A Few Tips for a Good Flight Physical
As a Senior and HIMS AME, I have had the experience of helping many pilots through the FAA medical certification process at many levels and involving many circumstances. The physical exam and application process ideally should run smoothly, but sometimes the exam takes an unexpected turn. Occasionally, the hang-up may be related to a previously unknown medical condition the pilot may be suffering from which becomes revealed during the exam. Other times, the hang-up may be related to issues that, with proper planning, can many times be avoided. This article is focused on planning accordingly to mitigate avoidable issues.
Tip Number 1: Find an AME who will be your advocate
First and foremost, I would relay that there are two kinds of AMEs. The first type of AME is one who performs the exam and leaves any FAA relevant medical issues for the pilot to manage. In this scenario, the AME defers exams with medical complications to the FAA and leaves the pilot to manage and decipher what the FAA may need for certification. In some cases I have seen, the pilot had no idea what was going to happen. In these situations, the pilot is on their own to manage any requests from the FAA and many times can feel completely adrift. In my experience, most pilots do not speak "FAA medical" and truly, they shouldn't have to as it is the role of the AME to bridge that gap.
Any pilot who has had their medical application deferred to the FAA knows that the deferral process can feel like the application has been inserted into a black box with no known certification date in sight. For professional pilots, being grounded during this process is fully undesirable. Occasionally, deferral and or grounding is unavoidable, but in many instances proper planning by the pilot and/or assistance from the AME can result in an avoided deferral and grounding.
The second type of AME is one who actively assists the pilot with managing FAA medical certification issues and who works to properly and efficiently establish certification. This type of AME will help the pilot in many ways, such as personally calling the FAA, providing a detailed list of required medical documentation or required medical tests, providing instruction of who the pilot needs to contact, collecting medical documents to send in to the FAA for certification, and is available to the pilot for assistance. As a pilot, private or professional, it is to your benefit to seek out an AME that falls within the second category. If you are a pilot who has had frustration with the certification process, it may be related to your choice of AME.
As a pilot advocate, I provide all of my contact information, including my personal cell phone number to pilots, so they can reach me anytime with any issue they may be having. In many instances, the issues are easily managed, but ultimately my goal is for the pilots to be at ease regarding their medical status by having immediate access to an advocate and a helpful resource.
Tip Number 2: Obtain any required medical documentation before your physical
Having your medical documentation ready before your physical may have a direct effect on whether your application is deferred or not. This is because AMEs have a time limit for submitting your physical exam to the FAA. Once your physical is completed, the AME has two weeks to submit the exam to the FAA or they will get a black mark on their record. If a pilot comes in for a physical and is not properly prepared, two weeks may not be enough time to gather medical documentation or have medical tests performed that may be required by the FAA. Needless to say, there is incentive for the AME to submit the exam, regardless of the pilot's medical qualification status. If the required documentation is not available, the AME will be forced to defer the case to the FAA. If you have questions regarding your medical qualification status, contact your AME well in advance of your physical to discuss what medical documentation and/or testing you may need.
Tip Number 3: Fill out MedXpress before your appointment
Fill out MedXpress before your physical and bring your confirmation number to the appointment. Occasionally, pilots will forget to complete their MedXpress application before their physical. Typically, AMEs do not plan time in their schedule for pilots to fill out the MedXpress application. As one can imagine, this could disrupt the AME's schedule and could result in a rescheduling of your physical or worse, a laps in your medical certification.
Tip Number 4: Do not sabotage your blood pressure
If you happen to have hypertension or have had mild elevation of your blood pressure, do not do things to make it worse for your exam. I have seen pilots who fail the blood pressure requirement because they have consumed large amounts of caffeine on the morning of their physical or who ate a very salty meal the day before. This has happened to both young and old pilots. In one case, a pilot in his 30's, who was very athletic and who had no prior problems with his blood pressure, drank several energy drinks on the morning of his physical. Usually, these drinks contain a fair amount of caffeine. He was not able to pass the blood pressure requirements during his physical and had to obtain three separate readings over the next week in order to qualify. Most professional pilots do not want to be grounded because of a relatively avoidable issue. My recommendation is to eat low salt meals the day before your exam and take a break from coffee, etc. the morning before your physical.
Tip Number 5: Avoid strenuous exercise and high protein foods on the morning of your physical
This recommendation stems from the urine test pilots are required to perform during the physical. This test screens for two things: sugar and protein in urine. Typically, protein in someone's urine can be an indicator of kidney disease or other metabolic abnormalities, but it is not uncommon for a pilot's urine to test positive for protein after they have done a heavy workout or drank or eaten protein supplements on the morning of their physical. A heavy workout can cause protein to be released from muscles which then gets filtered out of the blood by the kidneys and ends up in the urine. Likewise, someone who eats a lot of protein, can have excess protein in their blood, which again is filtered by the kidneys and ends up in their urine. In both cases, this can create a problem with a flight physical and possibly could end up with otherwise healthy pilots unnecessarily having to see multiple doctors and/or getting multiple medical tests while their medical certificate has been deferred. It is ok to perform heavy workouts and drink or eat protein supplements, its just probably not the best thing to do on the morning of your flight physical.
Tip Number 6: Bring a copy of any pertinent FAA correspondence to your appointment.
If you have received any mail from the FAA regarding your medical certification, your AME will need to be aware of the contents of the FAA letter. If you have any contact with your AME prior to your physical, that is the time to let them know of the correspondence. The usual FAA protocol is to mail an identical letter to your AME for their knowledge. If you see a new AME, you will have to supply the letter for your physical.
Some pilots have a Special Issuance or "SI" associated with their medical certification. This letter should as well be presented to your AME if they do not have a copy.
Tip Number 7: A few other recommendations
Here are a few other recommendations that you need to consider when getting your flight physcial:
1. Bring your driver's license to any initial visit with an AME. The AMEs office will need to verify your identity.
2. Make sure to bring your glasses or wear your contacts when you go for your physical.
3. Bring a copy of your current or most recent FAA medical certification.
Ultimately, it is both the AME and the pilot who can affect the efficiency and ease of medical certification. Approaching the process as a team effort with an understanding of what is needed is usually the best pathway through the process.
If you have experiences or suggestions that may help pilots avoid potential issues during there re-certification process, please share in the comments section below.
