AOPA Pilot Magazine - December 2022 - 26

FLIGHT MD
Avoiding
health care
Addressing onerous third class
medical requirements
BY DR. BRENT BLUE
I HAVE DISCUSSED several times how successful BasicMed has
been. Since the program became available to pilots in 2017, more
than 70,000 pilots have qualified to use the privileges. Today,
more than 50,000 pilots are actively flying with non-AME
exams-and, according to the FAA, with no difference shown
in accident rates or medical incapacitations in flight when compared
to a third class medical. The data shows that FAA third
class medical requirements for any pilot with medical issues are
not clinically indicated and statistically irrelevant.
I attended a conference at Brook Army Medical Center
led by Dr. William Hoffman, a neurologist who is investigating
pilots' health care. Hoffman, in conjunction with the
University of North Dakota and others, is designing studies to
help enlighten the reasons for the avoidance of health care and
non-reporting of medical issues on flight medicals in both the
military and civilian pilot populations.
BasicMed was enacted by Congress to get around the bureaucracy
and delays associated with third-class medicals and to
improve the private pilot, private physician relationship. The
successful program increased the duration of the medical qualification
for those over 40 years of age but also requires the pilot
to take an online education course covering aeromedical topics.
There is no equivalent educational requirement to obtain a third
class medical. One of the most important aspects of BasicMed is
that, after an initial AME exam, subsequent exams can be conducted
by an AME or by a state licensed physician.
In other words, exams can be done by your own doctor, someone
who knows your medical history better than anyone, someone
that you can talk to about a condition and get treated without the
fear of losing your certificate. Pilots are required to self-certify
before each flight, and this still applies for all levels of medicals.
Exams and testing are based on clinical medicine and the clinical
judgement of the physician doing the exam, not a cookbook
of requirements.
It is one thing to argue third class medicals versus BasicMed
and there are proponents of each. However, if pilots are avoiding
necessary health care because of the effect on their third class
medicals, then everyone loses. Hoffman opens his lectures with
a photo of brothers who are both pilots sitting across from each
other in an airline cockpit. Then he explains how one died from
26
AOPA PILOT / December 2022
a heart attack even though the pilot had chest pain warnings for
which he never sought care. The other pilot committed suicide
over the grief of losing his brother. He had never sought psychological
counseling.
This family tragedy is obviously an extreme example, but
probably not a unique example of pilots avoiding medical or
psychological care. In fact, there have been several suicides
by student pilots who have had their dreams of being professional
pilots quashed after discovering antiquated disqualifying
FAA medical rules. For instance, many children are diagnosed
with attention deficit disorder (ADD) and placed on medication.
This may be related to better recognition of the disorder
or often times, a casually made misdiagnosis. However, if a person
is under current or past treatment for ADD, they will be in a
world of hurt when they apply for their FAA medical. An applicant
currently on ADD medication has little to no chance of being
granted a medical. A person who no longer takes medication
for ADD will have to spend a great deal of time and money to
be " certified " that they were either misdiagnosed or no longer
need medication.
During our meeting at Brook, an FAA representative stated
that many FAA requirements are not clinically indicated but are
required because there is no data to justify changing them. In the
medical world, a " clinically indicated " test or evaluation means
something that will reveal a status and/or cause an action or
decision to be made. If there are FAA requirements that are not
clinically indicated there is no reason to require pilots to meet
them, other than that is the way the FAA has always done it. Not
a great value proposition.
There are operational limitations such as six seats or less
or gross weight of less than 6,000 pounds that are part of the
current BasicMed law. There are no valid medical reasons for
these operational limitations, and they were put in place to help
get support to establish the program.
Now that we have data
that demonstrates safety, these
limitations should be removed
so even more pilots have the
ability to switch to BasicMed.
brent@brentblue.com
DR. BRENT BLUE is a
Senior AME/HIMS certified
who sees pilots at the
Driggs, Idaho, airport (DIJ).
He flies a Cessna 185 and a
1942 Noorduyn Norseman.
AOPA Pilot Magazine - December 2022

Table of Contents for the Digital Edition of AOPA Pilot Magazine - December 2022
