The doctor is IN

Medical qualification for flight

If you've already spent a little time around the airport, you may have heard some discussion of aviation medical certificates--often simply called medicals. Maybe your instructor has told you to obtain one, which usually means your first solo flight is approaching. Or perhaps you've never heard the term.

Pilots must meet certain medical standards, specified in Part 67 of the federal aviation regulations, in order to fly an aircraft as pilot in command. For most pilots, this means visiting an aviation medical examiner (AME)--a physician authorized by the FAA to administer flight physicals. Your flight instructor should be able to recommend a nearby AME; AOPA's Medical Certification department can refer you to doctors in your city or county; or you can search the database on AOPA Flight Training Online. A medical certificate is not required in order to fly gliders, hot air balloons, or light sport aircraft, but these pilots are not exempt from medical requirements.

If you're just beginning your flight training, your medical certificate is also your student pilot certificate. You'll need to obtain one before you can solo. Only a few medical conditions are absolutely disqualifying, but others can require some additional steps (and patience) before you are certified (see "Cautionary Conditions," p. 41).

The FAA issues three classes of medical certificates. A first class medical is required for pilots who exercise airline transport pilot (ATP) privileges, primarily those flying for the airlines; it is valid for ATP privileges for six months. A second class medical is required for pilots who fly commercially, in such operations as crop dusting or carrying passengers for hire; it is valid for commercial privileges for 12 months. Third class is appropriate for student pilots and private pilots who fly for pleasure or personal business (but not for hire).

Can I qualify?

Most people who begin flying lessons are young, and few have medical problems disqualifying them from flight. In many ways medical qualifications are liberal. You do not need perfect vision; you may have crossed eyes or color vision deficiency. Even if you are a diabetic on insulin or oral medication, have high blood pressure for which you're taking medication, had a bleeding ulcer, or lost one leg, it is likely that you can be certified.

A medical certificate is required to be on your person before you can solo, act as pilot in command, or as a required crewmember. The duration of a medical certificate is measured in calendar months. This means that a first class medical is valid until the end of the sixth month after issuance; a second class is valid for 12 months; and the third class is good for 24 months or longer (see below).

When should I get my first medical?

How long before solo should you seek a medical? There are two scenarios.

If you are perfectly healthy--you do not have a chronic illness, are not on medication, are not impaired (eyeglasses are acceptable)--then timing depends upon when you expect to solo, and how much notice your AME needs to set up an appointment. Consider several hours of flight lessons to confirm that you enjoy flying, as there is little reason to spend money on a medical certificate that you will never use.

If you do have a medical condition and are serious about flying, visit an AME early. Even before seeing the doctor, research the special requirements for pilots with your condition. See the accompanying lists (pp. 41-42) and AOPA's online medical resources. However, just because your condition is on either list does not necessarily mean that you are disqualified from flying.

Happy fortieth birthday

If you obtain a medical certificate before your fortieth birthday, it is valid as a third class medical for 36 months (three years). So it is worthwhile to see your AME while you are still 39 years old. If you wait longer, your certificate will be valid for only 24 months. This youthful extension does not apply to first or second class certificates used as such; their valid periods are independent of age. An exception is that a first or second class certificate issued before age 40 can be used for third class purposes for 36 months.

Is a first class certificate the best?

Is a first class medical certificate worth obtaining? The answer is "no," unless your aircraft operations require such a certificate. This usually means you are employed by an air carrier and are piloting very large aircraft.

Students considering a career in aviation sometimes seek a first class certificate to test the waters. They would like to know if they would qualify in the future.

An examination for a first class certificate is no different from that given second and third class applicants, with one exception--the requirement for an electrocardiogram, and that's based on age. However, some first class standards are more stringent.

I suggest you seek only the level of certification that you need. If you would like to know if you could meet first class certificate requirements, simply ask your AME. You may have had a cardiogram and know that it was unremarkable. However, unless you have or had a heart problem, it is extremely unlikely that a screening cardiogram will demonstrate a first class disqualifying problem. Cardiograms of asymptomatic people rarely identify significant cardiac disease.

There is another reason not to overreach. If your AME has to deny a first class certificate, that becomes a permanent part of your medical record. You can expect to be asked why you were disqualified at future visits, though you may be fully qualified to hold second or third class certificates.

Renewing your medical

There are several strategies in the timing of medical certificate renewal. Scrooges like to minimize cost. They fly with their old certificate until the last day of the month, and on the first day of the next month they hope they can renew. If all goes as planned they gain a month with each renewal (because the certificate is good to the end of the month).

However, suppose the AME finds a medical problem, even a minor problem, that delays recertification. If you see your AME earlier in the month before expiration, there may be time to rectify the problem by obtaining necessary consultation or tests. It is likely that you can continue to fly during the time problem is sorted out, unless you have a regulatory disqualifying condition.

The other problem with a last-minute renewal is if on that particular day you are sick--even with a self-limited condition (the symptoms go away over time)--the AME may not be able to pass you. Say you had an appendectomy a day or two earlier, or have a blocked ear and vertigo from a virus. An AME may be reluctant to qualify you that day. However, in a week or two the problem likely would be resolved, and recertification would not be an issue.

Most AMEs are busiest the last two or three days of each month, for obvious reasons. As it does not matter when during the month you renew, an early or middle-of-the-month renewal is probably easier to schedule, and the best strategy.

Temporary grounding

At some time in your life you are likely to have a medical condition and temporarily be unable to fly. It is the pilot's responsibility to determine medical airworthiness before each flight (see "Legal Briefing: Self Help," p. 65). Just because you have a medical certificate in your wallet or purse does not prove you are medically qualified on any given day. If you are nauseous and are vomiting, you should ground yourself. If you have back pain and cannot tolerate sitting and can barely walk, do you need an expert to advise you it's best not to fly? If you have a stuffed-up nose and blocked ears, flying will only make things worse. The list of temporary medical problems that should lead to brief grounding is large, and left to a pilot's judgment.

But what if you are not sure? Your treating doctor should be asked, but unless he or she has an aeromedical background an authoritative answer may not be available. An option is to ask your AME. Or, if you are an AOPA member, a free phone call to the medical certification specialists at AOPA's Pilot Information Center (800/USA-AOPA) will likely provide the information.

New medication

Say your doctor has prescribed a new medication. Can you and should you fly? There are three issues to consider. Is the condition requiring the new medication disqualifying? Is the new medication acceptable to the FAA? How soon should you fly after beginning the medication?

Your doctor may not be conversant with medically disqualifying conditions, and you may have to seek guidance elsewhere. The issue becomes more tangled when the question concerns FAA acceptance of a specific prescription medication. In both cases your AME may help. However, the single best reference concerning a drug is the list maintained by AOPA's medical certification department. This list of FAA-allowed and disqualifying medications is available at AOPA Online.

It is wise to see what happens on the ground before testing the drug aloft. In most cases, you should be on a new prescription for two or more weeks before you attempt to fly.

Serious medical condition

Sooner or later each of us will face a serious medical condition. There will be no doubt we cannot fly. Now how do you get requalified? Unless your condition is disqualifying by regulation, once you recover, you can fly again using the same unexpired medical certificate. However, upon renewal it is likely you will have to submit information to your AME and the FAA concerning the illness. Therefore, collect the information ahead of time. Keep a list of all the doctors you visited, their addresses, and when and why you saw them. If a specialist issued a report, you had surgery, or were hospitalized, get a copy of your records. You may have to pay a small fee for copies, but it is worthwhile having control of your own medical data.

I recommend you make three copies of any medical record. One copy should be kept in your personal file. It may be as valuable as your logbook. Another copy can be provided to your AME or to the FAA, and you have one copy to show a consultant.

If you expect to walk out of your AME's office with a valid certificate after a serious medical event, you must do some homework. In addition to complete medical records, you should research your condition on AOPA Online. Some medication conditions have to be deferred; the AME doesn't have a choice. But your AME can reissue your medical for some serious histories after initial FAA clearance--diabetes, certain heart conditions, prostate cancer, and asthma, to name a few. Requirements may include letters from specialists, the results of specific tests, a required period of recovery, your family history, and lifestyle details (smoking, exercise, diet). If you do not present this information to your AME, your certificate cannot be issued, and you can expect a longer delay than if you had acted sooner.

Notify your AME's office of your new medical problem prior to the examination date. Advise that you will bring the necessary medical information with you. You may wish to discuss the option of sending the information directly to the FAA, or forwarding the information to the AME's office for review prior to your appointment.

Basic exam preparation

Regardless of your medical status, you can help your AME with some preparation. Review your last medical application--your AME should have given you a copy--and of course you carefully filed it away with other important personal papers. If not, you can get a copy from your AME's office.

Go over the old application line by line, and decide what changes, if any, will be required on the new application. This way, you'll be sure to arrive at your AME's office with the information you need to complete the application.

AOPA Online has an innovative interactive form called TurboMedical. Fill out an application electronically, and get feedback about your answers. The program "flags" areas that may trigger problems in obtaining or renewing a medical certificate, and provides resources to help you obtain more information. Print out the completed form and use it as a reminder when completing the official form in the doctor's office. You are less likely to make a mistake or feel pressured.

AMEs have little joy in delaying or denying medical certification. You can help yourself, and keep your AME happy, by being informed and prepared.

Dr. Ian Blair Fries is a CFI, senior aviation medical examiner, and ATP, and holds a Lear 35 type rating. He serves on the AOPA Air Safety Foundation Board of Visitors and is cochairman of the AOPA Board of Medical Advisors.

Want to know more?

Links to additional resources about the topics discussed in this article are available at AOPA Flight Training Online.