PA as an AME

Ventucky Red

Ventucky Red

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With more and more physician assistants becoming the vanguard of medicine these days, and AMEs disappearing faster than a bad Tinder date spotting their ex across the bar, does anyone know if the FAA; with all their recent enlightened decisions, would consider allowing PA to do them?

I know, stop sounding logical...
 
Why do they even need doctors? They are administrative, they don’t use medical standards, they don’t think they owe a standard of care…. The whole system is at odds with them being doctors, and just puts the doctors at risk.

The guy at the faa in charge of all hims determinations for “important 121 cases” has ZERO qualifications in the area of substance abuse.

I’m completely confused as to why they would tie their hands by requiring doctors… don’t even need PA qualifications to do what they don’t do…

Big push now to qualify PILOTS to be counselors for pilots who want mental health help… RATHER THAN recommend they see.. you guessed it, A DOCTOR.

Can’t make this stuff up.
 
Man what is your issue....the guy in charge of hims determinations is a board certified psychiatrst.
Get a grip, man. -----------------------------------------------------------------

All designees are "dropping like flies" yet the FAA doesn't see it- "Weh have enough DPEs" they say. THey just don't have DPE avaialability.

The D.Mech. Examiners are faced with 20 hour exam @ $0.00 an hour and that's not gonna last long
The AMEs are getting crushed uner the 3 MByte upload maximum. But FAA doesn't see it.

Everyone is "get my check go home and make it to retirement".
 
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Ventucky Red said:
With more and more physician assistants becoming the vanguard of medicine these days, and AMEs disappearing faster than a bad Tinder date spotting their ex across the bar, does anyone know if the FAA; with all their recent enlightened decisions, would consider allowing PA to do them?

I know, stop sounding logical...
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As a Family Physician and former Air Force Flight Surgeon, I think it’s a reasonable consideration so long as it’s done in alignment with the mission of the FAA.

And given that they’re Aviation Medical EXAMINERs and not physicians, seems like the change could be fairly simple.
 
bbchien said:
Man what is your issue....the guy in charge of hims determinations is a board certified psychiatrst.
Get a grip, man. Or go back to the bottle.
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As much as I respect your contributions to the forum and to airmen, that comment was rather unbecoming.

 
Tools said:
The guy at the faa in charge of all hims determinations for “important 121 cases” has ZERO qualifications in the area of substance abuse.
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This is an interesting take- who in particular are you referring to? I struggled to find anything that aligns with this view via my own research.
 
robin ardoin said:
As much as I respect your contributions to the forum and to airmen, that comment was rather unbecoming.

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Deleted.

But for those of us who do addictionology the body of posts here show
Relentless bitterness
Not at peace
Shifting of blame to FAA and to others
Always critical to anyone but himself
 
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When I worked as a physician in a troop clinic at Ft Campbell one of my PAs was an Aviation PA. He took care of many helicopter pilots under the supervision of a Flight Surgeon. He would be more capable than most civilian physicians for doing Basic Med if allowed by law. The problem is that many mid levels (and physicians) are not really qualified from a medical perspective in my opinion.
 
The question at hand was answered by senatorial questioning of Maj Gen Brett Wyrick (a general surgeon (trauma) and Deputy Nation RFS). The video is no longer up on Youtube, I think this was ~2022.

Senator Duckworth: "General Wyrick, why cannot APRNs become AMEs?"
Reply: "Senator, you were a helicopter pilot. You clearly understand experience and time at the stick do you not?"
...upon which, the Senator yielded the floor.

The operational analog is, "Are you gonna let some COM AMEL fly 190 pax around (121 scheduled)?"
What Tools proposes (to let other pilots do medical evals) is to say, "you gonna let some doctor be a flight deck check airman?"

Really. Grinding the axe is no no net value.
 
So….. is it subjective or objective? An NP or PA can surely go through a medical exam checklist.

How about NP and PAs eligible for 3rd class? That would at least take pressure off of the limited MD AME workload. Heck, why not have a regular, non AME MD, NP, PAs be able to issue a 3rd class? Seems to work for Basic Med.

But….. the FAA hasn’t asked for my suggestion/opinion yet.
 
WDD said:
So….. is it subjective or objective? An NP or PA can surely go through a medical exam checklist.

How about NP and PAs eligible for 3rd class? That would at least take pressure off of the limited MD AME workload. Heck, why not have a regular, non AME MD, NP, PAs be able to issue a 3rd class? Seems to work for Basic Med.

But….. the FAA hasn’t asked for my suggestion/opinion yet.
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It depends. It's not just filling out a checklist. That's the kind of work a midlevel should excel. The issue is decision making for a specialized form of medicine. Per the AOPA guide for physicians on Basic Med:

"If your clinical judgment after completing the examination and discussing the patient’s medical history is that you are not aware of any medical condition that, as presently treated, could interfere with the individual’s ability to safely operate an aircraft, you will complete Section 3 of the FAA examination form and return it to the patient"

So now we are introducing significant judgement and decision making that most physicians are probably not qualified to make unless the patient is actually healthy. I my opinion Basic Med is self certification with an extra hoop to jump through so it probably wouldn't make a difference. How would any medical provider other than someone formally trained in aerospace medicine know if one or a combination of medical conditions can interfere with an individual's ability to safely operate an aircraft?
 
bbchien said:
Deleted.

But for those of us who do addictionology the body of posts here show
Relentless bitterness
Not at peace
Shifting of blame to FAA and to others
Always critical to anyone but himself
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precisely
 
GBear286 said:
It depends. It's not just filling out a checklist. That's the kind of work a midlevel should excel. The issue is decision making for a specialized form of medicine. Per the AOPA guide for physicians on Basic Med:

"If your clinical judgment after completing the examination and discussing the patient’s medical history is that you are not aware of any medical condition that, as presently treated, could interfere with the individual’s ability to safely operate an aircraft, you will complete Section 3 of the FAA examination form and return it to the patient"

So now we are introducing significant judgement and decision making that most physicians are probably not qualified to make unless the patient is actually healthy. I my opinion Basic Med is self certification with an extra hoop to jump through so it probably wouldn't make a difference. How would any medical provider other than someone formally trained in aerospace medicine know if one or a combination of medical conditions can interfere with an individual's ability to safely operate an aircraft?
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The idea of only a formally trained in aerospace medicine doctor can do this for a 3rd class is a theory. We have real world evidence that Basic Med is working well with the judgments being made by non AME medical people.

Theory vs evidence -
 
WDD said:
The idea of only a formally trained in aerospace medicine doctor can do this for a 3rd class is a theory. We have real world evidence that Basic Med is working well with the judgments being made by non AME medical people.

Theory vs evidence -
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That implies this issue has been formally studied. There are many aviation accidents where we really don't understand the cause or contributing factors. I believe the evidence you claim exists is more anecdotal than scientific.

The big question is if formal medical screening of pilots offers a significant safety benefit over what is effectively self certification for general aviation. It may not, so why not just eliminate what is likely just Basic Med theatrics? The reason we can usually get away with not effectively screening GA pilots is that incapacitating events are uncommon. Think of all the passengers with really bad underlying disease who fly commercial daily and that diversions due to medical emergencies are fairly rare. There is more to flying than not becoming incapacitated during flight but that's a big part of what medical screening attempts to minimize.

So if a GA pilot wants to fly a light aircraft in uncongested airspace and the passengers understand the pilot's medical fitness has not been formally evaluated, then self certification is fine by me. The lack of a competent medical evaluation is unlikely to result in many nonparticipant injuries or deaths. People engage in many highly risky activities such as rock climbing and cave diving and it's not my business if they want to risk their lives. When an airplane falls out of the sky in most parts of this country it's unlikely it will land on somebody. Driving a car puts others at risk more than general aviation. It is hard to quantify the risk to public safety due to pilot medical issues but probably very low. How much risk to nonparticipants is acceptable is a separate issue.

What gives me heartburn is when medical providers imagine or knowingly profess to have expertise where they do not and this is very common. I think Basic Med gives a false sense of security. Aerospace Medicine is a medical specialty best left to people with formal training, at least for pilots with a complicated medical history. Which pilots require a truly competent medical evaluation and under what circumstances to protect public safety is up for debate.
 
US has benefited greatly from the Aeromedicine expertise we developed. Those who fly high performance, demanding aircraft such as military aircraft, civilian jet transport, etc. are generally vetted well.

My suggestion only pertains to the GA, 3rd class type of pilot. You don't need to have the ability to pull 9 g's and be on the top 1 percent of hand eye coordination, spatial analysis, etc. to fly a Cessna for a $100 hamburger.

The data exist - not antedotal - that those on Basic Med who last did a 3rd class many years ago are no more dangerous than those on 3rd class. Therefore, my suggestion that "normal" doctors can successfully determine if a person can do Basic Med. We will now be getting a new crop of data, readable in may be five years, of those flying Cessnas on MOSAIC / on a driver's license. Looking forward to seeing that data, but I'd assume (hope?) that someone looked at that and had some valid reason to believe they would also fly as safe as those on Basic Med / 3rd class.

Appreciate the discussion. I also know it's a moot suggestion on my part, but it does contribute to the thinking of "what is a safe physical and mental status for flying", which is good to keep one self aware on their own status.

Cheers!
 
bbchien said:
The question at hand was answered by senatorial questioning of Maj Gen Brett Wyrick (a general surgeon (trauma) and Deputy Nation RFS). The video is no longer up on Youtube, I think this was ~2022.

Senator Duckworth: "General Wyrick, why cannot APRNs become AMEs?"
Reply: "Senator, you were a helicopter pilot. You clearly understand experience and time at the stick do you not?"
...upon which, the Senator yielded the floor.

The operational analog is, "Are you gonna let some COM AMEL fly 190 pax around (121 scheduled)?"
What Tools proposes (to let other pilots do medical evals) is to say, "you gonna let some doctor be a flight deck check airman?"

Really. Grinding the axe is no no net value.
Click to expand...
That’s so ironic. His dad was a Medical Administrator in the Air Force and I BELIEVE the first non-physician Deputy Surgeon General - pulled up entirely by the Surgeon General at the time.

FWIW Wyrick was, umm, not well respected even though his boss, Chip Roadman, was outstanding. I was in the AF SG office at the time, so have first-hand experience.

He was a direct beneficiary of the opposite of what his son said.

His son sounds like his dad - and a trauma surgeon :D
 
His actual reply to Senator Duckworth was “you do understand the difference between 70 hours, 700 hours and 17,000 hours do you not?”

And as for WDD IMO shortly FAA will have to give up 3rd class totally. Of course the these pilots will be limited as there are mo agreements with other nations who guard their airspace from relatively unevaluated pilots. The resources are being taken up by class 2 and class1. It will be moot, I have 3rd class guys waiting eight months for FAA concurrence.

And to GBear, what I have avoided saying is essentially that if an AME doesn’t understand what the FAA wants (and why) before the application, he needs reconsider his practice. You are saying I think, the same thing. I discourage airman application until we have an acceptable package.

Denial rate is pretty near Zero and no back and forth. I haven’t met a physician extender who can do that.
 
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It woulda been sweet if her reply was “What do you think of a paper-pushing Administrator with zero clinical training or experience rising to the level of Deputy Surgeon General? No need to answer: you’re clearly the beneficiary of that scenario”.
 
bbchien said:
His actual reply to Senator Duckworth was “you do understand the difference between 70 hours, 700 hours and 17,000 hours do you not?”

And as for WDD IMO shortly FAA will have to give up 3rd class totally. Of course the these pilots will be limited as there are mo agreements with other nations who guard their airspace from relatively unevaluated pilots. The resources are being taken up by class 2 and class1. It will be moot, I have 3rd class guys waiting eight months for FAA concurrence.

And to GBear, what I have avoided saying is essentially that if an AME doesn’t understand what the FAA wants (and why) before the application, he needs reconsider his practice. You are saying I think, the same thing. I discourage airman application until we have an acceptable package.

Denial rate is pretty near Zero and no back and forth. I haven’t met a physician extender who can do that.
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Do u see Canada accepting Basic Med?
 
wellknow said:
Do u see Canada accepting Basic Med?
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No. Tr__p is not cooperative so Ottawa wil not cooperate. Remember, the do not want to become the 51st State.
As an old mentor of mine was found of saying "Unbeerevable!".

I continue to be dumbfounded as to "how we got here".
 
hartwell said:
It woulda been sweet if her reply was “What do you think of a paper-pushing Administrator with zero clinical training or experience rising to the level of Deputy Surgeon General? No need to answer: you’re clearly the beneficiary of that scenario”.
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Tsk Tsk. You're letting your "true colors" show. LOL.
 
Are the Canadians still upset over the Poutine tariffs? Or the mayonnaise embargo?

bbchien said:
Remember, the do not want to become the 51st State.
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Not a problem. Just give Canada to North Dakota.


:p
 
Who knows? But with our activities in Greenland and in the Arctic we're for sure on Ottawa's "watch list". sigh.
 
"Relentless bitterness" is the chef's kiss of descriptors.
 
Why should Canada control our airspace? Maybe keep the 3rd for flying to Canada and scratch it for here.
 
the best solution is to cut the government bs and paperwork and let doctors be doctors and not FAA paper pushers.
 
Imagine if the crazy jumpseater who pulled the engine cutoff had been a ca or fo who pulled a germanwings. The faa is a screwed up bureaucracy with inconsistent standards but the medical division plays an important role
 
wellknow said:
The faa is a screwed up bureaucracy with inconsistent standards but the medical division plays an important role
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I won't deny that the role is important, but I question whether they're actually being effective in that role. Seeing little difference between Basic Med and a Class 3 in terms of safety, I doubt that the FAA is any more effective than your personal physician, or a walk-in clinic for that matter.
 
wellknow said:
Imagine if the crazy jumpseater who pulled the engine cutoff had been a ca or fo who pulled a germanwings. The faa is a screwed up bureaucracy with inconsistent standards but the medical division plays an important role
Click to expand...
If I recall, this wasn't a medical or mental issue as much bad decision making. He decided it would be just peachy to take drugs / mushrooms and then get into the cockpit. He had his 1st class, was vetted by the FAA medical system.

You can get a medical to see if you're color blind, can hear, and see 20/20, but that won't filter out stupid.
 
Well, he was self medicating with shrooms… the question then becomes would he have sought some more effective help if the faa wasn’t so draconian?

Maybe yes, maybe no…

The faa is now proposing you go get mental health advice from a “specially trained pilot”, w o w.

DO NOT go to a pilot for marriage or financial advice… but if you’re DEPRESSED (a VERY VERY DANGEROUS condition), ya, an amateur should suffice…

But, to be fair, most pilots would have likely advised AGAINST using shrooms! So what do I know?
 
Of all the things, he chose to self medicate vs non insurance paid, non medical counseling, or other possible options. Kind of goes back to bad decision making / can't fix stupid. But the guy's got a record / on probation, a federal felon, will need a mid life career change, etc., so wish him well with whatever non aviation future he ends up in.
 
WDD said:
....so wish him well with whatever non aviation future he ends up in.
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Oh, he may still have a future in aviation. He won't be allowed to fly again, but maybe he can find work counseling other pilots....
 
WDD said:
If I recall, this wasn't a medical or mental issue as much bad decision making. He decided it would be just peachy to take drugs / mushrooms and then get into the cockpit. He had his 1st class, was vetted by the FAA medical system.

You can get a medical to see if you're color blind, can hear, and see 20/20, but that won't filter out stupid.
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The Germanwings pilot was able to hide his medical condition because of German privacy laws.
 
mryan75 said:
The Germanwings pilot was able to hide his medical condition because of German privacy laws.
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True, but that has nothing to do with the US pilot deciding to take mushrooms. Or allowing PAs to do Basic Med. Or maybe even do 3rd class.

Just because something bad happened in another country doesn’t mean the US system can’t be improved.
 
WDD said:
True, but that has nothing to do with the US pilot deciding to take mushrooms. Or allowing PAs to do Basic Med. Or maybe even do 3rd class.

Just because something bad happened in another country doesn’t mean the US system can’t be improved.
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So why was it brought up then? It can be brought up to support one position but not dispelled, apparently.
 
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mryan75 said:
So why wasbord brought up then? It can be brought up to support one position but not dispelled, apparently.
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Don’t know. I don’t see how it enters into this discussion, but always enjoy hearing others POVs. Always learning, etc.
 
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