As I near semi-retirement from anesthesiology, I'm considering becoming an AME. Though I'm a big fan of BasicMed, I have my own reasons for not wanting to do BasicMed exams. So, a question for you AMEs: has BasicMed caused a noticeable drop in the number of Class III medicals that you do? If so, how much? I realize 2020 was weird, but what about 2019 as compared to 2017? I assume the number of Class II's would be nearly the same, but tell me if I'm wrong. My goal would be to gain Senior status so I can do Class I's, as I live near an airline hub. But a large decrease in II's and III's would mean it takes longer to do the requisite number of exams for Senior status. Thanks in advance.
My volume is definitely lower since BasicMed. However, some of my prior class 3 guys come to me for BasicMed now. IMO, do it because you want to help pilots fly and enjoy it... there's no money to be made (and that's coming from FM, not anesthesia)
At this point, about 15-20 percent of GA pilots have gone BasicMed. That's around 5% of all active pilots. Class 1 and 2 exams are the bread and butter of high volume AMEs.
You do "file" with the FAA when you notify the FAA that you're on Basic Med, provide the physician's ID number, etc.
Inquiring minds want to know - why would you (and other AME docs) choose to turn away those who need and are willing to pay for your services?
I'm not the OP, but I can see a lot of reasons why BM imposes a lot more liability than acting as an AME. Especially if the OP is an anesthesiologist by trade, not primary care.
As others have mentioned, you're required to take the online medical education course every 24 calendar months. When you do so, you report the date of your last comprehensive medical examination. So the FAA has a good idea of who is registered to operate under BasicMed, even if the agency has no insight on the airman's medical condition at the time of the exam.
It takes time to get to the Class 1’s. If no one is getting Class III’s, it could be tough. Class 1’s are definitely the way to go once that’s possible. It’s a lot easier for a family doctor or anyone else who already has an office to dabble in AME-hood. For me, I’d have to make enough to cover the rent, malpractice insurance, etc. I know an anesthesiologist who does 1000 aviation exams a year, so it can be done, and profitably. As to BM, I talked to my malpractice insurance carrier about doing BM exams. The underwriter told me they’d cover me for a dozen exams a year but, if I had a single claim on a BasicMed patient, they’d “non-renew” me for everything. That’s “claim,” not “loss.” An AME goes over an FAA-mandated list of conditions and certifies that, as of this date, this person doesn’t have any of them. For BasicMed, a doctor says, “It is my opinion that this person is safe to pilot an airplane.” That’s potentially a very different type of liability, pointing to the essential differences between clinical medicine and administrative medicine. It just hasn’t been litigated; it’ll be 10 years or more before anyone knows what the actual malpractice implications of BasicMed are. I suspect it’ll be a whole lot of nothing, but I don’t want to be the test case.
I agree the untested nature of basic med liability is a big concern. Generally, the standard of care for malpractice is to be performing care that is at least as good as the "typical" physician doing what you're doing. If you're an AME doing an AME exam, what you "should be" doing is very well laid out, and so regulated that it's an easy bar to hit. There hasn't yet been enough litigation around Basic Med to establish "typical." Since Basic Med was originally advertised as "your personal PCP can do the exam," will you be found negligent if you don't know the patient as well as a long-time PCP? Or is AOPA's "it's just a CDL" going to stick? In my mind, it's even a bigger concern for a doctor who is also a pilot. It's all too tempting to come up with worst-case scenarios for a Basic Med malpractice case, but this one is pretty easy to imagine: "As a pilot do you know that running out of fuel is a leading cause of general aviation accidents?" "Yes." "And as a physician, you signed this pilot off for basic med, saying he was safe to operate an airplane?" "Yes." "And didn't that pilot's wife just testify that while he was filling out your intake form, the pilot told your nurse that he is bad with numbers?" "I did hear that." "So you, as a pilot and physician, think that someone who is bad with numbers was safe to calculate the fuel burn in a 5 hour flight with changing winds?" "..." In some ways I think it would be easier for a physician who isn't a pilot: "Well, the pilot gave me this form from AOPA that says it's just like a CDL exam, so I did that and they checked all the boxes." Suddenly, you're renegotiating the "standard of care" to be a CDL exam, which you would probably get away with. In some ways, Basic Med is trying to have it both ways (to describe it generously) or a bait-and-switch (to be less generous). It's billed as "people won't be scared to go to the doc anymore, because their primary care doctor, who knows them best and knows all of their conditions and treatments, and can really assess the pilot's safety, will be the one to work with them to get everything treated and then approve them to fly." But then it's used as "make sure to go to a 'doc-in-the-box' that doesn't have access to your real medical records, and get signed off. If anything goes wrong, don't worry, they can't disapprove you, just go to another one." Overall I think Basic Med is definitely a good thing, as it limits the becoming-ever-more-ridiculous SI process, the permanent denials, etc etc. But I also think that a lot of basic med proponents try to have it in all the good ways: "great because any doc can do it," "great because your primary care doc knows you best," "great because there's no more liability than a CDL exam," "great because there's never any denial," but those won't all turn out to be all the way true at the same time. As a pilot, it's great. As a physician, I don't think I'll get involved. Personally, I would feel super comfortable doing basic med exams for long-term primary care patients, but super uncomfortable doing basic med exams as a one-time visit. (And as an anesthesiologist -- but at the opposite side of my career to OP -- I don't have any long-term primary care patients.)
I’m not totally sure I can envision the malpractice scenario you described, but I could see a physician who is also an AME having some issues explaining in a court room why they signed off a pilot who had a medical condition that was disqualifying under part 67 that would typically be deferred to the FAA medical certification division in OKC.
My AME performs Basic Med exams, and he applies the 3rd class standards, presumably using his own judgment with something that would require a decision from the FAA.
Maybe. But medical malpractice is a lot harder to prove than what many people imagine. And I doubt he's doing it for liability reasons, he just said he has to have some standard, so he uses the FAA. The only reason my internist wouldn't sign off was because he had no way to test my vision or hearing. Here had zero liability concerns. Different strokes for different folks.
Just like a CDL... Don't let the naysayers see this story. And don't lie on the exam.... https://wjla.com/news/nation-world/feds-semi-driver-who-killed-5-kids-lied-on-health-forms
I’ve had no decrease in volume and in fact am almost overwhelmed. For me, Basic remains a courtesy to airmen with longstanding SI compliance in which case I probably know more than the reluctant PCP.... For DOT exams, you take a course and get a certificate. That changes you away from “strict” liability to what I call “credentialed work”. None exists for basic med.
