Yes, but...

The course time does not include travel time or expenses for hotel and air. The majority of AMEs at the seminar have been performing exams for many years, as shown by a raise of hands. Most have kept current with FAA medical criteria through the relatively new monthly “AME Grand Rounds” online.

The stated primary purpose of the FAA’s aeromedical division is to prevent sudden incapacitation in flight. It also states the goal of prevention of subtle incapacitation such as cognitive decline or motor and sensory degradation.

The problem is that the FAA looks at almost every condition and its treatments as having possible impacts on aviation safety almost regardless of the potential risk. The medical division has more than 75 disease or condition disposition tables for AMEs to follow including this very special one added in March of this year: “condition not listed.” The point is that all these conditions have existed, but the medical world may not have recognized them or understood them in the past. Most important, these conditions have all existed over time and have not had aeromedical implications. Why does the FAA insist on supervising a pilot’s medical care that has no impact on aviation?

As an example, one of the listed conditions is polycystic ovary syndrome. Another is fatty liver, which just about anyone who is overweight has to some extent. Are these really a risk to “sudden incapacitation” or “subtle cognitive decline?”

What is a disposition table? It is a template that guides the AME with yes/no questions about the disease or condition. The problem is the FAA does not leave any discretion to the AMEs. If there is a “yes” answer on the template, the medical must be deferred to Oklahoma City. There is no such answer as “yes, but.” This creates a lot of deferrals to the certification office that create backlogs that could be prevented if the FAA trusted the AME’s judgment.

The FAA has created many Conditions AMEs Can Issue (CACIs), which is great except that the vast majority of them should be up to the AME without a template (for instance, hypothyroidism). The problem is the same as the disposition tables in that there is no “yes, but” choice.

Another example that keeps one shaking their head is the recent change in color vision testing. This computerized “upgrade” from the Ishara book plates or Titmus analog systems was stimulated by a 2004 FedEx landing accident where the NTSB cited the co-pilot’s color vision deficiency as the sixth possible contributor to the accident. During this most recent AME meeting, memorization of the color plates to cheat was mentioned as a problem. One would think concern over visual acuity cheating would be of more concern since the still-approved eye wall charts are easy to access online.

The bottom line is that the FAA medical staff does not trust pilots, local medical providers, or AMEs to know what is safe in aviation. For instance, if a pilot chooses to have a CT calcium score, which is a non-invasive scan to screen for plaque in the coronary artery, and it is high, the FAA has rules. The rule is that if your score is 400 or more, you cannot get or keep a medical until you have further coronary artery testing. I cannot imagine anyone, pilot or not, with a score that high, who would not do any further investigation since they are at a dangerous risk level for a heart attack. So, what is the harm in the FAA rules? It discourages pilots from getting a valuable test for a risk factor because of the fear of being penalized. BasicMed’s success has proven the FAA’s lack of trust is unfounded.

Why does the FAA insist on supervising a pilot’s medical care that has no impact on aviation?

The FAA also has hard and fast time limits on different levels of head trauma. These limits have been set by a panel of neurologists on some pretty shaky clinical reviews and ignore individual situations. The agency’s attitude is always worst-case situation regardless of absolute risk. This is frustrating for pilots and AMEs alike. When you get into ambiguous grading of injuries as mild, moderate, and severe, you can imagine how a minor error in a medical record documentation can extend an FAA-mandated no-fly period from two years to four.

The number of AMEs keeps dropping each year because retirements are not being filled by new providers, and also some AMEs who drop out because they are no longer willing to waste three days of their life every three years to check an AME certification box.

Remember to thank your AME next time you see him or her for being there for you.

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