Rant: 3rd class medical - 8+ weeks

[flyingron]

My AME only does medicals and certain other occupational physicals. Still, I can't believe it's a tremendous money maker, but he's "semi-retired" as was a previous one (who did medicals, giving a 50% discount to pilots) whose major money maker was administering the FAA/DOT drug testing programs.

 

[azure]

Kinder description than I would use . . . I'd go with self-perpetuating, self serving bureacracy, capable of loosing the same piece of paper at least three times, feeding a pointless process that probably reduces safety far more than it has ever enhanced it. I'm thinking degraded proficiency, while waiting for Larry, Moe, and Curly to shove documents at each other.

I think a better argument is that it gives pilots an incentive to either not visit, or be less than forthcoming with their health care providers. Maybe that also helps indirectly to reduce safety, though it's likely a very small and unmeasurable effect given how rare medical incapacitation is as a cause of accidents.

 

[orange]

The doctors here (NYC area) seem to be doing well. There is a ton of them, and they all charge $150 minimum. And most of the ones that I contacted when shopping for an AME made it clear that they only accept cash. When a doctor sees a patient with insurance, they get maybe $60 between insurance and co-pay or whatever. Here, they get $150+. And the ones that I called were pretty booked up, so they do aviation medicals in between their regular patients.

 

[Sundancer]

I think a better argument is that it gives pilots an incentive to either not visit, or be less than forthcoming with their health care providers. Maybe that also helps indirectly to reduce safety, though it's likely a very small and unmeasurable effect given how rare medical incapacitation is as a cause of accidents.

Well said; expressing frustration that the nonsense has persisted so long. . .

 

[DFH65]

The doctors here (NYC area) seem to be doing well. There is a ton of them, and they all charge $150 minimum. And most of the ones that I contacted when shopping for an AME made it clear that they only accept cash. When a doctor sees a patient with insurance, they get maybe $60 between insurance and co-pay or whatever. Here, they get $150+. And the ones that I called were pretty booked up, so they do aviation medicals in between their regular patients.

I asked the local AME here who only does aviation medicals what the impact was for him if 3rd class went away. He is in a small market near a class C airport. He said about 50% of his patients were class 3 and he may retire or semi-retire. That in the small market there just wouldn't be enough business to do aviation physicals full time.

 

[HamishTHaggis]

Feel your pain in the delay. Just got my medical (3rd class) last Friday after a similar process. I also worked with Dr. Bruce, who I cannot recommend enough to anyone in a difficult situation. From deferment to issuance was 13 weeks. At Dr. Bruce's recommendation I called once a week to ask about the status, it was repeatedly told that it was "in the review process." Eventually I convinced my local AME to contact Oklahoma as well, and while it may be coincidence, that seem to break things loose. Four days later when I called I was informed that it was "being worked on today and can expect a response within a few days." Sure enough, I received it less than a week later in the mail. It seems to me that the original statement of "in the review process" simply means it's been assigned to a doctor and is sitting at the bottom of their queue or similar. Untruthful, misleading, and intended simply to reduce the level of frustration and string us along. In any case, I did ultimately receive it, but as I say it was about 13 weeks after paperwork was submitted. From what I've been hearing they must prioritize first and second class applications over hours, which certainly doesn't help the turnaround times. In any case, best of luck, and I hope yours comes back soon.


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[bflynn]

If all is well, you'll be in and out of doctor's office in 30 minutes...

This is one of the myths that people who haven't experienced the combative side of the FAA medical system don't understand. Everything can be well but you can still have to spend thousands of dollars and many hours of your time convincing the FAA of it.

Don't equate a delay in the FAA system with an actual medical problem.

 

[bflynn]

Honestly, I can't understand how it's even that. I was charged $99 for my third class medical. I can't see how any doctor is making any money with a charge that low. The visit was a half hour and there was piles of paperwork.

$99/half hour is $198/hour, which is ~$400,000/year. Was the doctor with you for half an hour? Typically when I have to see a doctor, we are together for 15 minutes.

 

[Fearless Tower]

This is one of the myths that people who haven't experienced the combative side of the FAA medical system don't understand.

It isn't a myth. It's sad reality.

But to clarify: By saying all is well, we understand it to mean simply that there are no flags to awaken the medical bureaucracy in OKC. I don't think anyone seriously thinks that breezing through an FAA medical (even a 1st Class) means they are certifiably healthy. The AA pilot who died not too long ago of a massive heart attack in flight should dispel that idea.

 

[topgun260]

I understand your rant but did you really expect a program run by the Federal Government to be quick and efficient?

On a side note, are SI's that common? I don't remember hearing about hardly anyone applying for a SI 25 years ago. I wonder what the ratio of regular medicals to SI's are now? I know the doc and staff are always amazed that I am over 40 with no medical issues and walk out with no limitations on my medical. They claim that this is unusual and want to know my secret.

 

[flyingron]

Actually I believe it's a mixture of two things:

1. Some things are available as SI now that were outright denials before.
2. Some things are newly become an issue requiring SI.

Take, for example, Sleep Apnea. 25 years ago nobody talked about this and the insurance/medicaid-bilking CPAP industry hadn't come around (in fact the concept of CPAP for this didnt even get proposed until 1980). Couple this with an overly idiotic SI system for this condition certainly increases the FAA's backlog.

 

[arnoha]

$99/half hour is $198/hour, which is ~$400,000/year. Was the doctor with you for half an hour? Typically when I have to see a doctor, we are together for 15 minutes.

My appt. was about 20-30 minutes. But there was a pile of paperwork to do, and then I was deferred to Oklahoma, which was another pile of paperwork. Then there was the coordination of the requested information.

Even with only 30 minutes devoted to my appt, $400k can't possibly be enough yearly income to run a medical office. Let's see: you'd have to fit all overhead, a doctor, a nurse, front desk, administration. Math does not add up in my head.

 

[azure]

I understand your rant but did you really expect a program run by the Federal Government to be quick and efficient?

On a side note, are SI's that common? I don't remember hearing about hardly anyone applying for a SI 25 years ago. I wonder what the ratio of regular medicals to SI's are now? I know the doc and staff are always amazed that I am over 40 with no medical issues and walk out with no limitations on my medical. They claim that this is unusual and want to know my secret.

Yes, SIs are very common today. Used to be, many of the conditions that can be certified with an SI today, would get you denied. There is a contrary move to take some conditions that were once SIs into the CACI program (Conditions the AME Can Issue), but I believe in general that's a much slower process, so the number of conditions certifiable on an SI goes up.

There are also "wastebasket diagnosis" conditions that the FAA seems to not know how to handle, so they make them SIs; for example IBS, even IBS-C. I can't even fathom the logic behind that (and neither can my AME; he just says, I don't write the rules).

 

[Palmpilot]

I get the impression that if the doctors can't figure out what you have, then the FAA assumes it must be something incapacitating. Not exactly "evidence-based medicine," IMO.

 

[LDJones]

All you guys waiting on a 3rd class and whiling away your time, have you considered taking up soaring in the meanwhile?
You don't need a medical, only to self certify as "healthy", although your CFI-G might have a problem releasing you for solo if you show up wheezing and dragging a white cane.
But if you have a valid driver's license and believe there is a decent chance the FAA will approve you for a 3rd class, odds are you'd be good enough to solo gliders.
And if you think gliders are somehow inferior or less fun than powered airplanes, I can assure you that if you love flying, this is the pinnacle. It doesn't get any better, believe me!
(And when/if you get your vaunted 3rd class and start flying power planes, your glider experience will make you a much better pilot, as a bonus.)

Those waiting are disqualified from gliders.

 

[LDJones]

I feel the OPs pain, having watched a student of mine jump through expensive hoops for a year to get a Third Class with nothing disqualifying in her history but an errant prescription by a doctor. The process is insane.

 

[Palmpilot]

I feel the OPs pain, having watched a student of mine jump through expensive hoops for a year to get a Third Class with nothing disqualifying in her history but an errant prescription by a doctor. The process is insane.

It sounds like there's a SERIOUS lack of due process here.

 

[Fearless Tower]

It sounds like there's a SERIOUS lack of due process here.

True, but unlike firearms, there is no constitutional right to fly.

 

[Palmpilot]

True, but unlike firearms, there is no constitutional right to fly.

Maybe, but there is a constitutional right to due process.

 

[LDJones]

Maybe, but there is a constitutional right to due process.

But generally only as it applies to rights. Since they've defined flying as a privilege they pretty much define their own due process. And it sucks.

 

[Palmpilot]

But generally only as it applies to rights. Since they've defined flying as a privilege they pretty much define their own due process. And it sucks.

Due process is a right in and of itself. Saying that it only applies when there is already another right would make the due process clause pretty meaningless. The words on the page say that it applies to depriving people of "life, liberty, or property."

 

[Sundancer]

Roger that - FAA does not/not have a choice about issuing certificates, if/if you have completed all the hoops successfully. You pass the ride/physical/test, they don't have a choice, they have to issue. "Privilege" doesn't enter into it, and pretty sure a Federal judge would agree, if they were dumb enough to invoke that as a reason for denial. "Yeah, your honor, he's passed the check ride and physical, but he said mean things about us on the internet. . ."

But yeah, they do get to define the hoops, to a large degree. We need a check and balance on 'em, or some other method that doesn't leave them as the final arbiter; maybe an independent third party making the final calls. . .other than having to make a Federal case out of it. Definitely need a "penalty" when they start an action, figure out it doesn't have merit when the pilot gets a good lawyer, and then just drop it and walk away. Maybe triple fees, and a six month moratorium on the similar actions?

 

[RotorDude]

Those waiting are disqualified from gliders.

If what you say is true, then the FAA needs to update its own page:

When do I need a medical certificate?
You need a medical certificate before flying solo in an airplane, helicopter, gyroplane, or airship. <snip>
If you are going to pilot a balloon or glider, you don't need a medical certificate. All you need to do is write a statement certifying that you have no medical defect that would make you unable to pilot a balloon or glider.

 

[Palmpilot]

Roger that - FAA does not/not have a choice about issuing certificates, if/if you have completed all the hoops successfully. You pass the ride/physical/test, they don't have a choice, they have to issue. "Privilege" doesn't enter into it, and pretty sure a Federal judge would agree, if they were dumb enough to invoke that as a reason for denial. "Yeah, your honor, he's passed the check ride and physical, but he said mean things about us on the internet. . ."

But yeah, they do get to define the hoops, to a large degree. We need a check and balance on 'em, or some other method that doesn't leave them as the final arbiter; maybe an independent third party making the final calls. . .other than having to make a Federal case out of it. Definitely need a "penalty" when they start an action, figure out it doesn't have merit when the pilot gets a good lawyer, and then just drop it and walk away. Maybe triple fees, and a six month moratorium on the similar actions?

Exactly.

The post I was responding to with my due process comment was about a case where a medical certificate was delayed for a year, and cost the applicant a bunch of money, because of a condition that the applicant didn't have. As the legal maxim goes, "Justice delayed is justice denied."

 

[LDJones]

If what you say is true, then the FAA needs to update its own page:

I was thinking of Sport Pilot that explicitly disqualifies you if you're denied a medical. But it's been a grey area on gliders since being denied a medical could trigger the 61.53 prohibition: "...shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner."

 

[Palmpilot]

I was thinking of Sport Pilot that explicitly disqualifies you if you're denied a medical. But it's been a grey area on gliders since being denied a medical could trigger the 61.53 prohibition: "...shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner."

You said "Those waiting are disqualified from gliders" [emphasis added]. Waiting for the FAA to act on your application is not the same as knowing that you have a condition that would make you unsafe to fly.

 

[LDJones]

You said "Those waiting are disqualified from gliders" [emphasis added]. Waiting for the FAA to act on your application is not the same as knowing that you have a condition that would make you unsafe to fly.

The only times I'm aware of someone waiting on a medical are those who've been denied previously, then jump through the hoops and are waiting on the SI. You walk out with a medical in hand unless there's an issue.

 

[Palmpilot]

The only times I'm aware of someone waiting on a medical are those who've been denied previously, then jump through the hoops and are waiting on the SI. You walk out with a medical in hand unless there's an issue.

It's not clear whether the cases being discussed in the thread involved a denial or just a deferral. A deferral does not necessarily mean that the applicant is not safe to fly - it means that the FAA has not yet made a determination.

Do you think the student you mentioned, who had to wait a year to get a doctor's erroneous prescription corrected, would have been unsafe to fly gliders during that period?

 

[tmcquinn]

I don't know what motivates AMEs to give physicals but I'm glad they're out there. Once upon a time I was seeing a cardiologist who offered to be my primary physician. I asked him why he would be willing to treat my everyday maladies after going through all that training. He told me it was nice to see a healthy patient every once in a while. Maybe some AMEs share this view.

 

[RotorDude]

I was thinking of Sport Pilot that explicitly disqualifies you if you're denied a medical. But it's been a grey area on gliders since being denied a medical could trigger the 61.53 prohibition: "...shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner."

The actual requirement for glider pilots (as quoted in the link I provided above) is to "certify" that he/she believes they can operate a glider in a safe manner. That some docs and/or bureaucrats think that because the pilot got some oddball diagnosis or medication long ago it requires more paperwork or hoop-jumping doesn't necessarily change the pilot's own belief that he/she is healthy to fly, and that's what they'll certify to.
As I understand it, it's up to the CFI-G to ensure that, along with basic flying ability, the student seems healthy enough to fly gliders before releasing him/her to solo.

 

[LDJones]

The actual requirement for glider pilots (as quoted in the link I provided above) is to "certify" that he/she believes they can operate a glider in a safe manner. That some docs and/or bureaucrats think that because the pilot got some oddball diagnosis or medication long ago it requires more paperwork or hoop-jumping doesn't necessarily change the pilot's own belief that he/she is healthy to fly, and that's what they'll certify to.
As I understand it, it's up to the CFI-G to ensure that, along with basic flying ability, the student seems healthy enough to fly gliders before releasing him/her to solo.

I've flown gliders for the last 17 years and it's considered a grey area by many. A good article is linked below:
http://www.danlj.org/~danlj/Soaring...al-Qualification-for-Glider-Pilots_p12-14.pdf

 

[Palmpilot]

Good article!

 

[RotorDude]

I've flown gliders for the last 17 years and it's considered a grey area by many. A good article is linked below:
http://www.danlj.org/~danlj/Soaring...al-Qualification-for-Glider-Pilots_p12-14.pdf

I read that article, and essentially it's just a lot of verbiage saying that if a glider pilot believes he/she is healthy enough, he may fly, per FAA regulations. Getting back to my original post in this thread, if you want to fly, and believe you are healthy enough to do so safely, go for it (in gliders).

 

[Palmpilot]

I read that article, and essentially it's just a lot of verbiage saying that if a glider pilot believes he/she is healthy enough, he may fly, per FAA regulations. Getting back to my original post in this thread, if you want to fly, and believe you are healthy enough to do so safely, go for it (in gliders).

I felt that the article was more helpful than that, in that it gave guidance on how to make the decision, and examples of the kinds of things to watch out for.

 

[RotorDude]

I felt that the article was more helpful than that, in that it gave guidance on how to make the decision, and examples of the kinds of things to watch out for.

Sure, but same bottom line.

 

[LDJones]

I read that article, and essentially it's just a lot of verbiage saying that if a glider pilot believes he/she is healthy enough, he may fly, per FAA regulations. Getting back to my original post in this thread, if you want to fly, and believe you are healthy enough to do so safely, go for it (in gliders).

But have a medical issue after being denied a medical by an AME and the FAA might have a less sanguine view. That's the grey area. Such a denial is a "reason to know" and ignoring it might fall under the careless and reckless.

 

[RotorDude]

But have a medical issue after being denied a medical by an AME and the FAA might have a less sanguine view. That's the grey area. Such a denial is a "reason to know" and ignoring it might fall under the careless and reckless.

Do you have a precedent for that (specifically for a glider pilot)?
The way I read it, you certify you are healthy enough to fly a glider safely. You are not a doctor, and are not expected to be one or act like one.
That it's "grey" just means a bunch of guys may debate it in the hangar, but not that there is any real doubt (per valid precedent) about glider pilot self certification.
I stand to be corrected, however.

 

[azure]

Do you have a precedent for that (specifically for a glider pilot)?
The way I read it, you certify you are healthy enough to fly a glider safely. You are not a doctor, and are not expected to be one or act like one.
That it's "grey" just means a bunch of guys may debate it in the hangar, but not that there is any real doubt (per valid precedent) about glider pilot self certification.
I stand to be corrected, however.

It's possible that, just like for LSA, you're expected to consult with one if there's any doubt. But I agree, being denied a medical, or knowing that you don't qualify for a 3rd class, is not in itself "reason to know" you can't operate a LSA or glider safely. A denial is unfortunately prohibitive against LSA ops because of the catch 22 rule, but not against glider ops.

 

[RotorDude]

I'd also add that for new glider pilots there are at least two obvious "checkpoints" for their general health beyond their self certification: their CFI (pre-solo and pre-checkride), and their DPE, during the checkride. For rated glider pilots, the FR should also act as a minimal health screen.
Sure, it's not like the white-coated stethoscoped doc sticking probes and peering into you, but I'd argue that a "field competency" test could be in some ways stronger/stricter/more relevant than the clinical office tests.
Just a few examples: if you huff and puff excessively or turn strange colors when you push the glider it might indicate a cardio-vascular-pulmonary issue. If you can't spot traffic, circling birds, or the windsock and/or distant smoke direction (and the resulting favored runway) when your CFI/DPE easily can, it might indicate a visual issue. If your decision making, esp. under simulated duress (e.g. rope break or tow plane "emergency" at 200') is shaky, it might indicate a mental issue. And so on.
My guess is that an experienced DPE can learn a lot about your overall personality, attitude, judgment and mental health during the oral, and about your general health once you go out to fly.
Not perfect, of course, but neither is the office visit.

 

[Palmpilot]

There are some medical issues that are serious enough that it would obviously be unsafe to fly anything. There are others where that is not the case.