It doesn’t matter how healthy you think you are, if you aren’t at least a little apprehensive going into an FAA medical exam, you probably have the wrong approach. Worse, showing up on your AME’s doorstep unprepared to explain existing and prior health issues—as minor as you think they are—could mean a hurry-up-and-wait FAA decision process that can drag on for six months or more.
Wingman Med attempts to tame that dragon, working in the background to help pilots get their medical paperwork in order before showing up for the dreaded exam.
I spotted Wingman Med’s Bonanza (an eye-catching flying billboard) on a transient ramp and, after the company returned my call for an interview in less than 24 hours, spent the morning hangar flying with company co-founder, Dr. Keith Roxo, for an attention-getting earful on the gotchas lurking within the understaffed FAA aeromedical certification department.
Mavericks
Roxo and his partner, Dr. Daniel Monlux, are Top Gun F/A-18 jocks turned aerospace medicine physicians. Training from the Naval School of Aviation Safety with multiple areas of medical board certification proved useful in helping friends and military aviators navigate FAA medical dilemmas after discharge, so together they formed Wingman Med (which has a growing number of consulting staff physicians), expanding their mil spec perspective to the rest of us. More on the company’s menu of consulting services later. First, Doc Roxo, who handled the most complicated cases for fellow Navy pilots, offered some valuable words and guidance worth sharing with civilian pilots.
It’s all about risk
First, he suggested that pilots should lose the mindset they bring to primary care physicians; going to an AME for certification is different and it revolves around risk.
“Your primary care doctors assess your condition and figure out how to make you better. The FAA’s Aeromedical Division is there to assess your risk when operating an aircraft,” Roxo warned.
The risk, of course, is the likelihood of you having a medical problem in flight due to existing health troubles or meds. Dumbing it down to the car insurance policy risk, he made a good point. “Showing up to your AME with a handful of medical issues not being managed by proper, modern protocols (or unapproved meds) is like a teenager showing up at an agency to insure his sports car with a handful of speeding tickets and accidents.” When it comes to conditions, the AME is following a checklist and there are plenty of attention-getting conditions that will require some explaining and paperwork as backup.
Moreover, you may have certain conditions that a primary care physician (or PA) might accept as minimal, but aren’t compatible with the FAA’s view of aeromedical safety. Part of that isn’t only related to the condition, but also in the choice of medications being used to treat the condition. The point is, your health provider isn’t necessarily considering your body’s airworthiness when it comes to performing at high altitudes (as but one example) like the FAA is.
Roxo pointed out that the FAA is only looking at you on the paperwork that’s provided to them. And so you may be stable with a medical condition that falls within FAA aeromedical guidelines, but if it isn’t properly documentable, the FAA has no way of knowing it. Like aircraft approvals, aeromedical approval is all about precisely prepared paperwork.
How serious is it, Doc?
It’s worth considering the symptoms associated with even benign conditions—some you might have simply gotten accustomed to. One example is hypothyroidism, with symptoms that often include fatigue and sluggishness—a hot topic in safety.
But when treated with the right dosage of medicine that keeps your hormone values in a good range, the thyroid disease generally has little to no impact to your daily life and your ability to safely pilot an aircraft. But without providing the prescribed dosage and lab results, the FAA has no idea how we’ll you’re doing.
Perhaps your long-standing ulcerative colitis was cured through intestinal surgery. While you finally lead a normal life and don’t take any medication for the disease, without presenting the right documentation (including surgical reports and a recent assessment from your surgeon), the FAA might deem you unfit to fly because they’ll think you lack normal bowel function. This preparedness (with the right documentation) could be the difference between getting your medical certificate issued on the day of the exam or having to wait many months or longer to get it.
As if your white-coat-elevated blood pressure wasn’t elevated enough, think of an FAA medical exam as you would a checkride. It’s pass or fail, and the FAA AME is an examiner just as a DPE is. Don’t prepare, and you might fail.
Find the right AME
Certainly, this isn’t one that pencil whips an applicant. They’re out there in small numbers, and some eventually get their certificates pulled—voiding the exams they performed.
Good practical experience matters, which can work to your benefit if they examine a lot of airmen. As an example, Dr. Roxo pointed out that there are three types of AMEs. The first type may not exactly be as enthusiastic and passionate about flying as the typical GA pilot, but answered the call from a few pilots in his community to offer FAA medical exams as part of his practice. This AME may do the minimum number of FAA exams in a year (count ‘em on one hand) and does the required training once every three years. By no means does this make him a bad AME, but since the FAA puts out updates almost a dozen times per year, he may not be up on the latest actions and approaches to dealing with certain conditions. This could mean certificate deferments that were actually eligible on the spot. Moreover, he may not have the time built into his clinical schedule to help you navigate the certification process if there is a problem that requires the right supporting paperwork.
The other type of AME runs an FAA medical exam mill—doing 30-plus FAA exams per day. These docs may not be problematic for the pilot who has no issues—no meds, no diseases, no injuries and no surgeries. But bring these doctors 30 pages of medical records to sift through during your appointment and you run the risk of this doctor deferring your certificate unnecessarily simply because the workflow doesn’t fit the business model.
The AMEs that fit somewhere in the middle are those who share your same passion for aviating and do have the time to effectively assist you. You’ll recognize them early in the exam simply by their ability to talk your language—flying.
Dr. Roxo pointed out that pilots commonly complain that their AME didn’t seem willing to help them work through their certification problem. But remember, these docs are in business to make money, and asking them to do more work for just the price of a typical FAA medical exam is asking for a lot.
“When you pay for an FAA medical exam, you’re paying for that 20-minute appointment where the doctor performs the exam,” Roxo told me. He’s right. You’re not paying for the doctor to review the records or for advice on how to get through the approval process. And this, among other gotchas, is where Wingman Med’s services come in.
Like a wingman
The Top Gun marketing fits the expertise, but in my multiple conversations with Doc Roxo I couldn’t help but realize he really does want to help pilots maintain FAA medical certification with the least amount of hassle. Plus, because it’s their primary business, the physicians at Wingman Med stay up to date on the latest FAA aeromedical matters and certification by regularly attending aeromedical training events, plus they handle nothing but aeromedical certification cases as expert consultants.
The first thing Wingman Med does is assess the totality of the applicant’s medical condition. Roxo told me that pilots often come to him concerned with one single medical issue, but it’s really important to take a broad look at the pilot’s condition as a whole.
“Sometimes people are concerned about a medical condition, but it may not be an issue in the eyes of the FAA. But that same pilot may have a condition that they themselves aren’t concerned with, but the FAA will be,” he said. Wingman Med will run you through a screener, called the MedXpress Simulator, because it includes the questions pilots must answer when submitting their real application.
Wingman Med wants to see how an applicant answers these questions, setting specific guidelines on what will be required for supporting paperwork from a treating physician with the goal of getting through the process as quickly as possible. Wingman Med won’t issue you the medical certificate and its doctors generally won’t write the notes for you to bring to your doctors. But they will provide generic examples of what you might ask your doctor to provide in terms of paperwork and specific FAA language.
The other important point to consider is that since your primary care provider may only see you once a year, they might not write complete or detailed historical notes for every visit, but instead an update to the previous notes. That just isn’t sufficient for the FAA, which doesn’t have access to the applicant’s charted notes. Instead, they’ll need the whole story for each visit.
On initial contact with Wingman Med, it offers 15 minutes of free consulting with an aerospace physician for an initial screening. The reality for some applicants is there’s nothing Wingman Med can do, and it won’t take long for Wingman Med’s doctors to spot impossible roadblocks. If you’re ineligible for medical certification for five years because of a head injury, the advice is to wait it out as instructed and perhaps revisit the services as you get closer to potential recertification. Wingman Med spoke highly of the Mayo Clinic’s Aerospace Medicine division and sometimes refers complicated cases there. We covered the Mayo Clinic’s services in the February 2019 issue of Aviation Consumer. There’s also Pilot Medical Solutions and the Aviation Medical Advisory Service. We’ll take a fresh look at both for airline and corporate pilots in a follow-up article.
If the FAA has mandated an in-person evaluation for a certificate holder, Wingman can’t really help because it works with the applicant virtually. For some with easy issues, the 15-minute screening can solve the applicant’s concerns in moving forward with an exam by an AME.
If not, the next step is signing up for Wingman Med’s Record Review and Case Preparation service. This is a deep dive into the applicant’s medical history with advice on what paperwork the applicant should gather to support certification. But there are no promises that even with the right paperwork you’ll be issued a medical certificate on the spot. Your condition might still require deferment. All communication with the FAA’s medical department is handled via U.S. mail (a law from the 1950s), and it won’t accept medical notes from PAs and nurses.
But the way Doc Roxo sees it, being deferred with the right paperwork in place is far better than waiting it out only to find that it’s wrong or incomplete. As of early 2024, deferment periods have typically been six months or more. Part of that is because of sheer volume. The FAA processed over 450,000 exams last year alone, while staffed at only 75 percent.
Doc Roxo told me he likes to think Wingman Med can cut wait times in half because of the right counseling and preparedness.
An investment big or small
After the initial free consultation, Wingman Med charges a flat-rate fee of $1800, which includes a case review, a detailed list of actionable items you’ll need to look after (treatment, labs, radiographic studies and record gathering, as examples) and in some cases direct communication with physicians and the FAA on your behalf. The services conclude with the FAA’s final decision on your application.
Since a VA disability rating can have a big impact on FAA medical certification, the $5000 combined VA and FAA Record Review and Case Preperation is a service that reviews your entire military medical history and offers personalized VA claim guidance, in addition to guiding you through the FAA medical certification process.
If you already have a valid medical certificate, but have previously reported a health issue to the FAA and don’t want to have troubles moving forward, there’s a per-year Subscription service to maintain the medical. Think in terms of maintaining the medical if you had serious issues in the past. The Subscription service gives you ongoing communication (often via email) with Wingman Med’s physicians, who, as one example, will advise you which medications are approved for medical certification. Again, your primary care doc might not be thinking about your airworthiness when prescribing meds. For pilots with third-class certificates the fee is $450, it’s $550 for second-class certificates and $700 for first-class certificates. If you develop a new medical condition in between certification, the company provides its full Record Review and Case Preparation service at no charge. For its Subscription service, Wingman Med requires that you have disclosed all of your known medical conditions on the most recent Med-XPress application and hold a valid FAA medical certificate.
If you’re concerned about how some of the questions you will answer on MedXPress will affect your ability to achieve FAA medical certification, Wingman Med’s aerospace doctors, for a $50 fee (payable on the company’s website), will evaluate your answers and discuss potential problem areas with you.
Worth mentioning is that Wingman Med has a good website (www.wingmanmed.com) with a lot of free resources, including a searchable medication database to see if the drugs you are taking might cause a certification snag.
Finally, Wingman Med is working to build a network of “aviation-friendly” physicians who might write the detailed notes the FAA needs ahead of time, in hopes of eliminating unnecessary snags when it’s time for another stressful visit to an AME.
