AME's and BasicMed

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I've found that lots of AMEs don't like BasicMed. Even had a HIMS AME tell me that you are ineligible for BasicMed if your medical certificate is a special issuance (which conflicts with 14 CFR 61.23(c)(3)(ii)(A)), and that the only people who fly on BasicMed "have something to hide from the FAA". It's like they cannot accept that Part 68 just sets for a more lax medical standard (which also comes with limitations) that airmen have to meet.

I would like to get some input from the AMEs here as to why this is.
 
My husband got his Basic Med from his AME. He let his classs 1 expire, walked in for a consult, and 30 minutes later, walked out with a fresh Basic Med. He has Multiple Myleoma, an incurable form of cancer. So long as you don't fall into one of the three categories they list, you should be fine. The whole thing was a nothingburger and he is permananty disabled. He used to be a Captain on 747's. I think it depends on the AME, ours has always been fair, no Santa Claus, but not a hard a$$ either. I've heard a lot of standards MD's and DO's hesitate to sign Basic Med due to the liability and malpractice risks and since they hardly see them. Remember, you can always do a consult with an AME and risk nothing.

RadialGal
 
Dana said:
Call me cynical, but Basicmed (and sport pilot) threaten the AME's monopoly on airman medical certification.
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Meh. If that was all there was to it, AMEs would be happy to do BasicMed exams. There are a couple of other things:

1) Many AMEs honestly believe there's a benefit of airmen medical exams for everyone. They're doing their part to keep flying safe for pilots, passengers, and bystanders on the ground. If you think that way, you're going to think BM is a step in the wrong direction.

2) From the doctor's perspective, BM and FAA Med incur different levels of liability. The FAA medical is strictly administrative. The doctor signs a form saying "at this moment, all of these boxes get checked." It's the FAA, then, that declares the pilot is medically fit to fly. The doctor's part is purely administrative, and carries almost no liability exposure. That administrative protection doesn't exist in BasicMed. The doctor signs off an impression that the pilot is, in that doctor's opinion, fit to fly. The liability of that, while still small, is many multiples higher than what's incurred doing an FAA medical.
 
Curious Guest said:
I've found that lots of AMEs don't like BasicMed. Even had a HIMS AME tell me that you are ineligible for BasicMed if your medical certificate is a special issuance (which conflicts with 14 CFR 61.23(c)(3)(ii)(A)), and that the only people who fly on BasicMed "have something to hide from the FAA".
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A local AME who actually likes Basic Med and started doing Basic Med exams right out of the gate, told me something similar.

He stopped doing Basic Med exams for awhile because, according to him, almost everyone who came to him wanted Basic Med because they knew they couldn't get a medical. Because he is an AME and knows FAA's standards, he was concerned about the liability of signing off on the exam for airmen he knew didn't meet them.

He understands that basic med is a lower standard, but that doesn't help on the liability issue because in front of a jury, it would be pointed out that he substituted his judgment for the FAA's
 
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OneCharlieTango said:
1) Many AMEs honestly believe there's a benefit of airmen medical exams for everyone. They're doing their part to keep flying safe for pilots, passengers, and bystanders on the ground. If you think that way, you're going to think BM is a step in the wrong direction.
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If this were the case, I think a concientious AME would prefer doing the Basic Med exam himself, rather than letting the airman go to doctor who has no aeronautical background.

OneCharlieTango said:
2) From the doctor's perspective, BM and FAA Med incur different levels of liability. The FAA medical is strictly administrative. The doctor signs a form saying "at this moment, all of these boxes get checked." It's the FAA, then, that declares the pilot is medically fit to fly. The doctor's part is purely administrative, and carries almost no liability exposure. That administrative protection doesn't exist in BasicMed. The doctor signs off an impression that the pilot is, in that doctor's opinion, fit to fly. The liability of that, while still small, is many multiples higher than what's incurred doing an FAA medical.
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:yeahthat: I think this is the bigger issue. Personally, I believe it's not a significant concern compared to all the other liability a doctor incurs, but it probably sounds pretty scary to a poorly informed insurance company.
 
Half Fast said:
Personally, I believe it's not a significant concern compared to all the other liability a doctor incurs, but it probably sounds pretty scary to a poorly informed insurance company.
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And like most things involving aviation, the insurance companies don’t see a big enough market to bother calculating the risk, so “poorly informed” is the norm.
 
Dana said:
Call me cynical, but Basicmed (and sport pilot) threaten the AME's monopoly on airman medical certification.
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Neither BasicMed nor SP privileges are a medical certificate. AMEs are still the sole designee for medical certification.

What those two efforts has changed is who needs an FAA medical certificate to begin with. By removing some demand, especially around non-revenue airman that require ome-time or recurring SIs or CACIs, that should also lighten the load at the FAA and, just maybe, over time lead to faster resolution for those that do need that one time SI.
 
Half Fast said:
but it probably sounds pretty scary to a poorly informed insurance company.
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Insurance companies don't like being poorly informed. They are actually very well informed compared to pretty much everyone else, including government agencies. They look at data, and don't have anyone telling them to look at their data differently for political reasons. If BasicMed posed an elevated risk aircraft insurance companies would charge more to insure BasicMed pilots. They don't.
 
Jeff Oslick said:
Insurance companies don't like being poorly informed. They are actually very well informed compared to pretty much everyone else, including government agencies. They look at data, and don't have anyone telling them to look at their data differently for political reasons. If BasicMed posed an elevated risk aircraft insurance companies would charge more to insure BasicMed pilots. They don't.
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That misses the point. The question isn't whether Basic Med pilots pose a greater risk than medically certified pilots; the question is who bears that risk.

An AME who issues a third-class medical based on FAA standards has no liability if the pilot has a medically related incident.

An MD, including an AME, who signs of on Basic Med has no such protection. And an AME in particular has the curse of knowledge.

An AME defendant forced to testify that he certified an airman as medically fit to fly, knowing that the airman could not meet the FAA's standards, might be--as the kids say--cooked.
 
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Jeff Oslick said:
They look at data, and don't have anyone telling them to look at their data differently for political reasons.
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But they do ignore a lot of things aviation involving lack of data, primarily for financial reasons…there’s not enough money to be made to cover the cost of the data.
 
Lindberg said:
That misses the point. The question isn't whether Basic Med pilots pose a greater rush than medically certified pilots; the question is who bears that risk.
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Agreed. One cannot overestimate the effect of liability fears, whether warranted or not.
 
Yeah, I can tell you right now no doc is making big bucks doing aviation physicals. There are specialties in medicine that are, relatively speaking, overpaid. But doing FAA physicals isn't it... The money in medicine continues to be in doing procedures. Unless your AME can do a colonoscopy while doing your flight physical, he or she isn't really making that much!
 
I don’t know about that not getting rich. I looked for an AME that would do basic med(in Albuquerque), found one that chargers $600 for basic med, didn’t ask what he charges for 3rd class. When I retired from medicine I did a few flight physicals a week, charged $55. That was 20 years ago.
 
Eldorado said:
I don’t know about that not getting rich. I looked for an AME that would do basic med(in Albuquerque), found one that chargers $600 for basic med, didn’t ask what he charges for 3rd class. When I retired from medicine I did a few flight physicals a week, charged $55. That was 20 years ago.
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I am certain malpractice premiums have gone up in the past two decades.... My doc did my Basic Med exam as part of my annual physical, so I guess insurance paid for it. Then again, I pay him 2 AMU/yr for the privilege of being his patient....
 
Eldorado said:
…I looked for an AME that would do basic med(in Albuquerque), found one that chargers $600 for basic med, didn’t ask what he charges for 3rd class…
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That’s a don’t ask/go away price. I bet anyone trying to schedule would find the appointments full in perpetuity.

The third class was probably $150.
 
A local AME and pilot used to do Basic Med but quit because his malpractice insurer threatened to pull coverage. I think AOPA would give Basic Med a boost if they would develop some sort of supplemental coverage for Docs who provide the service.
 
Sounds like FAA legal team needs to issue an interpretation regarding the assumed liability of doctors who perform BasicMed exams.
 
I remember 5 years ago or so that I asked my AME who did my 3rd class about Basic Med. He said no, because Basic Med was only for people who are not physically fit to fly and are trying to get away with something.

Of course doesn't make sense, because if the doctor thinks the person isn't physically fit to fly based on the exam he isn't signing it. And if the exam doesn't reveal any data that the person isn't physically fit, then what basis does the doctor have to say the person can't fly?

So I put that one in the box of "I was specially selected to be an AME, and I can't contemplate or accept the idea that any doctor can do what I can do. I'm the guy to decide who flies, not those other doctors".
 
There are a couple of problems with docs and Basic Med

Insurance usually doesn't cover something like a Basic Med exam. It's kind of like a scuba clearance or DOT physical. It's not required for your health, which is why insurance doesn't cover it. It's either for your occupation, so in theory your employer should foot the bill, or recreation, where, well, you foot the bill. A lot of doc's don't like dealing with these kind of non covered extras. 600 is too steep. But if you think that a decent lawyer nowadays is $400 hr(am I paying too much:confused:), and that a halfway thorough Basic Med evaluation would be 20-30 minutes of history and physical and 5-10 minutes of paperwork time, a charge of ~200-300 isn't all that unreasonable since insurance covers nothing. As a courtesy, some docs would just do it during a regular physical and absorb the cost, but...

The pesky liability question, combined with the average doc's having no clue about what makes someone "safe" or "not safe" to fly. We all knew in medical school that, if you wanted an aviation physical, you went to an FAA doc, so to speak, someone with extra training. The issue never came up. And then congress came a long and said your doctor can sign this form stating whether it's safe to fly or not and legally attest to this.

Subsequently all of us docs just kinda looked at each other in a great big imaginary noon lunch meeting and muttered to each other, "WTF does this mean..." Especially since, at the end of the Basic Med exam form, right above where the doc signs, is the attestation that, essentially, the doc finds the patient fit to fly. The average doc isn't taught squat about aviation medicine.

When congress cooked up Basic Med, it appears they didn't ask the FAA much, which was probably good. The problem was that it appears congress didn't ask practicing doctors what they thought either. You and I understand Basic Med, but the average non-pilot doc doesn't know anything about it, unless he or she goes out of his way to learn. Until I got into aviation, I didn't know anything about aviation medicine/Basic Med. I don't know if the average malpractice carrier actually has rules against signing this kind of form, but I will say that, depending on where a doc works, and perhaps which malpractice carrier he or she has, there is some "pressure" and "recommendations" not to sign these forms...

Congress could have put in some basic protections for docs, a "good faith clause," etc that at least shielded a doc at least partly. I'm sure the lawyers, i.e. most of congress, doesn't generally like this idea. But, if you want to encourage a group to do something (i.e. get your doc to sign a Basic Med form) then offering at least some limited protection from negative consequences might be helpful.

If the average doc doesn't know anything about aviation medicine, isn't well compensated for a Basic Med exam, and is exposed to liability, well, not surprising that we're not all clamoring to do Basic Med exams...

So, it appears, for the time being, finding a Basic Med doc is going to be a bit spotty.

FWIW my internist doesn't do them either so I found a local chiropractor who does them. Yeah, so, not sure the system is working exactly as intended...
 
When Basicmed was created, I suspect the congresscritters thought it would improve safety, since the form would be signed by your existing primary doc who hopefully knew you and your medical history better than the AME you see once every few years. The problem arises when you're one of the many healthy younger pilots who don't have a primary doc, or your primary doc won't sign it for whatever reason.

I guess I was lucky, my primary doc had no problem with basicmed... but one of his other patients was the AME who did my last medical... and that AME himself didn't have a current medical so doubtless was on basicmed, probably from the same doc. That AME flew his Bo until he was 91, when a couple of taxiing incidents convinced him it was time to hang up his wings.
 
Some states, like mine, don't consider a Chiropractor to be a qualified medical practitioner, so that limits the pool as well.
 
Mark K said:
If the average doc doesn't know anything about aviation medicine, isn't well compensated for a Basic Med exam, and is exposed to liability, well, not surprising that we're not all clamoring to do Basic Med exams...
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The average doc doesn't know anything about scuba diving or automobile racing, either, yet they had no problem signing my forms for those. Both of those impose much greater physical stress, and are in harsher environments, than flying.

Prior to about 1960, aviation medicals were signed off by any physician, much like Basic Med today. Almost no physicians practicing today recall that, and they (and their insurance companies) have been conditioned to think there's something special about medical requirements to fly a little bugsmasher a few thousand feet AGL. There isn't, and Sport Pilot has been demonstrating that for twenty years now.
 
Chip Sylverne said:
Some states, like mine, don't consider a Chiropractor to be a qualified medical practitioner, so that limits the pool as well.
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While I can see an NP or a PA doing an exam, I'm puzzled how a chiropractor can do a medical exam. If you believe in what a chiropractor does, you're a consenting adult so go forth and God speed.
 
Half Fast said:
The average doc doesn't know anything about scuba diving or automobile racing, either, yet they had no problem signing my forms for those. Both of those impose much greater physical stress, and are in harsher environments, than flying.
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Nicely said. Have to keep things in context. We're talking about flying a Cessna. This isn't about being able to endure 9 G's in a dog fight, endure 6 months of weightlessness on the ISS, or fly high performance, complicated passenger jets with a hundred or so people depending on you.

The medical ability required to fly a Cessna withing the limits of Basic Med is well within the capability of a "common" non AME doctor to determine.
 
The problem is not that I can't make a judgement of a person's level of fitness.

Rather, things like fitness for a particular activity, or say disability, are often legally defined, and not medically defined. I was once called to testify on behalf of a patient who I medically opined was completely disabled. I ended up getting chastised by the judge who explained in no uncertain terms that my job was to delineate my patient's medical conditions and she would decide whether the patient was disabled. Disability, like "fitness to fly," is ultimately not entirely a medical question. It's a legal one that depends on who is defining disablity or fitness to fly.

You can be disabled by the VA legal definition, but not the SSA definition. Or by the SSA, but not by the folks that forgive student loans. (You kind of have to be essentially dead in order to be disabled from repaying your student loans...). You can be fit to fly under Basic Med but not under class 3 or higher.

Because congress and the FAA are defining fitness to fly differently.

Had the folks who cooked up 8700-2 just left out the last sentence above where the doc signs, "I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft," and instead just said something to the effect, "I certify the patient does not have the "X" number of listed disqualifying medical conditions."

The doc could do a good faith history, exam, discuss medications and medical conditions, confirm the absence of the legally defined disqualifying conditions, document all this and not expose himself to undue legal liability. I suspect most docs would be ok signing a form along these lines.
 
Mark K said:
…
Had the folks who cooked up 8700-2 just leftout the last sentence above where the doc signs, "I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft," and instead just said something to the effect, "I certify the patient does not have the "X" number of listed disqualifying medical conditions."….
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That seems like a sensible thing Congress could do. They ordered the birth of BasicMed, they can certainly order (by way of a line item in a bill) that change.

That’s something AOPA and EAA should be lobbying for.
 
WDD said:
I remember 5 years ago or so that I asked my AME who did my 3rd class about Basic Med. He said no, because Basic Med was only for people who are not physically fit to fly and are trying to get away with something.
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That's a pretty weird interpretation of basicmed by your AME. I can easily pass the FAA medical of any class, but I choose Basicmed because it doesn't cost me anything. During my annual checkup with my PCP, he also signs off the basicmed. It takes him 2 extra minutes to check the boxes and sign, so he never charged me extra for it. So I basically get a new basicmed every year. In my case at least, basicmed is easy, takes less time, and costs less as compared to a regular FAA medical - it's not because I am not physically fit to fly.
 
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Mark K said:
instead just said something to the effect, "I certify the patient does not have the "X" number of listed disqualifying medical conditions."
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Nice point. How about skipping it altogether? Have the doctor just sign the form to signify who did the exam.

In so much that if a person passes each line in the Basic Med exam form, that person has been deemed by Congress to be fit to fly within the constrains of Basic Med. The doctor's opinion on "fit to fly" is not needed.
 
Mark K said:
Rather, things like fitness for a particular activity, or say disability, are often legally defined, and not medically defined.
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Fitness under Basic Med is not legally defined. There are no pass/fail criteria.

Would you be unwilling to sign a medical form for scuba diving? How about a DOT physical?
 
Since Basicmed was created, has any doctor faced legal trouble for signing off a pilot?
 
Half Fast said:
Fitness under Basic Med is not legally defined. There are no pass/fail criteria.

Would you be unwilling to sign a medical form for scuba diving? How about a DOT physical?
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Well, it depends. If someone is healthy, no meds, no medical problems, well, then that's easy and many docs might sign the form. If a 65 year old with emphysema, has had a bypass, and is a sedentary couch potato, walks into my office and says, "it's my lifelong dream to scuba dive," well, this guy gets a referral to someone who as extra training in dive medicine...

Dive medicine network

And for DOT exams, well turns out the average doc can't do these any more. We used to, but the DOT put a stop to that and now you need an extra certification to do DOT physicals. I guess having the average doc who didn't know anything about the rules fill out the DOT forms was, perhaps, not ideal.

DOT requirements for medical examiners

So yes, the doc needs additional training and certification to determine whether or not you can drive a bus or truck. But, no additional training needed to determine whether you can fly a plane?

In Basic Med it's true that there are no clear pass fail criteria except the exclusion conditions.

Which is my point exactly. And WDD gets it. Since there is no criteria, why have me document they are safe to fly?

If there is no pass/fail criteria, why have the doc sign a statement implying the pilot has met some sort of criteria and passed?


The problem is a savvy lawyer might dig up something that would preclude the pilot from getting a class three and ask me why I signed the form? I could say, "Unlike a class 3, there is no criteria," but is that defense going to fly in front of a jury? Honestly telling the average person/juror, "there is no pass/fail criteria" just doesn't sound like it's right. It's legally, technically correct. But it's probably not morally and ethically right.

I actually have no idea if any doc has been sued under basic med. But docs practice under the threat. The best defense against a malpractice suit is good medical treatment. But some things, like basic med exams, scuba physicals are optional activities, so to speak. No doc is obliged to complete these forms if they don't wish to. If they perceive the risk >>> reward, well... Since congress didn't really spell out the criteria, they should not have written the form the way they did...
 
I have filled out application and renewal forms for medical malpractice companies every year for more than three decades in several states. I have never come across a question about performing physical exams of any sort, aviation or otherwise. They ask about high risk procedures, things like delivering babies, bariatric surgery, in-office anesthesia etc, but not about performing physicals. While I am certainly no fan of any medical malpractice insurer, blaming them for not doing Basic Med exams is not valid in my experience.
If any physician has had coverage denied or rates raised for doing any sort of exam, I would like to hear about it.
Jon
 
When I 1st inquired with my AME about doing Basic Med instead of jumping through and paying for the Annual hoops for my Special Issuance 3rd class. He said something like he didn't care for it much.
The next year he actually asked me "have you considered Basic Med? When it came time to renew I had him do the Basic med Exam. He did state the liability concerns mentioned previously in this thread, but since I still qualified for a 3rd class medical and probably a 2nd class medical had I chose to do so he was happy to sign the Basic med form.

Brian
 
As basic med with Few standards, and mosaic with fewer standards become the norm, expect the insurance comapanies to raise rates even further and set their own requirements.
 
sarangan said:
That's a pretty weird interpretation of basicmed by your AME. I can easily pass the FAA medical of any class, but I choose Basicmed because it doesn't cost me anything. During my annual checkup with my PCP, he also signs off the basicmed. It takes him 2 extra minutes to check the boxes and sign, so he never charged me extra for it. So I basically get a new basicmed every year. In my case at least, basicmed is easy, takes less time, and costs less as compared to a regular FAA medical - it's not because I am not physically fit to fly.
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It may sound weird to you, but multiple AMEs have reported having that experience.
 
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