Avoiding health care
Addressing onerous third class medical requirements
Today, more than 50,000 pilots are actively flying with non-AME exams—and, according to the FAA, with no difference shown in accident rates or medical incapacitations in flight when compared to a third class medical. The data shows that FAA third class medical requirements for any pilot with medical issues are not clinically indicated and statistically irrelevant.
I attended a conference at Brook Army Medical Center led by Dr. William Hoffman, a neurologist who is investigating pilots’ health care. Hoffman, in conjunction with the University of North Dakota and others, is designing studies to help enlighten the reasons for the avoidance of health care and non-reporting of medical issues on flight medicals in both the military and civilian pilot populations.
BasicMed was enacted by Congress to get around the bureaucracy and delays associated with third-class medicals and to improve the private pilot, private physician relationship. The successful program increased the duration of the medical qualification for those over 40 years of age but also requires the pilot to take an online education course covering aeromedical topics. There is no equivalent educational requirement to obtain a third class medical. One of the most important aspects of BasicMed is that, after an initial AME exam, subsequent exams can be conducted by an AME or by a state licensed physician.
In other words, exams can be done by your own doctor, someone who knows your medical history better than anyone, someone that you can talk to about a condition and get treated without the fear of losing your certificate. Pilots are required to self-certify before each flight, and this still applies for all levels of medicals. Exams and testing are based on clinical medicine and the clinical judgement of the physician doing the exam, not a cookbook of requirements.
It is one thing to argue third class medicals versus BasicMed and there are proponents of each. However, if pilots are avoiding necessary health care because of the effect on their third class medicals, then everyone loses. Hoffman opens his lectures with a photo of brothers who are both pilots sitting across from each other in an airline cockpit. Then he explains how one died from a heart attack even though the pilot had chest pain warnings for which he never sought care. The other pilot committed suicide over the grief of losing his brother. He had never sought psychological counseling.
This family tragedy is obviously an extreme example, but probably not a unique example of pilots avoiding medical or psychological care. In fact, there have been several suicides by student pilots who have had their dreams of being professional pilots quashed after discovering antiquated disqualifying FAA medical rules. For instance, many children are diagnosed with attention deficit disorder (ADD) and placed on medication. This may be related to better recognition of the disorder or often times, a casually made misdiagnosis. However, if a person is under current or past treatment for ADD, they will be in a world of hurt when they apply for their FAA medical. An applicant currently on ADD medication has little to no chance of being granted a medical. A person who no longer takes medication for ADD will have to spend a great deal of time and money to be “certified” that they were either misdiagnosed or no longer need medication.
During our meeting at Brook, an FAA representative stated that many FAA requirements are not clinically indicated but are required because there is no data to justify changing them. In the medical world, a “clinically indicated” test or evaluation means something that will reveal a status and/or cause an action or decision to be made. If there are FAA requirements that are not clinically indicated there is no reason to require pilots to meet them, other than that is the way the FAA has always done it. Not a great value proposition.
There are operational limitations such as six seats or less or gross weight of less than 6,000 pounds that are part of the current BasicMed law. There are no valid medical reasons for these operational limitations, and they were put in place to help get support to establish the program. Now that we have data that demonstrates safety, these limitations should be removed so even more pilots have the ability to switch to BasicMed. 
