PapernScissors wrote:Where have we seen credible reports of non-physicians evaluating pilot medicals of any class, and making substantive decisions on either special issuance or denial? I don't recall any mention of non-physiciansmaking those decisions in any article I've read in AOPA or EAA 'zines, or in any aviation 'zine. I am a frequent reader of NTSB accident reports I pull from the NTSB's aviation DB. What I generally see are reports of pilots who lied on their FAA Medicals, theb successfully hid serious health issues (and prescribed, OTC, and illegal drugs on from the AME or Basic Med physiciam)... then kill themselves & others in an aircraft accident.

Please link all these reports where medical was the primary cause

I remember reading of some pilots who got taken to court for not telling the FAA about some VA benefits that would have made them unable to get a medical, what seems to have gotten skipped in that print was that they all were already end of career, and their medical “conditions” never surfaced during any routine exams by a AME, never were noticed during their checkrides every 6 months, never noticed by their co pilots or FO, or FA, gate crew, never even came up off duty to the point anyone called HR. Sounds like the FAA saved the flying public from...well I’m not sure, but I’m sure high 5s were abound in OKC after the article came out.


Also per your doc question, I’d say every decision out of OKC or DC, when those doctors label someone with something it’s not a real medical dx, nor can they be held liable for malpractice, so they might be a MD, but they arnt acting in that capacity anymore than a pilot who’s on a flight but not responsible for it.


Being a federal employee is a privilege, just as being a airman, I’m responsible if I screw up in that capacity, I put my license on the line for any and every call I make, so should the folks at OKC per their MD license.


But the crux of the question was the accident rate by pilots medical class. I just don’t see how taking the government out of medicine in this context would be anything but good, make a list of what a airman will have to do, let a primary care doc sign off if it can be done, with his MD and malpractice on the line, I’d even be cool with having pilots have to have a primary care doc, even if it was just for a yearly checkup. Having the ultimate call be made by the practitioner who has hands on the Pt and has been seeing the Pt for a long time, and UNLIKE the FAA actually has skin in the game, that just makes obvious sense.

NineThreeKilo wrote:

PapernScissors wrote:Where have we seen credible reports of non-physicians evaluating pilot medicals of any class, and making substantive decisions on either special issuance or denial? I don't recall any mention of non-physiciansmaking those decisions in any article I've read in AOPA or EAA 'zines, or in any aviation 'zine. I am a frequent reader of NTSB accident reports I pull from the NTSB's aviation DB. What I generally see are reports of pilots who lied on their FAA Medicals, theb successfully hid serious health issues (and prescribed, OTC, and illegal drugs on from the AME or Basic Med physiciam)... then kill themselves & others in an aircraft accident.

Please link all these reports where medical was the primary cause

I remember reading of some pilots who got taken to court for not telling the FAA about some VA benefits that would have made them unable to get a medical, what seems to have gotten skipped in that print was that they all were already end of career, and their medical “conditions” never surfaced during any routine exams by a AME, never were noticed during their checkrides every 6 months, never noticed by their co pilots or FO, or FA, gate crew, never even came up off duty to the point anyone called HR. Sounds like the FAA saved the flying public from...well I’m not sure, but I’m sure high 5s were abound in OKC after the article came out.


Also per your doc question, I’d say every decision out of OKC or DC, when those doctors label someone with something it’s not a real medical dx, nor can they be held liable for malpractice, so they might be a MD, but they arnt acting in that capacity anymore than a pilot who’s on a flight but not responsible for it.


Being a federal employee is a privilege, just as being a airman, I’m responsible if I screw up in that capacity, I put my license on the line for any and every call I make, so should the folks at OKC per their MD license.


But the crux of the question was the accident rate by pilots medical class. I just don’t see how taking the government out of medicine in this context would be anything but good, make a list of what a airman will have to do, let a primary care doc sign off if it can be done, with his MD and malpractice on the line, I’d even be cool with having pilots have to have a primary care doc, even if it was just for a yearly checkup. Having the ultimate call be made by the practitioner who has hands on the Pt and has been seeing the Pt for a long time, and UNLIKE the FAA actually has skin in the game, that just makes obvious sense.

Simple solution is already available: Basic Med. Or are you an airline wannabe? If so, read the information on disqualifying conditions, and go get a flight physical.

MTV

asa wrote:This hatred of the FAA medicals is hilarious to me. People are arguing that it's a pilot's job to self regulate based on health? What a joke - nearly everyone with a disqualifying condition probably thinks they are okay to fly. If you can't pass a medical, and then can't get a special issuance or appeal, sorry but move along.

If anything, I think medicals should be stricter for commercial pilots. Am I saying this because I'm 30 and I haven't hit all those bumps in the medical road? Probably. But do you really want your family flying on airplanes with people who a medical doctor determines can't hold an actual medical but they can have basic med?

Okay, ASA, here's an example from personal experience: I was diagnosed with malignant melanoma at age 64. Surgeon removed the lesion, and also took a sentinal lymph node to verify that the disease had not yet spread into the lymph system. It had not.

I got the surgeon's report to present on my next medical application. According to the surgeon and my dermatologist, I was clear of disease. To be on the safe side, I consulted with a friend who happened to be a Senior AME. I did NOT begin the medical application process, this was just a consult. He looked at the surgeon's report and said, "Houston, we have a problem". The problem was the depth of the lesion that was removed. It was just a wee bit deeper than the FAA's (arbitrary) maximum allowable depth.

Okay, so what did that mean? It meant that I would need a Special Issuance annually for the next five years (assuming the melanoma didn't return in that time), and that SI would require a bunch of testing each year....as in full body MRI, brain scans, etc, etc. Plus independent interpretations by specialists of those test results. Approximate bill to complete: Around $6000 a year.

My dermatologist, when asked about ordering these tests, and the approximate costs, stated flatly that this was totally ridiculous. In fact, she called a Doctor friend of hers who was also an AME, and he verified the testing required. She then called the Regional Flight Surgeon's office and actually spoke with the Flight Surgeon hisself. I was sitting in her office during that call and was signalling: "No names, please!!!". She was shall we say, rather direct in her view of the FAA's position on this.

So, rather than spend upwards of $30 K over the next five years, I sold my beloved Cessna 170B and bought a Piper PA-11, which could legally be operated in the Light Sport category. I also retired (again) because my job required that I hold a medical certificate.

Now, in fact, I was ready to retire anyway, so I should probably thank the FAA for more or less forcing my hand. No complaints there.

But, the point of this long diatribe is that, under Basic Med, I could have continued to fly that 170. Melanoma is not disqualifying under basic med.

There is in fact a remote risk that Melanoma can attack the brain. The good news is, as my dermatologist pointed out, that I will have several routine exams every year to look for any recurrence of the disease. And, it's not a fast moving disease.

So, that's MY story of dealing with the FAA's aeromedical system. I was fortunate that my disease occurred at an age and a time when retirement actually looked pretty good anyway. Had it happened twenty or thirty years earlier, I'd likely have been spending a LOT of $$ on needless testing.

MTV

mtv wrote:

NineThreeKilo wrote:

PapernScissors wrote:Where have we seen credible reports of non-physicians evaluating pilot medicals of any class, and making substantive decisions on either special issuance or denial? I don't recall any mention of non-physiciansmaking those decisions in any article I've read in AOPA or EAA 'zines, or in any aviation 'zine. I am a frequent reader of NTSB accident reports I pull from the NTSB's aviation DB. What I generally see are reports of pilots who lied on their FAA Medicals, theb successfully hid serious health issues (and prescribed, OTC, and illegal drugs on from the AME or Basic Med physiciam)... then kill themselves & others in an aircraft accident.

Please link all these reports where medical was the primary cause

I remember reading of some pilots who got taken to court for not telling the FAA about some VA benefits that would have made them unable to get a medical, what seems to have gotten skipped in that print was that they all were already end of career, and their medical “conditions” never surfaced during any routine exams by a AME, never were noticed during their checkrides every 6 months, never noticed by their co pilots or FO, or FA, gate crew, never even came up off duty to the point anyone called HR. Sounds like the FAA saved the flying public from...well I’m not sure, but I’m sure high 5s were abound in OKC after the article came out.


Also per your doc question, I’d say every decision out of OKC or DC, when those doctors label someone with something it’s not a real medical dx, nor can they be held liable for malpractice, so they might be a MD, but they arnt acting in that capacity anymore than a pilot who’s on a flight but not responsible for it.


Being a federal employee is a privilege, just as being a airman, I’m responsible if I screw up in that capacity, I put my license on the line for any and every call I make, so should the folks at OKC per their MD license.


But the crux of the question was the accident rate by pilots medical class. I just don’t see how taking the government out of medicine in this context would be anything but good, make a list of what a airman will have to do, let a primary care doc sign off if it can be done, with his MD and malpractice on the line, I’d even be cool with having pilots have to have a primary care doc, even if it was just for a yearly checkup. Having the ultimate call be made by the practitioner who has hands on the Pt and has been seeing the Pt for a long time, and UNLIKE the FAA actually has skin in the game, that just makes obvious sense.

Simple solution is already available: Basic Med. Or are you an airline wannabe? If so, read the information on disqualifying conditions, and go get a flight physical.

MTV

I’m currently in the industry

It’s just odd, I had a certain opinion of the FAA when I was a low time guy, a they are very respected and super knowledgeable, buuut the old guys talk shit about them, but they’d also probably yell at me to get off the grass so, meh

Got my CFI, great, but taxing, experience at the FSDO, my respect went way up, old guys were just being old guys.

Well as the decimal point moved over in my logbook, I witnessed more and more, and my view of the FAA changed, the ops side of the house at least seemed grounded in some reality, though often lazy and often opting for the easiest option, they overall did well.

But what I have seen with students, fellow line pilots, read about, when it comes to the medical branch, I think it really needs to be mostly eliminated, replace all classes with what basic mostly is, give the standards to the airman, have their primary doc make a call, if a specialized call is needed have the airmen and their primary seek that out, if board certified MDs say ok, that’s all the FAA should need.

MTVs story is exactly like what I’m talking about as far as the silliness of the FAA.

asa wrote:This hatred of the FAA medicals is hilarious to me. People are arguing that it's a pilot's job to self regulate based on health? What a joke - nearly everyone with a disqualifying condition probably thinks they are okay to fly. If you can't pass a medical, and then can't get a special issuance or appeal, sorry but move along.

If anything, I think medicals should be stricter for commercial pilots. Am I saying this because I'm 30 and I haven't hit all those bumps in the medical road? Probably. But do you really want your family flying on airplanes with people who a medical doctor determines can't hold an actual medical but they can have basic med?

Lots of interesting views here. MTV's story is one of several I have heard where the pilot would be of little risk(virtually none) to their passengers from a medial standpoint, but the FAA's standards need deeper evaluation and it turns into a huge PITA. So, I am not 30 (Although still not twice 30!) and have hit one of those bumps, which is why I am flying a Champ right now. I was on Basic med for no other reason than to save a few bucks and some time. I could have easily passed a third class (or higher) medical. I can tell you that I would be comfortable with a pilot on basic med flying me around, as most of the BIG risks associated with pilots falling out of the sky are also disqualifying under basic med. I don't know anyone currently on basic med right now that couldn't also get a third class medical. From what I have seen it's a convenience thing. Granted my sample size is very small and I am sure there are many exceptions. From what I have seen there is little evidence that a FAA medical sets a higher bar or better insures that a pilot is less likely to have a incapacitating event in the cockpit. What they should do is limit the amount of bar-b-que or pizza someone holding a first class medical can eat.....

Pete

I am grateful we have the basic medical program. It bypasses OKC and Washington DC in the approval process leaving it up to your PCP. A screening medical exam is not going to be predicative of anything other than the obvious. Obviously we want fit and healthy pilots but the FAA medical exam has pushed a lot of people out of aviation that have no real disqualifying health problems. MTVs history is a story many aviators will tell. Costly annual testing for SI medicals that result in many people giving up flying. We all need to assess our fitness to fly every time we get in an airplane.

Below is a recent study comparing fatal accident rates between Basic medical and Third class medical airman. It essentially shows no significant difference between the two groups for total and fatal accidents. I will admit - I only read the abstract but I am going to guess the Basic Medical Cohort is older and inherently more at risk for disease.

https://www.faa.gov/data_research/resea ... 202118.pdf


Josh

Dog is my Copilot wrote:I am grateful we have the basic medical program. It bypasses OKC and Washington DC in the approval process leaving it up to your PCP. A screening medical exam is not going to be predicative of anything other than the obvious. Obviously we want fit and healthy pilots but the FAA medical exam has pushed a lot of people out of aviation that have no real disqualifying health problems. MTVs history is a story many aviators will tell. Costly annual testing for SI medicals that result in many people giving up flying. We all need to assess our fitness to fly every time we get in an airplane.

Below is a recent study comparing fatal accident rates between Basic medical and Third class medical airman. It essentially shows no significant difference between the two groups for total and fatal accidents. I will admit - I only read the abstract but I am going to guess the Basic Medical Cohort is older and inherently more at risk for disease.

https://www.faa.gov/data_research/resea ... 202118.pdf


Josh

Thanks for that!

Be nice to see some medical stats now between 1st and 3rd class airmen for medical caused crashes, I between my gut feeling and what I have seen in my time in the industry, I’d wager the difference between 1st and basic won’t be much different.

As I noted earlier in this thread, aircraft accidents with a probable cause based on the PIC suffering an in flight medical issue are extremely rare.

MTV

NineThreeKilo wrote:..... I just don’t see how taking the government out of medicine in this context would be anything but good, make a list of what a airman will have to do, let a primary care doc sign off if it can be done, with his MD and malpractice on the line, I’d even be cool with having pilots have to have a primary care doc, even if it was just for a yearly checkup. Having the ultimate call be made by the practitioner who has hands on the Pt and has been seeing the Pt for a long time, and UNLIKE the FAA actually has skin in the game, that just makes obvious sense.

This is what BasicMed is all about.
Unfortunately, there are apparently a lot of doctors out there who will not do BasicMed exams.
The only thing I can figure is that they are afraid of the liability--
in your words: "with his MD and malpractice on the line".

I did my first BM exam 4 years ago withg an AME.
This year I did it with my regular doc who I see once a year.
I passed just fine, but two friends of mine who also went to him for a BasicMed got turned down.
Both due to high blood pressure-- although their BP was below the FAA 3rd class redline of 155/95,
it was higher than the doc was comfortable with.
So the BasicMed thing has it's downside along with it's upside.
FWIW both guys went back a week or two later & their BP passed muster.

hotrod180 wrote:

NineThreeKilo wrote:..... I just don’t see how taking the government out of medicine in this context would be anything but good, make a list of what a airman will have to do, let a primary care doc sign off if it can be done, with his MD and malpractice on the line, I’d even be cool with having pilots have to have a primary care doc, even if it was just for a yearly checkup. Having the ultimate call be made by the practitioner who has hands on the Pt and has been seeing the Pt for a long time, and UNLIKE the FAA actually has skin in the game, that just makes obvious sense.

This is what BasicMed is all about.
Unfortunately, there are apparently a lot of doctors out there who will not do BasicMed exams.
The only thing I can figure is that they are afraid of the liability--
in your words: "with his MD and malpractice on the line".

I did my first BM exam 4 years ago withg an AME.
This year I did it with my regular doc who I see once a year.
I passed just fine, but two friends of mine who also went to him for a BasicMed got turned down.
Both due to high blood pressure-- although their BP was below the FAA 3rd class redline of 155/95,
it was higher than the doc was comfortable with.
So the BasicMed thing has it's downside along with it's upside.
FWIW both guys went back a week or two later & their BP passed muster.

For sure, I just wish we would replace the system for 1st - 3rds with basic med.

Having a doc known to you turn you down is much more acceptable on the err on the side of caution line, compared to some paper pusher playing doctor in OKC/DC shooting you down for something with no bearing on anything.

NineThreeKilo wrote: Having a doc known to you turn you down is much more acceptable on the err on the side of caution line, compared to some paper pusher playing doctor in OKC/DC shooting you down for something with no bearing on anything.

Agreed - just go find another doctor who is willing to sign the form on a day when the BP is not high. For the record - out of control blood pressure is not a disqualifying condition for basic medical. The beauty of basic medical is it bypasses the FAA. If you were declined by an AME on an 8500-8 form you're going through a more complicated process. Possibly special issuance. I think the best plan is to find an AME who signs Basic medicals. Do not fill out the 8500-8 form until you've consulted an AME who is knowledgeable on the process.



Josh

Dog is my Copilot wrote:

NineThreeKilo wrote: Having a doc known to you turn you down is much more acceptable on the err on the side of caution line, compared to some paper pusher playing doctor in OKC/DC shooting you down for something with no bearing on anything.

Agreed - just go find another doctor who is willing to sign the form on a day when the BP is not high. For the record - out of control blood pressure is not a disqualifying condition for basic medical. The beauty of basic medical is it bypasses the FAA. If you were declined by an AME on an 8500-8 form you're going through a more complicated process. Possibly special issuance. I think the best plan is to find an AME who signs Basic medicals. Do not fill out the 8500-8 form until you've consulted an AME who is knowledgeable on the process.



Josh

Agreed

I’m a healthy young guy, but I still do a full medical on myself just before I go into the AMEs office