Weird Situation with the FAA

[Llewtrah381]

That’s the issue, they ARE practicing medicine. Otherwise they wouldn’t have a medical division reviewing things at the regional or federal level. The AME/HIMS AMEs would be doing everything…and there wouldn’t be a need for 90% of the treads here.

Reviewing medical records to determine fitness for performing aviation tasks is NOT practicing medicine any more than a life insurance company sending someone over to my house to check my blood pressure and weight to determine premium rates is.

Actually, less so. Unlike the life insurance company, the FAA does not physically examine anyone themselves, make a diagnosis themselves, or prescribe treatment themselves. To my knowledge the information they receive is not shared with any other entity.

You can believe they’re “practicing medicine” if you want but it’s false.

 

[Tarheelpilot]

This is why I never goto a doctor.

 

[Lindberg]

True, it is mainly civil. I should have said an allegation of negligence was made. That negligence has put the OP into thr position of “defending” himself to prove it’s not accurate.

The FAA said, you need to prove it’s wrong by taking more test, even though the offending Dr said they were wrong.

It should have ended there, but the FAA didn’t act with common sense of reasonableness.

I’m ending my part to this threat.

Wishing all a safe and happy Sunday!

You're spectacularly good at missing the actual point of threads in order to grind your ax. The OP overcame the inaccurate information in his file. That's done.

What the OP is dealing with now is the FAA's request for additional information pertaining to a condition he actually has.

 

[Salty]

I just wrote some notes about you. Make me show them to you.

If you use those notes to violate my rights using governmental power you’d better believe I will attempt to gain access to them.

 

[Lindberg]

If you use those notes to violate my rights using governmental power you’d better believe I will attempt to gain access to them.

Nobody's rights are being violated in the OP's story. And you've still said nothing about how the FAA would get it's hands on the medical records of an uninvolved third party.

 

[hindsight2020]

The question that is being dodged is the degree of injury that occurs when you cannot afford to prove your own innocence, stemming from negligence by the govt sanctioned providers. That's where the FAA process is partly culpable imo. 10K in AME rent-seeking in order to correct the mistake of a third party that causes you loss of income, is a heck of a lot more injurious than if someone assaulted me and took 10K cash out my hand coming into the bank. At least in the latter case I'd still have a 1st class to pursue a 6 figure W2 the next day. I guess some sycophants never heard (or deny the existence) of the term moral hazard.

There is a financial incentive by the regulatory-medical complex to victimize licensees, and those adjacent to the grift are claiming plausible deniability. It's dishonorable.

 

[Llewtrah381]

The question that is being dodged is the degree of injury that occurs when you cannot afford to prove your own innocence, stemming from negligence by the govt sanctioned providers. That's where the FAA process is partly culpable imo. 10K in AME rent-seeking in order to correct the mistake of a third party that causes you loss of income, is a heck of a lot more injurious than if someone assaulted me and took 10K cash out my hand coming into the bank. At least in the latter case I'd still have a 1st class to pursue a 6 figure W2 the next day. I guess some sycophants never heard (or deny the existence) of the term moral hazard.

There is a financial incentive by the regulatory-medical complex to victimize licensees, and those adjacent to the grift are claiming plausible deniability. It's dishonorable.

Did you read the OP? Which “government sanctioned provider” committed negligence? I 100% agree the physician who referred him for an MRI and crossed it with someone else’s history is culpable and should be sued for the damages but see no indication that was an AME, FAA physician, or any other kind of “government sanctioned provider”.

Add: the physician evaluating the elevated IOP - the actual wrongdoer - appears to have been someone who is not an AME so how was the “regulatory-medical complex”, whatever the heck that is, involved in the bad parts of this situation?

 

[TCABM]

…“regulatory-medical complex”, whatever the heck that is…

I won’t pretend to answer for my esteemed blue brethren, but my experience under USAF (and for a few years, USA) Flight Surgeons, is that the Flight Surgeon, who is your PCM, refers out to specialty care, then works with the specialist to determine whether a waiver (SI) is required, based on the unique circumstances.

When I had melanoma, all it took for Big Blue to put me back on flying status was pathology with clear margins and an occupational health visit that showed I could manipulate the affected limb and joint as required for my job.

Fast forward ten years, and an FAA Class 3 required the entire pathology along with continuous Derm notes from quarterly FBSEs, since detection.

Big Blue’s philosophy was quarterly for five years and, if no recurrence, semi-annual for five, the annual there-after.

I submitted what I had to the FAA, and they eventually approved with an admonition that my records were lacking and the only saving grace was continuous DOD Flight Surgeon oversight.

I went BasicMed primarily because a career’s worth of AF Aerospace Medicine oversight taught me knowing how to play the game was more important than playing the game.

ETA: I won’t go into the details surrounding a childhood ASD repair the FAA approved in the late 80s when I want back to them for my one-time Class 3 to get on BasicMed. Ok

 

[Llewtrah381]

I won’t pretend to answer for my esteemed blue brethren, but my experience under USAF (and for a few years, USA) Flight Surgeons, is that the Flight Surgeon, who is your PCM, refers out to specialty care, then works with the specialist to determine whether a waiver (SI) is required, based on the unique circumstances.

I, too, am an “esteemed blue bretheren” and was one of those Flight Surgeons during my 24 years of service.

Radically different systems with radically different customers. Although my pilot patients believed the best they could do was break even (they were on Flight Status when they walked in to see me and would be on Flight Status when they walked out), my job was to keep them flying over the long haul and keep the mission effective. Everything filtered through us and we made many day-to-day decisions on the spot. Decisions about your melanoma, etc. were handled at the Major Command level (as I recall) and based on criteria. It was about the warfighter, even if sometimes they didn’t think so.

The FAA isn’t about the pilot. It’s about the safety of civilian aviation. There is really much, much less of a “chain of command” for AMEs than in the military and zero chain of command for the referred-to specialists, unlike in the military (whether they’re military or civilian specialists).

 

[TCABM]

I, too, am an “esteemed blue bretheren” and was one of those Flight Surgeons during my 24 years of service.

Radically different systems with radically different customers. Although my pilot patients believed the best they could do was break even (they were on Flight Status when they walked in to see me and would be on Flight Status when they walked out), my job was to keep them flying over the long haul and keep the mission effective. Everything filtered through us and we made many day-to-day decisions on the spot. Decisions about your melanoma, etc. were handled at the Major Command level (as I recall) and based on criteria. It was about the warfighter, even if sometimes they didn’t think so.

The FAA isn’t about the pilot. It’s about the safety of civilian aviation. There is really much, much less of a “chain of command” for AMEs than in the military and zero chain of command for the referred-to specialists, unlike in the military (whether they’re military or civilian specialists).

In short, I believe the FAA treats every medical as an initial issuance without regard to the history the agency and other agencies with the same authority has with the airman.

That, likely, is one of two big differences. The other is an FAA third class has to deal with partial pressure up to the bozosphere in theory, while big blue acknowledges cabin altitude plays a factor, along with appropriate environmental aids, be it supplemental O2, speed pants, or a pressure suite.

As for my ASD repair, Big Blue didn’t really care given paper copies of handwritten notes that were 15 years old. Same stuff FAA wanted at my initial class 3. Fast forward and FAA wanted a bubble echo and stress test, despite 35+ years distance and continuous FSO oversight for 24 of those years, all of which encompassed the same period my FAA medical covered.

FAA said none of history mattered.

 

[UTLonghorn_1979]

In short, I believe the FAA treats every medical as an initial issuance without regard to the history the agency and other agencies with the same authority has with the airman.

That, likely, is one of two big differences. The other is an FAA third class has to deal with partial pressure up to the bozosphere in theory, while big blue acknowledges cabin altitude plays a factor, along with appropriate environmental aids, be it supplemental O2, speed pants, or a pressure suite.

As for my ASD repair, Big Blue didn’t really care given paper copies of handwritten notes that were 15 years old. Same stuff FAA wanted at my initial class 3. Fast forward and FAA wanted a bubble echo and stress test, despite 35+ years distance and continuous FSO oversight for 24 of those years, all of which encompassed the same period my FAA medical covered.

FAA said none of history mattered.

Eagerly awaiting others' replies.

 

[TCABM]

Eagerly awaiting others' replies.

View attachment 140730

Don’t know why. I engaged Bruce before I decided to apply for a one-time Class 3. We worked thru all my documentation and addressed most of the issues so he could issue in office.

After the fact, OKC wanted the cardiac tests. I scheduled what was asked for and submitted the requested documentation.

We did discuss with the cardio people what, exactly, was needed and nothing more nor nothing less was submitted.

 

[UTLonghorn_1979]

Don’t know why. I engaged Bruce before I decided to apply for a one-time Class 3. We worked thru all my documentation and addressed most of the issues so he could issue in office.

After the fact, OKC wanted the cardiac tests. I scheduled what was asked for and submitted the requested documentation.

We did discuss with the cardio people what, exactly, was needed and nothing more nor nothing less was submitted.

Your replies are common sense and seem reasonable, tough to "argue with." But I'm sure some still will.

 

[Llewtrah381]

In short, I believe the FAA treats every medical as an initial issuance without regard to the history the agency and other agencies with the same authority has with the airman.

That, likely, is one of two big differences. The other is an FAA third class has to deal with partial pressure up to the bozosphere in theory, while big blue acknowledges cabin altitude plays a factor, along with appropriate environmental aids, be it supplemental O2, speed pants, or a pressure suite.

As for my ASD repair, Big Blue didn’t really care given paper copies of handwritten notes that were 15 years old. Same stuff FAA wanted at my initial class 3. Fast forward and FAA wanted a bubble echo and stress test, despite 35+ years distance and continuous FSO oversight for 24 of those years, all of which encompassed the same period my FAA medical covered.

FAA said none of history mattered.

Remember (more for the “audience”): your Flight Surgeon was not only your AME but your mandated Primary Care doc. On the civilian side, the AME is not much more than a documenter: zero treatment, and diagnosis made primarily from the evaluation of others. Two VERY different systems with two very different objectives.

 

[UTLonghorn_1979]

Remember (more for the “audience”): your Flight Surgeon was not only your AME but your mandated Primary Care doc. On the civilian side, the AME is not much more than a documenter: zero treatment, and diagnosis made primarily from the evaluation of others. Two VERY different systems with two very different objectives.

In all sincerity, I'm truly confused on who's doing what then within the FAA, and their designees, in issuing a medical certificate.

When the AME does the medical exam and issues the medical in office, what are they "practicing?" What service, what profession? They evaluate the applicant's medical fitness by performing an FAA approved "medical exam," correct? Is that practicing medicine, consulting, what?

What are their qualifications otherwise to evaluate, pass, fail or defer? This is a facetious question, somewhat, but why call it a medical exam if the person administering it isn't performing a medical evaluation?

If they don't treat, diagnose, etc. and rely upon the evaluation of others to do that, why aren't those specialist issuing the medical rather than the AME? What is the FAA then doing, or how can the FAS say someone is unfit to fly when the specialist say fit to fly in their opinion? How do they determine that upon their own review if they aren't performing in some sort of medical capacity?

Why can Primary Care Docs issue Basic Med without FAA consult? What makes their evaluation/practice different in the real world perspective of seeking safety for the public vs. that of an AME?

Reviewing medical records to determine fitness for performing aviation tasks is NOT practicing medicine any more than a life insurance company sending someone over to my house to check my blood pressure and weight to determine premium rates is.

You can believe they’re “practicing medicine” if you want but it’s false.

I don't understand how it is not practicing medicine when their job is to evaluate physical and mental health, and it's called the Office of Aerospace Medicine?

Again, I'm not trying to be argumentative, I truly don't understand the reasoning behind the existing practices.

 

[TCABM]

In all sincerity, I'm truly confused on who's doing what then within the FAA, and their designees, in issuing a medical certificate.

When the AME does the medical exam and issues the medical in office, what are they "practicing?" What service, what profession? They evaluate the applicant's medical fitness by performing an FAA approved "medical exam," correct? Is that practicing medicine, consulting, what?

….

The AME is exercising limited delegated agency authority to certify the presented medical history complies with 14 CFR 67; if it does not, the AME must defer to the agency or deny the medical. The standards for each of the major body systems are codified in part 67, while techniques and specific guidance is provided in the Guide to AMEs and other agency communications.

…
Why can Primary Care Docs issue Basic Med without FAA consult? What makes their evaluation/practice different in the real world perspective of seeking safety for the public vs. that of an AME?...

The only differences are Congress wrote a law to create BasicMed and the airman’s privileges for operating under BasicMed are more limited than under a Class 3 medical.

 

[Llewtrah381]

I don't understand how it is not practicing medicine when their job is to evaluate physical and mental health, and it's called the Office of Aerospace Medicine?

Again, I'm not trying to be argumentative, I truly don't understand the reasoning behind the existing practices.

(I was typing this when TCABM responded above)

I, too, am not trying to be argumentative in this reply and will try to illustrate. Please remember I've never been an AME and it's been over 25 years since I was an active AF Flight Surgeon. I may get some AME details incorrect and am happy to be corrected.

Let's say I've been TCABM's AME for a long time and when he shows up this time with no reported changes since his last Class 3, I notice a very suspicious mole on his arm. Although I'm really worried about its appearance, since it doesn't appear to interfere with his ability to fly, I sign off his Class 3 AND advise him to see his regular PCM or, if his insurance covers it, see a dermatologist. I don't write the consult and don't plan to see him back to follow up on the mole but I tell him of my serious concern it may be a melanoma. I didn't biopsy it to confirm diagnosis, I didn't initiate treatment, and I didn't arrange follow-up for it. I did not practice medicine: I assessed his fitness for flying.

Let's say TCABM and I are both still on Active Duty and I'm his Flight Surgeon. He comes in for his flight physical and I see the mole. I still sign off the flight PE (since, at the moment, there's nothing to endanger his mission performance) but I also refer him to Derm and arrange follow-up with me. If Derm does a biopsy and it's normal, we're done. If they discover it's a melanoma that has spread and chemotherapy is warranted, I need to ground him during treatment and reassess his ability to do his Flight-rated job. In my capacity as his PCM I had the mole evaluated, oversaw treatment, and was following up. I was practicing medicine.

In the OP, the physician evaluating the ocular hypertension was practicing medicine: they were making a diagnosis, arranging appropriate treatment, and following the patient. They also messed up the paperwork, which caused the particular issue (as an aside, this snafu shouldn't be happening in a time of electronic medical records and constant checks of names/birthdates at every step of the process but it does (I'm speaking as a former hospital "surveyor")). OKC was trying to assess paperwork they received indicating the individual had cognitive impairment and seizures. The AME was sorting out the paperwork snafu for the OP. Neither of the last two were actually making diagnoses themselves, treating the patient, or following the condition. That's why I say they're not practicing medicine.

As I said, I'm open to the possibility I'm off the mark re AME stuff but I'm pretty sure it's close.

HTH

 

[UTLonghorn_1979]

The AME is exercising limited delegated agency authority to certify the presented medical history complies with 14 CFR 67; if it does not, the AME must defer to the agency or deny the medical. The standards for each of the major body systems are codified in part 67, while techniques and specific guidance is provided in the Guide to AMEs and other agency communications.


The only differences are Congress wrote a law to create BasicMed and the airman’s privileges for operating under BasicMed are more limited than under a Class 3 medical.

Thanks, that answers the what. I really don’t understand the why and how it works in practice. Not that I literally don’t understand it, more so, why is it done this way? Really doesn’t seem as near as effective, efficient or actually safe for the public as it could be.

Or well.

 

[UTLonghorn_1979]

(I was typing this when TCABM responded above)

I, too, am not trying to be argumentative in this reply and will try to illustrate. Please remember I've never been an AME and it's been over 25 years since I was an active AF Flight Surgeon. I may get some AME details incorrect and am happy to be corrected.

Let's say I've been TCABM's AME for a long time and when he shows up this time with no reported changes since his last Class 3, I notice a very suspicious mole on his arm. Although I'm really worried about its appearance, since it doesn't appear to interfere with his ability to fly, I sign off his Class 3 AND advise him to see his regular PCM or, if his insurance covers it, see a dermatologist. I don't write the consult and don't plan to see him back to follow up on the mole but I tell him of my serious concern it may be a melanoma. I didn't biopsy it to confirm diagnosis, I didn't initiate treatment, and I didn't arrange follow-up for it. I did not practice medicine: I assessed his fitness for flying.

Let's say TCABM and I are both still on Active Duty and I'm his Flight Surgeon. He comes in for his flight physical and I see the mole. I still sign off the flight PE (since, at the moment, there's nothing to endanger his mission performance) but I also refer him to Derm and arrange follow-up with me. If Derm does a biopsy and it's normal, we're done. If they discover it's a melanoma that has spread and chemotherapy is warranted, I need to ground him during treatment and reassess his ability to do his Flight-rated job. In my capacity as his PCM I had the mole evaluated, oversaw treatment, and was following up. I was practicing medicine.

In the OP, the physician evaluating the ocular hypertension was practicing medicine: they were making a diagnosis, arranging appropriate treatment, and following the patient. They also messed up the paperwork, which caused the particular issue (as an aside, this snafu shouldn't be happening in a time of electronic medical records and constant checks of names/birthdates at every step of the process but it does (I'm speaking as a former hospital "surveyor")). OKC was trying to assess paperwork they received indicating the individual had cognitive impairment and seizures. The AME was sorting out the paperwork snafu for the OP. Neither of the last two were actually making diagnoses themselves, treating the patient, or following the condition. That's why I say they're not practicing medicine.

As I said, I'm open to the possibility I'm off the mark re AME stuff but I'm pretty sure it's close.

HTH

I like the second described process better. The PCM is more familiar with the patiant, has more history, and is actually able to tell if the patient/applicant is being honest on the MedExpress application. Seems safer, more thorough and actually practicing medicine, the study and understanding of medical conditions, seems an important piece of assessing flight fitness for a certificate titled as a “medical” one.:

"Let's say TCABM and I are both still on Active Duty and I'm his Flight Surgeon. He comes in for his flight physical and I see the mole. I still sign off the flight PE (since, at the moment, there's nothing to endanger his mission performance) but I also refer him to Derm and arrange follow-up with me. If Derm does a biopsy and it's normal, we're done. If they discover it's a melanoma that has spread and chemotherapy is warranted, I need to ground him during treatment and reassess his ability to do his Flight-rated job. In my capacity as his PCM I had the mole evaluated, oversaw treatment, and was following up. I was practicing medicine."

This is basicall what PCMs are doing for the 80K+ basic med pilots. Which accounts for roughly 70% of the entire private pilot population (i.e. non commercial or ATP).

Just my two cents.

 

[Llewtrah381]

I like the second described process better.

So do I. It’s why Flight Surgrons were/are the PCMs for rated people and their family. And, at least in my day, all were in uniform: I don’t think any operational FSs were GS civilians.

It may be best to think of AMEs as “medical DPEs”. DPEs need to be CFIs but, in their capacity as a DPE, they’re not instructing. Their customer actually is the FAA (and, therefore, the public) rather than the applicant. My DPE for my gyro was my main instructor but during the checkride he wasn’t instructing at all: he was representing the FAA to assess my qualifications for the rating I wanted. Similarly, BasicMed is kinda like Flight Reviews (a bit of a stretch but an interesting thought): the reviewer is assessing as well as coaching at the same time.

 

[MauleSkinner]

It may be best to think of AMEs as “medical DPEs”. DPEs need to be CFIs but, in their capacity as a DPE, they’re not instructing. Their customer actually is the FAA (and, therefore, the public) rather than the applicant.

A more correct analogy would be that their employer is the FAA, not the applicant.

 

[UTLonghorn_1979]

So do I. It’s why Flight Surgrons were/are the PCMs for rated people and their family. And, at least in my day, all were in uniform: I don’t think any operational FSs were GS civilians.

It may be best to think of AMEs as “medical DPEs”. DPEs need to be CFIs but, in their capacity as a DPE, they’re not instructing. Their customer actually is the FAA (and, therefore, the public) rather than the applicant. My DPE for my gyro was my main instructor but during the checkride he wasn’t instructing at all: he was representing the FAA to assess my qualifications for the rating I wanted. Similarly, BasicMed is kinda like Flight Reviews (a bit of a stretch but an interesting thought): the reviewer is assessing as well as coaching at the same time.

That’s a good anology.

I think it’s a poor administration of the process if the goal is to maximize safety to the public, as compared to the process we both agree is more intuitive and less prone to abuse/deception by the applicant, but it is what it is.

Thanks!

 

[TCABM]

Thanks, that answers the what. I really don’t understand the why and how it works in practice. Not that I literally don’t understand it, more so, why is it done this way? Really doesn’t seem as near as effective, efficient or actually safe for the public as it could be.

Or well.

There’s about a century’s worth of history to go thru, but the short answer is Congress requires the FAA to ensure passenger and public safety. One way to do that is through aeromedical criteria.

https://www.faa.gov/sites/faa.gov/files/about/history/people/medical_examiners.pdf

Because the FAA doesn’t have enough medical officers on staff (just like they don’t have enough ASIs), Congress allows the FAA to delegate some authority to private citizens as DPEs and AMEs.

Now, some AMEs are also PCMs for their airmen, but that’s rare. Most airmen don’t want their everyday doc to ground them for 7 days and require a follow up visit to get returned to flying status for a head cold. Yes, that’s what happens when a .mil flyer goes in with a cold; our flying status is re-evaluated every single time we see a doc.

The system isn’t perfect and it works well enough that something like 97% of all applications are eventually certified.

I get the frustration because my experience has been the FAA does a second review/second guesses the AMEs. Every time I’ve gotten an FAA medical, I walked out of the office with it and every time the FAA sent me a letter asking for more and giving me less than 30 days to get specialty testing done and sent back to them or my medical would be denied.

 

[MauleSkinner]

I get the frustration because my experience has been the FAA does a second review/second guesses the AMEs.

It’s not so much a second guess as it is a second run through to ensure the paperwork properly reflects the qualification. Just like they do with DPE paperwork.

 

[bbchien]

There’s about a century’s worth of history to go thru, but the short answer is Congress requires the FAA to ensure passenger and public safety. One way to do that is through aeromedical criteria.

https://www.faa.gov/sites/faa.gov/files/about/history/people/medical_examiners.pdf

Because the FAA doesn’t have enough medical officers on staff (just like they don’t have enough ASIs), Congress allows the FAA to delegate some authority to private citizens as DPEs and AMEs.

Now, some AMEs are also PCMs for their airmen, but that’s rare. Most airmen don’t want their everyday doc to ground them for 7 days and require a follow up visit to get returned to flying status for a head cold. Yes, that’s what happens when a .mil flyer goes in with a cold; our flying status is re-evaluated every single time we see a doc.

The system isn’t perfect and it works well enough that something like 97% of all applications are eventually certified.

I get the frustration because my experience has been the FAA does a second review/second guesses the AMEs. Every time I’ve gotten an FAA medical, I walked out of the office with it and every time the FAA sent me a letter asking for more and giving me less than 30 days to get specialty testing done and sent back to them or my medical would be denied.

And for us, on a borderline situation, the question is, "do we goldplate the application and ask for tests which might be judged unnecessary, or do we hold back knowing that the aimman may only have 60 days to obtain and provide same....".

And, sometimes CONSIDERABLE expense is involved.

 

[EdFred]

Don't forget that some with the FAA can't understand anything presented to them in anything other than crayon.

*cough* J___ H_____ *cough*

 

[Lindberg]

---

I like the second described process better.

Go for it. My first AME had a family medicine practice and was my PCP. He's dropped that now, but there are others. My current AME is a urologist and sees patients 3 days in that capacity.

The PCM is more familiar with the patiant, has more history, and is actually able to tell if the patient/applicant is being honest on the MedExpress application.

Because there are so many airmen looking to be more honest on their applications.

 

[TCABM]

And for us, on a borderline situation, the question is, "do we goldplate the application and ask for tests which might be judged unnecessary, or do we hold back knowing that the aimman may only have 60 days to obtain and provide same....".

And, sometimes CONSIDERABLE expense is involved.

Oh, I acknowledge that and it’s a tough place to be as an AME; I prefer your methodology.

That the AME guide stipulates deferral for a PRNC congenital heart defect repair when Part 67 does not require deferral/denial is the gray area second guessing I referred to.

Digging in to the AME Guide for Item 36, there’s a ton of stuff that dispositions to defer that points, I guess, to the extent of the the limits OKC will extend certification authority to the AME although only a handful of those conditions are mentioned in Part 67.

 

[UTLonghorn_1979]

---

Go for it. My first AME had a family medicine practice and was my PCP. He's dropped that now, but there are others. My current AME is a urologist and sees patients 3 days in that capacity.


Because there are so many airmen looking to be more honest on their applications.

Being honest is what put me on the

Oh, I acknowledge that and it’s a tough place to be as an AME; I prefer your methodology.

That the AME guide stipulates deferral for a PRNC congenital heart defect repair when Part 67 does not require deferral/denial is the gray area second guessing I referred to.

Digging in to the AME Guide for Item 36, there’s a ton of stuff that dispositions to defer that points, I guess, to the extent of the the limits OKC will extend certification authority to the AME although only a handful of those conditions are mentioned in Part 67.

That's all Greek to me, I'm just looking for a process that enables the applicant to have a decision within 30-60 days of the AME/HIMS AME sending their reports to the FAA as opposed to 9-12 months, in some instances.

 

[TCABM]

…
That's all Greek to me, I'm just looking for a process that enables the applicant to have a decision within 30-60 days of the AME/HIMS AME sending their reports to the FAA as opposed to 9-12 months, in some instances.

That’s something I cannot help with.

 

[UTLonghorn_1979]

That’s something I cannot help with.

if only!

 

[Llewtrah381]

A more correct analogy would be that their employer is the FAA, not the applicant.

At the risk of being seen as argumentative, I'm not sure either DPEs or AMEs receive any compensation from the FAA for their services, or other measures of actual "employment". At best they may be "franchises" of the FAA, I'd think. But if either strays from the FAA standards for their task, the FAA will part ways with them, I'm sure.

I think it’s a poor administration of the process if the goal is to maximize safety to the public, as compared to the process we both agree is more intuitive and less prone to abuse/deception by the applicant, but it is what it is.

It's a bit apples-to-oranges to compare military Flight Medicine with FAA stuff. As an AF Flight Surgeon both my patients and I were there to support the mission. We developed very close relationships with our patients in order to support that; they trusted we were there to keep them flying as best as possible even if it meant grounding them for some things. (As an aside, the wives, who became part of our family's core social group, did express some...umm...misgivings seeing a flight suit between their legs when they came in for their annual exams. But I digress.) Grounding them meant disabling a multi-million dollar asset (I'm talking about their training - not their aircraft), so was never taken lightly, at least by me.

Civilian-wise, the "mission" is completely different. Rather than national defense, it's to enable commercial and recreational flying while protecting the public from those private endeavors. And it's in a different medical context: medical care was universal and free in the military. Following up a pilot for a cold (to return them to flying status), which I wouldn't likely do even for a non-flying Active Duty member, didn't cost the patient a dime but would be something that would be billed in the FAA scenario (and probably denied by insurance as medically unnecessary).

Long-ish soapbox answer to say it's definitely not a perfect system and can always be improved but it's important to never lose sight of the actual missions of the military and FAA.

 

[Lindberg]

Being honest is what put me on the (sic)

I didn't recall that being your issue. I thought it was an unreported second condition that was discovered in the course of applying for an SI, that was neither treated nor resolved. But I may be thinking of someone else.

 

[MauleSkinner]

At the risk of being seen as argumentative, I'm not sure either DPEs or AMEs receive any compensation from the FAA for their services, or other measures of actual "employment". At best they may be "franchises" of the FAA, I'd think. But if either strays from the FAA standards for their task, the FAA will part ways with them, I'm sure.

That’s why it’s an analogy, not a statement of fact. But also at the risk of being seen as argumentative, the designee’s customer is the applicant, as the applicant is paying the bill.

But either way, the analogy is good. An applicant comes to a DPE or an AME and essentially says, “I think I’m qualified for this certificate/rating. Check my paperwork and conduct the required tests.” The designee either issues the paperwork showing qualification or doesn’t. The paperwork then goes to the FAA for review, and the FAA can override the decision of the designee if the paperwork doesn’t support the issuance of the certificate.

I don’t know what the percentages are on the medical side, but per the FAA’s statistics, about 20% of applicants who come to a DPE thinking they’re qualified are, in fact, not.

 

[Llewtrah381]

the designee’s customer is the applicant, as the applicant is paying the bill.

As an aside, I also worked as a Joint Commission (formerly "JCAHO") hospital surveyor, where I assessed hospitals for their compliance with Medicare standards. It was NOT CHEAP for the hospitals to get our surveys but it was actually probably cheaper in the long run for them than getting the "free" one from Medicare (CMS): their surveyors are incredibly picky, categorically don't do "teaching while surveying", and basically "nobody expects the Spanish Inquisition". By analogy, I think DPEs and AMEs, while still expected to hold tightly to the FAA standards (as we were expected to do with regard to CMS standards), offer a decent "human interface" to a Congressionally-overseen bureaucratic system.

 

[Hugh Despenser]

It’s things like this that show us that they do not have our interests, fairness, nor safety as priorities.

I’ll to that.
I am so thankful to be done with anything related to the FAA.

 

[Llewtrah381]

That’s the laugh of the week and it’s barely past noon on Monday.

Are there, or are there not, nameless, faceless, bureaucrat doctors somewhere inside the the Federal Bureau of Aviation making medical certification decisions on individuals they have never personally seen?

Read the later posts, if you’re trying to get a serious answer

 

[Albany Tom]

I feel bad for the OP for the hassles with his medical, and for having to wade through this thread, except for Dr Bruce and some others.

I know, open forum and all that, and I've done it myself, but still. OP - wish you the best getting through this.