need and whether you can be certified via “Conditions AMEs Can Issue” (CACI), or if you will need a special issuance. If a CACI is needed, print out the worksheet, write your name at at the top, and take it to your treating physician. Ask him/her to answer the questions and sign and date it. Then take the worksheet to your AME. This can be done up to 60 days ahead of time. Don’t even start the exam until you have this information.
These days, you would have to be very lucky to see a physician and get a report within 14 days. If it has to go to Oklahoma City, you would be fortunate to have your medical in six (6) weeks. You sure don’t want this to happen, if better planning could have prevented it. The last thing you want to do is send it in to see what the FAA wants.
Sometimes your AME will have to defer because you need a special issuance. Be sure to send EVERYTHING they ask for the first time! You don’t want them to have to request additional information.
You will need a letter from your treating physician to apply for a special issuance. Be sure you read his letter. If he hasn’t covered everything required, ask him to rewrite it. It will save time. Read all of the reports that you are sending. Make sure nothing is omitted! I wouldn’t request a special issuance until I was reasonably sure it would be issued.
If things seem to be taking a long time, you can call and inquire. In most cases, calling the regional flight surgeon’s office will be more helpful. You will not be permitted to talk to a physician. This is where a savvy AME can be a big help.
I wait one to two weeks to make sure all documents have been scanned, then call or email an FAA physician to see if the information has been received and whether anything else is needed. This requires that someone look at your application. By the time this has been done, the physician might put it on his to-do list and get it done. If more information is needed, you are weeks ahead of the process. You can be gathering the information before you ever receive the letter from them telling you what you need. If the information requested is not too long, your AME can FAX it to them.
Many FAA medical and administrative personnel are conscientious, professional and helpful, and are well aware of the system’s shortcomings. As we all know, the government works slowly. By understanding the system and your options, you can make the system work as well as possible and help speed up your certification. At the same time, you are helping the FAA staff to be as efficient as possible.
EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985.
Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII) and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season and held a Statement of Aerobatic Competency (SAC) since 1987.
DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.
