Updated FAA Medical Processes / Repost from Reddit

Stegoo_86

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Stego_86
Hello All,

I found this post on Reddit that was discussed a few days ago. I wanted to repost it here for everyone to take a look at it and see what you're thoughts may be. I know that we have a few HIMS AMEs who follow this form so I wanted to know what they thought about the upcoming changes and or work that is currently be done to help flying become more accessible.



REPOST:

A while back I had mentioned here and over at r/ATC that I was going to be going to the mental health talk here at Oshkosh. I did, and while I didn't take minute by minute notes I am gonna just write out what I remember.

The talk was split between one of EAA's Government Relations dudes (sorry if you see this I don't remember your name!) and Dr. Brett Wyrick, the Deputy Air Surgeon at the FAA. I expected it to be a complete train wreck, but it was actually pretty promising.

The first part of the talk to be honest was a bunch of "FAA is great" and "We love working with the FAA" from the EAA dude. You could see that a large portion of the audience was not really having it. Then they let Dr. Wyrick up, and he went straight to "I know it's broken. I am trying to fix it, and let me talk about how." He did say that his number one priority, and what he has told all the regional surgeons, is he wants as many people flying as he possibly can. They are tasked with figuring out how to get to "yes".

He stressed over and over when people talk about "they" with the FAA that it's really him. So I am going to use that terminology here. He really seems to want to own the problem.

Just a few things I remember:

  • His goal for Special Issuances is 60 days from the AME deferring to their office saying Yes or No. As part of that, they have revamped all the form letters that are sent to clarify up front what is required for them to say yes... all at once. No more back and forth. No more ambiguous letters that don't really describe what's happening or what they have a problem with, or what is needed for an SI. The new letters were approved by the lawyers and have started being used this month. He hopes this also improves the problem where AMEs are sending in hundreds of pages of documentation when the FAA only needed like 4. He attributes most of that to extremely poor communication on his behalf. When people don't know what's clearly needed, they just send everything to be sure. Meanwhile that clogs up the entire system.
  • He thinks 97% approval rate for Mental Health SIs is right about where he expects things to be. He shared some examples of the 3% that are being told no. Things like "The airman has shown that he can usually discriminate from voices that are real vs those that are hallucinatory".
  • No more mailing in paperwork to OKC. The insanity of how the Aeromedical branch were handling stuff was boggling. They would receive your paperwork, scan it in to an electronic system at OKC, then print it back out, mail it to DC or wherever. Now your AME can upload any documentation they need online and it stays that way.
  • He wants to be able to e-mail you to speed things up. However it's law that he has to use certified mail. They are trying to get language in the current FAA authorization to allow for e-mail.
  • He has increased the mental health practitioner count that reviews mental health SIs by 400% the last 2 years. He is still trying to hire another 12.
  • He wants to expand the AME program to Nurse Practitioners, but again that's a congressional issue so no movement.
  • He wants to put as many decisions as possible in the hands of the AME. This is doctor that's actually examining you, not some nameless suit in an office building at OKC or DC. Part of that is newer guidance around mental health conditions, if your AME can get it all documented, they will be able to issue.
  • In addition, he wants to drastically change the weight of practical tests such as your DPE checkrides (this is key to the ADHD problem he will address later). If you were diagnosed with ADHD in the past, but can pass an IR checkride, clearly you can focus just fine to shoot an approach. In his eyes, that speaks volumes about your ability in the cockpit.
  • They have already created a streamlined process for SSRI use that allows AMEs to issue certificates in many cases. In others, there is a flowchart that shows what the FAA will want up front for an SI. Wellbutrin was just added to the acceptable SSRI list.
  • If you are receiving disability compensation from the VA, you need to make sure you are disclosing those conditions to your AME. The VA is piping that data over to the FAA now.
  • PTSD also has a new checklist that allows the AME to issue without contacting FAA, the big "If" there is no PTSD episodes in the last 2 years. This has become a problem for veterans of our 20+ years of wars and ties into the VA problem above.
  • He wants to change most MH SIs to a "Here is your temp medical while we sort this out". He knows people are either not seeking treatment, or going to places under the radar and not telling their AME because it will affect their jobs. He wants AMEs to issue, and give the airman 180 days or whatever to gather what needs to be gathered, with reasonable assurances they will get a medical.
  • The number one problem they are dealing with right now is the massive influx of young aviators who were "diagnosed" with ADHD as kids and put on Ritalin or similar meds. He lamented that so many family practice doctors were/are doing it, even though they are not mental health experts. They are still trying to figure out the answer to this, in fact the FAA have a study team on site having Oshkosh attendees perform cognitive tests as part of the process to create new tests the AMEs can use to help invalidate old incorrect ADHD diagnoses. He expects that sooner or later they will have a checklist much like SSRIs or PTSD that the AME can use to fast track everything. It will also be a "one and done" test. The practical test weighting was also brought up again.
  • He acknowledges the "black box" problem. He is hoping the better letters for communication, changes to law that require formal arms length distance contact, and better AME guidance can help things along in that regard.
  • He asked if anyone in the audience knew who their regional flight surgeon was. I don't think any hands went up. He then said that in almost all cases the regional surgeons have the same authority as OKC and DC and are much more accessible to your AMEs. He is trying to get things pushed out to the lowest levels possible to get people in the air.
That's about all I remember. He was very easy to talk to, and invited anyone with questions to e-mail him directly which frankly was kind of shocking.

But, as we all know, words are cheap. Let's see if things get better. But at least he seems to understand there is a massive problem and is trying to fix it.
 
I saw that on Reddit this one reminded me of posts I read on this forum.

"He hopes this also improves the problem where AMEs are sending in hundreds of pages of documentation when the FAA only needed like 4."
 
Well, it’s good to know that mental health issues will no longer be the impediment to flying that they once were. Hopefully, he can also start working on on a process to get the alcoholics that have been sober for two months, flying. Self certification?
 
I've also been following these developments closely. I elected to postpone my PPL training until I could get my ADHD SI sorted out... I've basically just begun the SI process and have collected probably 60-70% of the required background paperwork.

Anecdotally, a couple of recent commenters on the same subreddit have shared their stories about the FAA issuing an SI solely based on the initial Neuropsych interview + a little essay about your life & experience with ADHD... so hopefully the trend is moving toward that and away from the CogScreen-AE unless it's deemed ABSOLUTELY necessary.
 
I've also been following these developments closely. I elected to postpone my PPL training until I could get my ADHD SI sorted out... I've basically just begun the SI process and have collected probably 60-70% of the required background paperwork.

Anecdotally, a couple of recent commenters on the same subreddit have shared their stories about the FAA issuing an SI solely based on the initial Neuropsych interview + a little essay about your life & experience with ADHD... so hopefully the trend is moving toward that and away from the CogScreen-AE unless it's deemed ABSOLUTELY necessary.

I've read that too. I'm still waiting it out a bit as I'm in no rush, just wanting to get back into flying. Got my PPL back in 04', stopped flying, then messed up by applying for a 3rd class instead of Basic Med. I've only been on an SSRI for a few years, and it's an approved SSRI. Was diagnosed with generalized anxiety and that's because I was dealing with a lot of stress from work and family. I could stop taking the meds, but I think they help and I don't feel it's necessary, especially when I see the board certified doc who gave me the meds every 3 months. The current path forward is just overkill for anyone in a similar situation. I don't know why I have to see/pay for a HIMS AME just because I take an approved SSRI. Just let me see my AME and take a cog test, but do we need to really shovel up 25 years of medical records and pay 10K in total seeing specialist? If I was going for a class 1 and trying for an ATP cert, I can see that. But not for PPL and IR private flying. My 2 cents.
 
The FAA aeromedical folk have NEVER, EVER come close to their own self-imposed time frames for processing. A bit over a decade or so ago, they started to get close, but today it is egregiously worse than the minimal goals they set for themselves.
 
I've read that too. I'm still waiting it out a bit as I'm in no rush, just wanting to get back into flying. Got my PPL back in 04', stopped flying, then messed up by applying for a 3rd class instead of Basic Med. I've only been on an SSRI for a few years, and it's an approved SSRI.

Not that is matters now, but you arent eligible for Basic Med unless you held a medical AFTER sometime in 06. So if you stopped back in 04, Basicmed wouldnt have been available to you.
 
The FAA aeromedical folk have NEVER, EVER come close to their own self-imposed time frames for processing. A bit over a decade or so ago, they started to get close, but today it is egregiously worse than the minimal goals they set for themselves.
To their credit, they did release the MOSAIC NPRM ahead of schedule. Granted, it was largely written by a private consortium.
 
To their credit, they did release the MOSAIC NPRM ahead of schedule. Granted, it was largely written by a private consortium.
Not that is matters now, but you arent eligible for Basic Med unless you held a medical AFTER sometime in 06. So if you stopped back in 04, Basicmed wouldnt have been available to you.
Every time I post....lol

My medical expired in July of 2009, I received my medical in the fall of 2004. I was certified for my PPL/ Single E Land in May of 2005.
 
Well, it’s good to know that mental health issues will no longer be the impediment to flying that they once were. Hopefully, he can also start working on on a process to get the alcoholics that have been sober for two months, flying. Self certification?
Is two months sobriety enough?
 
To their credit, they did release the MOSAIC NPRM ahead of schedule. Granted, it was largely written by a private consortium.
I'm not talking about that, I'm talking about the appalling performance of the aeromedical program.
 
Well, it’s good to know that mental health issues will no longer be the impediment to flying that they once were. Hopefully, he can also start working on on a process to get the alcoholics that have been sober for two months, flying. Self certification?
I realize that to many people things are starkly black or starkly white, but there is an large area between the extremes of zero tolerance and condoning dangerous behavior.
 
I realize that to many people things are starkly black or starkly white, but there is an large area between the extremes of zero tolerance and condoning dangerous behavior.
Agreed. But, when has the government ever been good at nuancing that middle ground?
 
Well, it’s good to know that mental health issues will no longer be the impediment to flying that they once were. Hopefully, he can also start working on on a process to get the alcoholics that have been sober for two months, flying. Self certification?
Two months sober isn't enough. Perhaps a year.
 
When you apply for a NICS approval, if the answer doesn't come back quickly (it usually does), it then defaults to "Approved".
That sort of system would speed things up. Sixty days for approval/disapproval, or automatically approved. Then make it more difficult to change that approval.
 
Well, it’s good to know that mental health issues will no longer be the impediment to flying that they once were. Hopefully, he can also start working on on a process to get the alcoholics that have been sober for two months, flying. Self certification?
I say just have them drink 2 cups of coffee then turn 'em loose.
 
Two months sober isn't enough. Perhaps a year.
Have alcoholics relapsed after a year? Some do, some don’t. My brother-in-law relapsed after 20 years of sobriety. What about the mentally ill? “He’s fine while he stays on his medication”. While the bleeding hearts feel that everything is not black and white, I view it as a slippery slope. I agree that denial because of 20 year old childhood ADHD medication is ridiculous. But If you have to have medication to deal with the normal stresses of life, even temporarily, then flying shouldn’t be for you.

So my question for this discussion is where does this expansion of the standard end?
 
Have alcoholics relapsed after a year? Some do, some don’t. My brother-in-law relapsed after 20 years of sobriety. What about the mentally ill? “He’s fine while he stays on his medication”. While the bleeding hearts feel that everything is not black and white, I view it as a slippery slope. I agree that denial because of 20 year old childhood ADHD medication is ridiculous. But If you have to have medication to deal with the normal stresses of life, even temporarily, then flying shouldn’t be for you.

So my question for this discussion is where does this expansion of the standard end?
Wherever it "ends" it should be the same for flying, bus driving, operating heavy machinery, etc.
There would likely be different standards for commercial and private, as there is now for ground transport.
But a year is a good number, I think, for the drinking issue, with zero tolerance.
 
Change can be difficult to understand and accept, especially when we have no control over the changes. Lord knows I don’t like all changes.

I also know there’s a lot of nuance that’s missed when the message is spread beyond the people who were in the room.
 
Agreed. But, when has the government ever been good at nuancing that middle ground?
Never mind the government. When have we ever been good at that? For better or for worse, the government is ultimately a reflection of us.

I watched jury reactions to drunk driving go from, "there but for the grace of god." when prosecutors couldn't buy a conviction to exactly the opposite. It happened so quickly.
 
Never mind the government. When have we ever been good at that? For better or for worse, the government is ultimately a reflection of us.

I watched jury reactions to drunk driving go from, "there but for the grace of god." when prosecutors couldn't buy a conviction to exactly the opposite. It happened so quickly.
Don’t get me started on drunk driving. I’d take Singapore’s approach to the whole issue.
 
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