It's time for a change
Aggressive action is needed in FAA’s current evaluation process
This was initially attributed to the FAA Reauthorization Act of 2024 and then to FAA/DOT legal. I am not sure whom the FAA is blaming now. The uproar has delayed the original implementation date from January 1 to March 1, 2025, as of this writing, but that may have changed by the time this column is in print. Even though this denial classification is a procedural change, having one on record has implications for future medical certificates and aircraft insurance.
The FAA medical department told AMEs that the solution to this change is to work with pilots who have new medical issues, to gather all the data and examinations as delineated in the online AME guide, and to submit them to the FAA with the new AME medical exam. This is supposed to speed up the review and granting timeline. As any pilot and AME who has gone through this process knows, the FAA is prone to ask for additional exams and information. Plus, one may have done an expensive evaluation in advance that was not necessary at all. This process is fraught with danger.
The FAA’s current evaluation process for deferred exams is months to years behind, mostly because of the agency’s own requirements, most of which are not based on logical clinical medicine. This new process just makes the AME a clerk without substance since the AME cannot grant a special issuance (SI). Officially, only the federal air surgeon can grant SIs, but the FAA has added many medical problems to this list that are not codified. It is also significant that the required evaluations are administrative and have had no outside review or approval.
The highly successful BasicMed program has shown pilot medicals done by any state-licensed physician, based on that physician’s judgment, has had no impact on safety whatsoever. The real question is: Why does the FAA not let AMEs, using FAA guidelines, approve all medical applications that would normally be deferred? This is highlighted by the FAA’s own statistics that show less than one-tenth of one percent of completed deferred applications are permanently denied. The CACI program (Conditions AMEs Can Issue) has also worked without any safety impact. The number of potential “inappropriate” medicals issued by AMEs is statistically insignificant.
The mission statement of the FAA is “to provide the safest, most efficient aerospace system in the world.” The statement says nothing about keeping pilots healthy or monitoring their health care. However, the FAA has migrated into telling pilots how to monitor their health, what tests they should have, and whether they are safe to fly by desk jockeys who have never seen or examined the pilot. AMEs see and examine the pilot, and they should make the decision on whether the pilot is safe to fly.
The waste of time and money, both for the pilot and the FAA, is something the Department of Government Efficiency (DOGE) should address. BasicMed has proven that the FAA’s check-the-box procedures, arbitrary templates, and rigid medical criteria have no effect on safety and certainly have no effect on pilot health—in fact may be detrimental to pilot health given the stress they create.
Dr. Susan Northrup, U.S. federal air surgeon, has made some changes that have helped improve the system, but it is like turning an aircraft carrier. She is obviously meeting resistance from old guard staff. Very aggressive action is needed. Here is what I would do if I ran the show:
1. All pending reviews of complete pilot medical files that have been more than 60 days in the queue be immediately granted their certificates.
2. All future pilot medicals that are deferred and have all the initial testing and information required by the FAA’s letter be granted a medical certificate within 60 days.
3. No added-on criteria requested by additional letters, which slow the system, be allowed. If the requirements are not in the first letter, no second bites by the FAA.
4. AMEs may grant all medicals that comply with FAA testing and exam criteria based on the AME’s evaluation of those results. No delays caused by sending files to Oklahoma City. This may require an act of Congress but now is the time when enabling legislation could be passed.
The FAA is probably way down the DOGE list, but the medical division may benefit from the agency’s evaluation. 
