Recently, I called the office of my primary care physician. I asked the person who answered the phone, “Will the doctor sign an FAA BasicMed form?” The person said, “Let me check,” and returned a minute later. “She cannot. You need to see an FAA doctor.” I tried to explain that she could, but I could not convince the desk person.
The following explains BasicMed, the Federal Aviation Administration (FAA) program for pilots.
For a very long time, the FAA required all licensed pilots to get a routine physical examination from an FAA-approved physician, called an aviation medical examiner, to fly an aircraft. The requirements for the physical vary with the type of flying. Airline pilots are required to get a first class physical every six months. At the other end of the scale, a private pilot flying a single-engine Cessna 172 needs a third class physical every two to four years depending on their age. A second class physical covers commercial pilots.
The first class physical is an intense exam that takes a while, as it should. The third class physical is a little more than a routine annual physical that has been known to trip up a lot of pilots whose physical situation is not bad at all.
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About ten years ago, Congress passed a law requiring the FAA to accept another form of physical exam. It is now known as BasicMed.
BasicMed physicals are intended to be performed by the pilot’s primary care physician, and are limited to pilots not flying for compensation. Originally, the size of the aircraft flown by a pilot flying under BasicMed was limited to 6,000 pounds. (Think six-seater.) After ten years of experience with pilots flying under BasicMed showing that the difference in accident rates among pilots flying under BasicMed versus third class physicals was indistinguishable, the FAA recently expanded BasicMed privileges to aircraft weighing up to 12,000 pounds.
For a pilot to fly under BasicMed, the pilot must take and complete a course on personal health. Several aviation organizations offer the course for free and it normally takes a couple hours. The pilot then makes an appointment to see a normal MD or DO, not a physician’s assistant or nurse practitioner. There is no requirement that the physician be certified by the FAA. To the contrary, it is intended to be conducted by the pilot’s personal physician.
Having taken multiple third class physicals, there is a perverse incentive. When you walk into the exam room of an aviation medical examiner, you are medically qualified to fly. You are seeing a doctor you have probably not seen in the past and are unlikely to see again in the future. The best that can happen is nothing and you walk out still being allowed to fly. The last thing a pilot will say to an FAA aviation medical examiner is, “I think I might have something wrong.”
On the other hand, when a pilot sees their own physician, the physician has a much better understanding of the pilot’s health. The pilot can freely discuss medical issues. It is often said that the test is simply this: If you would allow a person to drive a car, you can allow them to fly an airplane. The physical examination you are performing is the same annual physical you are doing anyway. It is often compared to a sport physical.
Calculating the numbers of pilots flying under BasicMed versus third class is difficult as they have different durations based on one’s age, but it is estimated that about 40 percent of private pilots are currently flying under BasicMed. It is expected that this number will only increase as the privileges allowed under BasicMed just recently increased. As pilots with three years remaining on a third class medical start closing in on their deadlines, it is expected that many of them will switch.
The elephant in the room is always liability. Has any normal physician ever been sued for signing a pilot’s BasicMed paperwork, then something happens to the pilot which brings that pilot’s medical condition into play? I could not find a reported case in which a physician was successfully sued for merely signing a BasicMed form. That doesn’t mean that it hasn’t occurred, but it is extremely uncommon. And given the condition of some elderly drivers I know that routinely see their physicians who do not pull their driver’s licenses, that concern is probably misdirected.
The BasicMed physician checklist is as follows:
- Physical exam: The physician must verify the completion of a full medical exam in accordance with the BasicMed checklist. This includes a basic eye and ear check.
- Review of medical history: The physician reviewed the pilot’s medical history.
- Discussion of medical conditions: The physician discussed any conditions that might have an effect on the pilot’s ability to fly now or in the future.
- Awareness of FAA medical standards: The physician understands aeromedical factors and how they might affect the pilot’s ability to fly.
- Confirmation: This is important. The physician is certifying the completion of the exam. You have conducted a comprehensive medical examination of the pilot in accordance with the BasicMed checklist. You are not saying that the pilot is safe to fly. All you are saying is that you conducted the exam. If, in your opinion, the patient should not be flying an airplane, tell them. It is the pilot’s responsibility to not fly. Of course, you should probably tell them that they should not drive either, but that is your choice. (Seventy-five miles per hour on a crowded interstate is probably much more dangerous than cruising along at 5,000 feet on a sunny day in a Cessna 172.) As you put everything else in the patient’s chart, you might add, “patient advised not to drive a car or fly as a pilot.”
The bottom line is simple. BasicMed shifts the responsibility. The physician performs and documents the examination. The pilot remains responsible for determining if he or she is safe to fly.
Paul Loschiavo is an airplane pilot.
