The Path to FAA Medical Certification Reform

When John came to in the hospital a number of years ago after a lapse of consciousness, you will appreciate that the very first concern he expressed was for his aviation medical certificate. Perhaps the most significant and deeply personal touchpoint with the FAA for every pilot is the medical certification process. To a pilot, the ability to fly is a profoundly important part of their very being.

FAA medical certificates are issued by the Aerospace Medical Certification Division (AMCD) in Oklahoma City. It is a part of the Civil Aerospace Medical Institute (CAMI). John and I recently had the opportunity to tour CAMI, and we found everyone to be knowledgeable professionals committed to their mission “...to assure civil aerospace safety.”

Considering the extreme importance to the pilot of his or her medical certificate, and the virtually unlimited power that the FAA’s aeromedical folks have over the very soul of the pilot, you would think they would bend over backward to convey a sense of great care to the pilot.

But as truly dedicated as the folks at CAMI are, that sense of care hasn’t been evident to many pilots. After John had his medical certificate denied, others related their own medical certification experiences to us. Many reported that the FAA’s approach to certification seemed heavy-handed and adversarial rather than helpful. In particular, they felt that the letters they received were cold and mean-spirited legal documents lacking in kindness or empathy.

A pilot who has followed the rules and reported a doctor visit revealing some medical imperfection often feels unfairly treated. Many who have disclosed very intimate and personal information feel the FAA doesn’t appreciate that the pilot voluntarily submitted the very information the FAA is now using against them. It does not appear to them that the FAA has their best interest at heart and wants to try to help them. Indeed, they often feel that the FAA doesn’t play by fair rules.

Rather than helping them get over a hurdle to “yes,” pilots often feel the approach appears to be to throw new hurdles in the path of applicants. Pilots attempting to obtain special issuance medicals frequently feel trapped in an involuntary game of whack-a-mole. Demands are made for numerous tests that the specialist treating the patient often feels are irrelevant — and sometimes unnecessarily risky. After the demands have been met and satisfied, new demands are made.

While this agonizing game is being played, it is not uncommon for the pilot to be deprived of his or her medical certificate, and often their livelihood, for many months. After the certificate has been received, when the next application for renewal is made, it is not unusual for a demand that was previously satisfied to resurface, starting the process all over again. It is easy to understand how this process led to a lack of trust, which, among other things, caused the hard push in Congress to allow pilots to fly light-sport aircraft with what is known as a “driver’s license medical.” It also led to third-class medical reform in Congress, which culminated in what is known as BasicMed.

Why haven’t the dedicated people at CAMI gained the support of the aviation community? As counterintuitive as it sounds, the problem begins with its mission “... to assure civil aerospace safety.” What could possibly be wrong with that mission? Who can complain about the assurance of safety?

Well, to assure absolute safety would mean we ground every pilot. The reality is that the management of safety is a trade-off. There is a balance between protecting the public and helping even medically imperfect pilots retain their privilege to fly. What we really mean when we talk about safety is that we want to strike the right balance. This is a difficult concept because there’s no bright line between “too risky” and “safe enough.” Adding “helping pilots keep flying” to CAMI’s mission statement would change everything. Suddenly, pilots would become “customers.”

Right now, these dedicated, well-intentioned people are trapped in a dysfunctional culture that has caused the loss of trust of the aviation community and even the disapproval of Congress. It cries out for leadership to change that culture into one that conveys their respect for pilots and the desire to serve them as customers.

Of course, it would be a dramatic change for the FAA to consider pilots as “customers” rather than as people they regulate. However, the California DMV has done it. It used to be a classic example of a dysfunctional government agency that everyone loved to hate. Now, after an amazing cultural reform, it does a wonderful job of conveying its respect for you and its desire to help you.

The Flight Standards Service of the FAA is another example. It has established a relationship of trust with the aviation community by pursuing core values such as creating a just culture, helping pilots get over hurdles to “yes,” promoting risk-based decision-making and treating people as individuals. The trust these principles have engendered has helped to create new FAA testing standards, the Compliance Philosophy, easier installation of nonrequired safety equipment and Part 23 aircraft certification reform. The result is an extraordinary balance of risk management and productivity.

The very good news is that in our conversations with the folks at CAMI, John and I learned they have made the decision to follow the spectacular example of the folks at the California DMV and the FAA’s Flight Standards Service. They intend to effectively manage the personal touchpoints with new policies and procedures that demonstrate concern for the constituencies they serve, including pilots.

They have already embarked on a program to improve their communications with pilots. Previously, their letters to pilots were largely directed by the legal department, which had no concept of the damage to the relationship with the aviation community the cold, legalistic letters were causing. Now they are re-crafting their letters to display the kindness and empathy that John and I observed when we met the folks at CAMI.

They have also made the decision to actively seek out other ways to mitigate risk rather than simple denial of a certificate. For instance, in John’s case, the FAA was responsive to his petition to mitigate the small risk of a repeat lapse of consciousness by requiring him to fly with another qualified pilot. This was not much of an imposition on us since most of our flying is in an airplane that requires two pilots. John is very appreciative of this solution and is very eager to see other pilots benefit from the policy.

The needed culture changes are very significant, and will be difficult to identify and implement. However, there is precedent right within the FAA. Flight Standards has reformed the way it evaluates pilots from a competency standpoint by participating with a working group for more than seven years in collaboration with varied constituencies of the aviation community. The spectacularly beneficial result is the Airman Certification Standards.

At our CAMI meeting, the representatives we met indicated they would be eager to participate in a similar working group to help design and implement medical certification reform. This is wonderful news that will benefit the entire aviation community.