Interesting Development

[UTLonghorn_1979]

Many many times. And the poor judgement show by drivers sure in't assisted by theiry PaO2s of 75.

If we’re going to talk about PaO2 of 75 as a major factor to poor judgment, then we should probably ground half of Colorado too.

Oxygen saturation isn’t the sole determinant of judgment, and the FAA knows that—which is why they don’t disqualify pilots/operations based on altitude alone. If PaO2 were the issue, we’d have entirely different standards for operating out of places like Leadville.

 

[jbarrass]

....... That's why ALPA has always maintained One Airspace One Standard......

A relevant context.

ALPA is a union for some Airline Pilots, most definitely not an advocacy group for the rest of us.

FWIW:

The FAA already has 6 different medical levels for various kinds of airman. Very inefficient, expensive, intrusive, and burdensome. There are no studies or analysis showing they improve safety, just hypotheticals and scary what-ifs. Reference to the only study I can find on actual efficacy: https://faa.gov/sites/faa.gov/files/data_research/research/med_humanfacs/oamtechreports/Mortality_Basic_Med_Pop.pdf……

They should be required to use the rulemaking process to come up with a transparent list of disqualifying conditions.

There are 15 disqualifying conditions in the FAR, but they deny medicals for hundreds of others (listed in a guide to Aviation Medical Examiners, no law or regularity basis). No tax dollars should be spent doing Special Issuances on Prostate cancer for a weekend (or any) pilot, etc. for example. It does not add to safety.

Medical decisions are based on DSM 3 (decades outdated) They should catch up.

Currently the Six levels:

1. The 1st class medical (Airline Pilots) has legs and given the public reliance on air transport makes some sense, but should be cleaned up.

2. The 2nd class (non airline commercial pilots). Another goal should be to reduce duplication. The rest of DOT has a medical already, replace it with a DOT physical. Duplication is not value added.

3. The 3rd class (private pilots flying friends and family not-for-hire). Should be eliminated entirely as a good start with very very minimal risk. Define it as a drivers license medical (like the proven Sport Pilot License). There should have been an immediate and significant improvement in wait time for the remaining pilots since CAMI now has many less cases to deal with. Unfortunately Parkinson's law seems to have applied here. MOSAC might get close...maybe.

4-6 No federal standard. Even the FAA has concluded the accident rate due to medical incapacitation using (a) Drivers licenses (for Sport pilots (slow 2 seat planes)) is incredibly low, (b) BasicMed (a replacement for most of the 3rd class forced on the FAA by congress) , or (c) none at all (Gliders, ultralights, balloons) is not statistically significant.

 

[UTLonghorn_1979]

I respect the Dr’s experience and the work done helping pilots navigate HIMS and the SI process—it’s not an easy path, and many have benefitted from that guidance.

That said, we also have to be honest about incentives. The current system—opaque, prolonged, and often overly rigid—creates dependency on gatekeepers and consultants. And when that becomes the norm, it’s hard to separate genuine medical advocacy from maintaining the status quo because it’s also a revenue stream.

The argument here isn’t about eliminating standards—it’s about making them more risk-based, transparent, and proportional to the type of flying and actual medical evidence. That’s not just better for pilots—it’s better for aviation safety and resource allocation.

If you’re confident in the system’s fairness, then reform shouldn’t be a threat. It should be a welcome opportunity to make it work better for everyone.

 

[bbchien]

I respect the Dr’s experience and the work done helping pilots navigate HIMS and the SI process—it’s not an easy path, and many have benefitted from that guidance.

That said, we also have to be honest about incentives. The current system—opaque, prolonged, and often overly rigid—creates dependency on gatekeepers and consultants. And when that becomes the norm, it’s hard to separate genuine medical advocacy from maintaining the status quo because it’s also a revenue stream.

The argument here isn’t about eliminating standards—it’s about making them more risk-based, transparent, and proportional to the type of flying and actual medical evidence. That’s not just better for pilots—it’s better for aviation safety and resource allocation.

If you’re confident in the system’s fairness, then reform shouldn’t be a threat. It should be a welcome opportunity to make it work better for everyone.

Reform is not a threat. When you get to a certain level you will always have work to do.

What is a threat is railing, going off on the deep end as you have many times, without constructive suggestion from you as to how to prevent Egyptair 777, Germanwings and now Air India. You could have been flying long ago had you had any insight at all, or simply have hired good help. You did not.

Then to the others who support creating aeromedical sepcialisits through legislation not education...even the current administration is not that stupid.

You think somehow you're going to get his help for free....or from the government (LOL)....and that' s where you delay has been....the only thing we can do for the present is "get your file through on the first go". And then it's "so unfair" that it takes so long. That's utter hypocracy.

 

[UTLonghorn_1979]

Reform is not a threat. When you get to a certain level you will always have work to do.

What is a threat is railing, going off on the deep end as you have many times, without constructive suggestion from you as to how to prevent Egyptair 777, Germanwings and now Air India. You could have been flying long ago had you had any insight at all, or simply have hired good help. You did not.

Then to the others who support creating aeromedical sepcialisits through legislation not education...even the current administration is not that stupid.

You think somehow you're going to get his help for free....or from the government (LOL)....and that' s where you delay has been....the only thing we can do for the present is "get your file through on the first go". And then it's "so unfair" that it takes so long. That's utter hypocracy.

There’s a difference between criticizing a broken system and “railing.” Pointing out legitimate inefficiencies, inconsistencies, and misaligned incentives isn’t hysteria—it’s advocacy. If constructive criticism makes people uncomfortable, that’s not on the critic; it’s on the system that tolerates dysfunction.

Bringing up Germanwings or EgyptAir as justification for rigid overreach in general aviation is a false equivalence. Those were tragic, high-profile airline disasters with systemic failures—not relevant examples for third-class private pilots trying to fly VFR in Cessnas. That kind of fear-based argument ignores scale, context, and proportionality—exactly what needs reform.

As for delays, it’s telling that “hiring good help” is presented as the only path forward—as if the process is designed to be so convoluted that pilots must pay for access or risk indefinite limbo. That’s not how a fair system should operate. And it’s not “hypocrisy” to point out that even well-prepared applications often get stuck due to bureaucracy, not medical risk.

Finally, no one is saying specialists shouldn’t be educated—we’re saying that if gatekeeping becomes a business model, we need to examine whether the process serves safety or just sustains itself. Reform doesn’t mean lowering the bar. It means making the system smarter, fairer, and more transparent. That benefits everyone—including the professionals trying to help.

 

[bbchien]

There’s a difference between criticizing a broken system and “railing.” Pointing out legitimate inefficiencies, inconsistencies, and misaligned incentives isn’t hysteria—it’s advocacy. If constructive criticism makes people uncomfortable, that’s not on the critic; it’s on the system that tolerates dysfunction.

Bringing up Germanwings or EgyptAir as justification for rigid overreach in general aviation is a false equivalence. Those were tragic, high-profile airline disasters with systemic failures—not relevant examples for third-class private pilots trying to fly VFR in Cessnas. That kind of fear-based argument ignores scale, context, and proportionality—exactly what needs reform.

As for delays, it’s telling that “hiring good help” is presented as the only path forward—as if the process is designed to be so convoluted that pilots must pay for access or risk indefinite limbo. That’s not how a fair system should operate. And it’s not “hypocrisy” to point out that even well-prepared applications often get stuck due to bureaucracy, not medical risk.

how would you know that? A well prepared application goes through.....a lot of folks here have experienced that. I just met with an injured public servant, from Las Vegas this AM. We're doing it RIGHT.

Finally, no one is saying specialists shouldn’t be educated

So we should work for free. Yeah, that's the ticket. Ever try to get a checkride - there's a group of highly qualified individuals....if you don't pay 'em what they're worth you can't get a checkride!

—we’re saying that if gatekeeping becomes a business model, we need to examine whether the process serves safety or just sustains itself. Reform doesn’t mean lowering the bar.

Unfortunately the experince with O-care seems to point otherwise. For garden vareity stuff APRNs are doing all right. But who comes with "garden Variety" stamped on their foreheads? I can't beginto tell you howm may files I get asked to review in which the APRN put 'em on meds becuase he/she didn't know any better.....eff'd up forever.

It means making the system smarter, fairer, and more transparent.

You could have gotten that on your first consult with an expert. Did you?

That benefits everyone—including the professionals trying to help.

Nope. That's why I say, Let third class, be decided in the offices. Devote what resources we do have to a DAUNTING task (FIGURING OUT WHAT's IN YOUR HEAD) to the guys who fly for hire. Hello, Ringy Dingy.....

 

[UTLonghorn_1979]

how would you know that? A well prepared application goes through.....a lot of folks here have experienced that. I just met with an injured public servant, from Las Vegas this AM. We're doing it RIGHT.

So we should work for free. Yeah, that's the ticket. Ever try to get a checkride - there's a group of highly qualified individuals....if you don't pay 'em what they're worth you can't get a checkride!

Unfortunately the experince with O-care seems to point otherwise. For garden vareity stuff APRNs are doing all right. But who comes with "garden Variety" stamped on their foreheads? I can't beginto tell you howm may files I get asked to review in which the APRN put 'em on meds becuase he/she didn't know any better.....eff'd up forever.

You could have gotten that on your first consult with an expert. Did you?

Nope. That's why I say, Let thrid call be decided in the offices. Devote what resources we do have to a DAUNTING task (FIGURING OUT WHAT's IN YOUR HEAD) to the guys who fly for hire. Hello, Ringy Dingy.....

You’re making a lot of assumptions about my case, my actions, and my intent. Your comments suggest this is a system that too often relies on insiders, personal networks, and paid navigation just to access basic due process. That’s a structural issue, not a personal failure.

And for the record, the assertion that I didn’t have good help simply isn’t accurate. My AME submitted a complete package, and I haven’t received a single request for additional information since it was submitted to the FAA, over 8 months ago. I’m stuck in bureaucratic limbo.

No one is saying professionals shouldn’t be compensated. Of course time and expertise deserve payment—same as with DPEs or instructors. But when the only realistic way to navigate a medical process is to pay someone to interpret a black box, and even then the outcome is uncertain or delayed, it’s fair to question whether the system is structured for safety or for preservation of bureaucracy.

Your comment about third class certification being handled in-office actually reinforces the argument. If the risk level is that low, why are we applying legacy-level scrutiny designed for ATPs? That’s not about protecting the NAS—it’s about institutional momentum.

This isn’t a call to lower standards. It’s a call to align them with operational risk, evidence, and transparency. The fact that so many qualified pilots are forced into months—or years—of ambiguity despite clean records and supportive documentation isn’t a fluke. It’s the signal that reform isn’t just warranted—it’s long overdue.

 

[wellknow]

Not to distract from your discussion with longhorn Dr. Bruce, but what I don’t understand is if an applicant gets sent to HIMS because of alcohol dependency or ssri’s, it doesnt just subject him to extensive testing and documentation of his mental state or progress in recovery. It allows the faa to comb through his entire medical record witha. microscope and require extensive additional testing and justification far beyond what other pilots have to endure. what is the justification for ssri applicants having to undergo that extreme level of additional medical scrutiny completely unrelated to any psychological or addiction issues.

 

[UTLonghorn_1979]

Not to distract from your discussion with longhorn Dr. Bruce, but what I don’t understand is if an applicant gets sent to HIMS because of alcohol dependency or ssri’s, it doesnt just subject him to extensive testing and documentation of his mental state or progress in recovery. It allows the faa to comb through his entire medical record witha. microscope and require extensive additional testing and justification far beyond what other pilots have to endure. what is the justification for ssri applicants having to undergo that extreme level of additional medical scrutiny completely unrelated to any psychological or addiction issues.

It’s a good question. The rationale they often give is that conditions like depression or substance dependence can have subtle, episodic, or delayed impacts on judgment—making it difficult to predict future impairment. So instead of evaluating the actual stability and treatment compliance of an individual, the FAA tends to apply broad protocols: psychiatric evaluations, neuropsych testing, years of documented abstinence or stability, and unrestricted access to full medical histories.

But this “guilty until proven innocent” approach is not practical. As I’m voiced on many occasions:

1. It’s not proportional – A pilot with a treated anxiety disorder and no impairment history is subjected to more scrutiny than someone with uncontrolled hypertension or early cognitive decline, which may pose greater flight safety risks.
2. It discourages treatment – Many pilots avoid seeking help for treatable mental health conditions because they know disclosure could trigger years of medical surveillance.
3. It creates inequality – Two pilots with similar risk profiles but different labels (e.g., “stress” vs. “depression”) are treated completely differently under the current framework.
4. It lacks transparency – Much of the FAA’s decision-making happens behind closed doors with little recourse or clear standards for applicants to follow.

The FAA claims it’s erring on the side of safety, but in practice, it often errs on the side of delay, burden, and risk aversion without strong data to justify it. That’s why many are pushing for reform: to bring the process in line with current medical science, reduce unnecessary barriers, and promote honesty and early intervention instead of fear and avoidance.

It’s a fact that individuals that are lying or hiding anxiety or depression are far more at risk of being dangerous than those that are being honest on applications, yet those being honest on applications are being punished.

It’s not about weakening standards—it’s about updating them to reflect reality.

As I’ve said a ton, the FAA is concerned with the appearance of safety, not addressing processes to increase actual safety.

 

[wellknow]

Thanks. But I was referring to them scrutinizing EVERY aspect of your medical history far beyond any psychological testing

 

[UTLonghorn_1979]

Thanks. But I was referring to them scrutinizing EVERY aspect of your medical history far beyond any psychological testing

Because they can, barring intervention from lawmakers.

 

[bbchien]

Nothing unfocused here. The reason FAA looks at everything is:

(1) the covariance of the diseases…it’s super high
(2) the def.of psychiatry is the total sum of all your behaviors so they have to look
(3) many posters don’t “get” that, and so expose other lacks of insight. And remember, there is a difference between sobriety, as one poster espouses, and recovery…..and it involves insight.

For example I have been working with a young woman and her mom who came for ADHD. But there’s a history in writing of drug abuse and anxiety disorder. She’s finally “got” that part and now we have three things to work on. Remember that to the agency, a pilot is a TOTAL package.

I have another beginning the trip down the road who in the recent past treated his PTSD with alcohol.

There’s a prolific poster here who sez sober, who has an astounding lack of insight…there is a problem, just not what he thinks it is….it’s apparently always someone else’s fault.and he always need to get the last word….

Personal responsibility
Gratitude for a second chance
Humility

Where are they if in recovery? I’m just not seeing any of it in the POA record of posts.

 

[UTLonghorn_1979]

Nothing unfocused here. The reason FAA looks at everything is:

(1) the covariance of the diseases…it’s super high
(2) the def.of psychiatry is the total sum of all your behaviors so they have to look
(3) many posters don’t “get” that, and so expose other lacks of insight. And remember, there is a difference between sobriety, as one poster espouses, and recovery…..and it involves insight.

For example I have been working with a young woman and her mom who came for ADHD. But there’s a history in writing of drug abuse and anxiety disorder. She’s finally “got” that part and now we have three things to work on. Remember that to the agency, a pilot is a TOTAL package.

I have another beginning the trip down the road who in the recent past treated his PTSD with alcohol.

There’s a prolific poster here who sez sober, who has an astounding lack of insight…there is a problem, just not what he thinks it is….it’s apparently always someone else’s fault.and he always need to get the last word….

Personal responsibility
Gratitude for a second chance
Humility

Where are they if in recovery? I’m just not seeing any of it in the POA record of posts.

We can all agree that the FAA needs to assess the whole pilot. But that doesn’t justify indiscriminate fishing through unrelated medical history, or applying a different standard of scrutiny based solely on someone’s transparency about mental health or recovery. That’s not covariance. That’s confirmation bias. If that bothers you, maybe what you’re calling “lack of insight” is really just discomfort with being challenged.
You seem to draw sweeping inferences from forum posts, and question someone’s sobriety and character without ever having evaluated them. That’s not psychiatry. That’s ego with a license.

Recovery isn’t about silence and submission.

So yes—personal responsibility, gratitude, and humility. All of those exist. But so does the right to advocate for fairness without having to kiss the ring of every consultant along the way.

And if getting the “last word” means not rolling over in the face of condescension, I’m good with that.

 

[bbchien]

And how would the whole pilot be assessed w/o asking the other questions. Do you think any psychiatrist would decline to point out other diagnoses?

And, See? Tries to get the last word yet again. Every time. No humility anywhere in any of a zillion posts. LIP service to the big three. And, Only sees condescension.

 

[wellknow]

Thanks for addressing my question Dr Bruce. Sorry it resulted in more attacks. It was helpful and useful insight and I appreciate it.

 

[Clip4]

Sounds like an easy explaining to me. “If it please the court, the FAA does not approve any medication it has not determined is safe for pilots to use while flying”. Add pages of scientific data and processes for determining medications are safe.

For those who haven’t seen this. Curious how FAA will respond to having to explain operating under their own universe of medical opinions.

Court rules FAA antidepressant denial 'arbitrary'

A federal appeals court took the FAA to task for failing to provide a rationale for disallowing a medication that is similar to approved prescriptions, a decision that could have implications for pilots being treated for various mental health conditions.

www.aopa.org

 

[GBear286]

And this is the problem. Everyone's a lawyer. Everyone's a doctor. Everyone's a mechanic. Everyone's an accountant.

I spend a considerable amount of time explaining to patients and their family members why my opinion does not align with Dr Google. It's only going to get worse as patients increasingly utilize ChatGPT and Grok.