The Three P's

Now that we are fully into spring 2021 and the bad memories of spring 2020 sort of behind us, pilots are out of hibernation and getting into the air with much vigor and enthusiasm. 

We can always tell in the PIC (Pilot Information Center) when this happens because our contact volume blows up as it did in early April. And when pilots start flying again, many of them need to renew their medical certificates, and sometimes those pilots aren’t issued medicals at the time of the exam. That results in a “deferral” of the application to the FAA for review. As most everyone who has engaged with the FAA will attest, a deferral is not a desired outcome of the AME visit as it means you, the pilot, walk out the door empty-handed and then wait until the FAA reaches out to you for information about the reason why you were deferred. That can take weeks, even though it can seem like months, especially if you are a working pilot who flies for a living.

I was emailing with one of the FAA Regional Flight Surgeons a few weeks ago about an airman who was waiting for a response from the FAA on his medical application. Our exchange revealed some of the common situations that we and the FAA share when it comes to interacting with pilots. In this situation, the airman called the FAA regional medical office and didn’t prepare for his call beforehand. He didn’t have any of his medical records to refer to, didn’t know the dates records were sent to the FAA, didn’t have the FAA letter sent to him asking for more information, and therefore couldn’t provide any details about medical testing, diagnoses, treatment, and generally was not well prepared to have the conversation. The regional office helped him as much as he could, but just didn’t have all the needed information to adequately research the case and assist the airman at that time.

Because the FAA communicates primarily in writing, the letters to airmen are sometimes not as clearly understandable as they could be. Efforts are underway to improve the tone and clarity of many of those letters that ask for more information. The best way to read an FAA letter is to reread it, probably several times! After a good focused read, what is being asked for usually starts to make some sense, so just take a breath and read it again and again until it is clear what is being asked. If you’re still not clear on it, just give us a call and we can help you decipher it.

The best way to avoid getting one of those information requests is the first “P,” Preparation. Pilots are planners. We don’t just “kick the tires and light the fires”; we plan each flight, be it a short hop to the airport for a good pancake breakfast or a long cross country with multiple stops. The same should apply to preparing for the FAA medical exam.

If you will be reporting something for the first time on the medical application—a new or changed medication, a visit to a health care provider for something other than a routine annual physical (which is still reportable, by the way!) or a “yes” response in item 18, the medical history part of the application—that you haven’t reported previously, do some homework to see what, if anything, you will need to provide to the AME that supports the newly reportable items. A good rule of thumb is if it’s a first-time disclosure on MedXPress, have some supporting documentation for your AME at the time of the exam to explain what happened, when it happened, and how you’re doing now. A statement from the treating physician or other health care provider is a good first step, and often is all that’s needed for the AME to issue your certificate at the time of the exam. has abundant resources on medications, medical conditions, and tips on what records the FAA will need and how to get them to the FAA, and if you don’t find what you need there, just get to us by phone or email so we can point you in the right direction.

“Process” or “Procedure” is a really important step in wading into the medical bureaucracy, because it’s where the rubber meets the road in getting your deferred application converted into an issued medical certificate as soon as possible. There are a couple of ways to approach this step. Let’s use a coronary artery stent procedure as an example, a common special issuance condition that we talk to members about every day. If you walk into the medical examiner’s office with your completed MedXPress application with a “yes” response to item 18g, “Heart or vascular trouble,” and note “heart stent” in the explanation box, but don’t have any medical records on the procedure, you just added about two months to the time you will wait for your special issuance. Your exam goes to the FAA as a deferral, as it must for first-time reporting. You will later receive a letter from the FAA asking for treatment records of the stent procedure and current testing.  Then you have to get into your health care portal from where the procedure was done to print out your records, and schedule an appointment with the cardiologist for a treadmill test (which could take weeks with COVID still in our midst) and lab work. Then, when you finally have everything together, you send the reports to the FAA and again wait for a response. Total time from date of exam to issuance could be six or more months!

A much better plan is to get all the testing and treatment records beforehand and have them with you when you see the medical examiner. Your application is still deferred, but you already know what they want and have all testing completed. You then mail your records to the FAA that are scanned into your medical file, matched up with your recently completed MedXPress application, and processed into workflow for review by a Legal Instrument Examiner and/or staff physician.

Put your PI#, App ID, MID#, and full name and date of birth on every page you send to the FAA. And mail your records yourself to the FAA. Don’t rely on anyone else to do that for you. It’s your medical, so take control of the chain of custody of those records to be sure what was included, when the records were mailed, and where they were sent.

Finally, PATIENCE! The FAA is working hard to get caught up and stay caught up, but that is a daunting task with the volume of records received into the Aerospace Medical Certification Division in OKC where the decision is made. Steps are ongoing to improve the overall customer experience. In fact, many of you received or may soon receive an email request to participate in a satisfaction survey from the FAA Office of Aerospace Medicine. PLEASE, PLEASE, respond to the survey!! The FAA is trying to fix many of the inherent problems in the way they do business, and if they don’t hear from the pilots, they don’t know how to prioritize the corrective actions. Do not be intimidated by the request to complete the survey. It is in everyone’s interest to help the FAA improve the medical certification process, and knowing the candid feelings of pilots will help the FAA make those needed improvements.

Get out and fly!

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.

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