Third Class Medical Reform - Third time should be a charm

[tony]

5 hours ago, Marauder said:

Even if they signed it into law today, the FAA will have up to a year to implement the change.

On this topic, is anyone one else worried about this moving to the hands of your primary care physician? I remember when I was dealing with an issue, my primary was absolutely resistant to signing anything pertaining to my flight readiness status. He only acquiesced when I provided a letter indicating that the AME would be responsible.

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Yes I am.  I don't think this will have quite the impact everyone thinks it will.  Its a far cry from the drivers license medical that it started from.  Now I have to ask my primary care physician to sign me off instead of an AME who only knows what I tell them.  This proposal has morphed into nothing more than third class medical privatization.  But I'm supporting. 

[DrBill]

Sent a customized email to my Rep.  I currently teach HPDE at NASA but was denied by FAA  in 2013.  I try again this October unless the bill passes.

Bill

 

[Marauder]

Having a physician sign a document stating you are in good health to conduct a particular activity is nothing new.  There are medical forms for PADI to dive and medical forms for both the SCCA and NASA to race cars.  I've done all three and never had an issue getting the doc to sign.  TCMR and airplanes will be no different.

George -- when you walked in for those evaluations were you in good health? Walk in with a medical condition and see what changes. If you never have been through the SI process you would be surprised at the crap you need to put up with to get through the issuance.

Call me sometime and I can share with you what I ran into to get my SI. And it had nothing to do with the original "deferred" condition. I'm just concerned some doctors will be conservative. The good news, it sounds like if you don't like the answer one doctor gives you, go to another.

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[jetdriven]

1 hour ago, GeorgePerry said:

Having a physician sign a document stating you are in good health to conduct a particular activity is nothing new.  There are medical forms for PADI to dive and medical forms for both the SCCA and NASA to race cars.  I've done all three and never had an issue getting the doc to sign.  TCMR and airplanes will be no different.

But how is a PCP able to determine if an individual is safe to pilot an aircraft?  Altitude affects some drugs, much as does alcohol.  And even if he thinks he can, my gut feeling is that none of them will sign it because everyone is afraid of getting sued.  Nobody I know has been sued, yet they all let the fear of it control their life.  

[GeorgePerry]

Just now, jetdriven said:

But how is a PCP able to determine if an individual is safe to pilot an aircraft?  Altitude affects some drugs, much as does alcohol.  And even if he thinks he can, my gut feeling is that none of them will sign it because everyone is afraid of getting sued.  Nobody I know has been sued, yet they all let the fear of it control their life.  

How is this any different from their abilities to determine if an individual is safe to dive or drive race a car.  Seems that the "minimal" liability exposure a doctor has is essentially the same across all of these various activities...I never had any difficulty getting my personal physician to sign my racing medical waiver

[Danb]

Just now, jetdriven said:

But how is a PCP able to determine if an individual is safe to pilot an aircraft?  Altitude affects some drugs, much as does alcohol.  And even if he thinks he can, my gut feeling is that none of them will sign it because everyone is afraid of getting sued.  Nobody I know has been sued, yet they all let the fear of it control their life.  

Dr.s will also have to comply with what there insurance carrier has in there particular also if he/she is not in a sole practice they must comply with the rules of the practice. Being in business I just don't see the majority of drs complying. I'll most likely in the advent it does pass go to my Ame and get a normal physical and the letter hopefully, if I'm still flying by 2018 at the earliest.

[jetdriven]

1 hour ago, tony said:

Yes I am.  I don't think this will have quite the impact everyone thinks it will.  Its a far cry from the drivers license medical that it started from.  Now I have to ask my primary care physician to sign me off instead of an AME who only knows what I tell them.  This proposal has morphed into nothing more than third class medical privatization.  But I'm supporting. 

Is this it? Because the physician takes data and states he recommends you for consideration of medical approve for racing.  The SCCA certifies it.

 

The physician statement earlier posted,  says he certifies your to be safe to pilot an aircraft.   Huge difference.

Look I like what's  being done here and I support the effort.  But I'm not too hopeful, as often the Intent of the new law is lost in the wording, and often due to special interests.  Such as the GARA, the definition of a high performance airplane (747 doesn't qualify), complex airplane (747 again, doesn't qualify),  far 23 rewrite only benefits manufacturers, banning of HID landing lights snuck in the "no EFIS in small airplanes AC,  Etc.  light sport pilots only need to possess a driver's license, this is more than that  .

 

 

 

Edited June 16, 2016 by jetdriven

[Marauder]

Just now, jetdriven said: But how is a PCP able to determine if an individual is safe to pilot an aircraft?  Altitude affects some drugs, much as does alcohol.  And even if he thinks he can, my gut feeling is that none of them will sign it because everyone is afraid of getting sued.  Nobody I know has been sued, yet they all let the fear of it control their life.  

How is this any different from their abilities to determine if an individual is safe to dive or drive race a car.  Seems that the "minimal" liability exposure a doctor has is essentially the same across all of these various activities...I never had any difficulty getting my personal physician to sign my racing medical waiver

George -- a race car is in a controlled environment. Big difference than flying an airplane over people's heads. Look at the changes NASCAR made to the barriers to protect the viewing public.

As for the car analogy. People view driving as a right. Flying has always been viewed as a privilege.

I really want the reform to happen. I just have been through the process and have my concerns that the future state may not be the ideal state.

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[Cruiser]

we can speculate all we want. Let's let this passed and then we can deal with the details. There will most certainly be a PBOR3 down the road.

[tony]

First off,  I applaud the team that has worked so hard to get this far.  But George, you're too close to it.   If you take a step back and ask yourself, what's the difference  between going to an AME and or going to your personal physician, the personal physician has more liability.  As Byron said, they are all afraid of getting sued.  They nice thing is what Marauder said, if you don't like the answer, you're free to shop around.  That's a plus. Going every four instead of two years, that's a plus. 

Here in Georgia, the only medical I need to drive a car is to pass an eye test.  POB2 is a far cry from that, but again I support the legislation. 

My rep is Barry Loudermilk who I have called four times to become a cosponsor.  His office (he) ignores my request.  That last time, I told his office that if I didn't see Barry supporting this legislation as a cosponsor, then he wasn't representing my interests.  Then I would vote for whoever his opponent was.  The other republican in the primary or the democrat in the general election.  I didn't care.  Barry didn't care because I have seen no movement on his support. 

Tomorrow will be the fifth call. 

[GeorgePerry]

2 hours ago, Marauder said:

George -- a race car is in a controlled environment.

You've never raced against me!  

We'll see how this all shapes up.  I'm hopeful that it gets done once and for all.  After it passes then the discussion can shift from if and when to how.

[kris_adams]

Just now, GeorgePerry said:

We'll see how this all shapes up.  I'm hopeful that it gets done once and for all.  After it passes then the discussion can shift from if and when to how.

I'm willing to take incremental improvements.  I know a lot of people have said this should be all or nothing (driver's license) but incremental change tends to be better accepted (and harder to argue against).

[Tom]

15 hours ago, GeorgePerry said:

Having a physician sign a document stating you are in good health to conduct a particular activity is nothing new.  There are medical forms for PADI to dive and medical forms for both the SCCA and NASA to race cars.  I've done all three and never had an issue getting the doc to sign.  TCMR and airplanes will be no different.

It's completely different for many reasons, more prominent including:
1) AMEs have basically no real medical liability so long as they provide exams consistent with FAA policies and guidance (fairly unique in all of medicine).
2) AMEs are able to write of tens off thousands of dollars of personal income tax annually on personal flying activities solely because the provide physicals to pilots.
3) Aviation accidents often involve multiple victims, property damage, and deep pockets  Diving and racing accidents are typically limited to one victim and little/no property damage.
4) There is no academic discipline called "racing medicine," no board certification in "racing medicine," no continuing education courses in "racing medicine"
5) The diving medicine community is extremely small, isn't full of goofy science and rules, and has never had any number of conflicts of interest for its patients.
6) There are no "racing medical experts" available/willing to testify against a family doc for clearing a driver with, for example, kidney stones to race. 

If there is no difference, can we count on AOPA to use its affiliated physicians and resources to stand up to the AME cartel in court when the time comes?

It's inflammatory to ask this, but will AOPA really ask it's affiliated physicians, some of whom have spent their entire life committed to the idea that 3rd class physicals are needed, to develop resources (such as a webpage) to guide non-AME physicians in providing these physicals?


 

Edited June 17, 2016 by Tom
spelling

[Aviator]

Also done.

[GeorgePerry]

Time will tell how easy or difficult this is.  AOPA is already working on the medical resources to support the change.  Medical course is finished and other supporting structures will be in place once the FAA gets their 12 months to weigh in.

[flyboy0681]

Don't all of you think this speculation stuff has gone on far enough?

 

[peevee]

should means recommended....

[1964-M20E]

18 hours ago, jetdriven said:

But how is a PCP able to determine if an individual is safe to pilot an aircraft?  Altitude affects some drugs, much as does alcohol.  And even if he thinks he can, my gut feeling is that none of them will sign it because everyone is afraid of getting sued.  Nobody I know has been sued, yet they all let the fear of it control their life.  

Honestly Mr FAA NTSB insurance inspector after the incident there was a small fire and my medical certificate burned up before I could get the fire extinguisher and it was 3 or 4 years ago I do not remember the doctor's name.

 

 

 

[Tom]

On June 17, 2016 at 10:06 AM, flyboy0681 said:

Don't all of you think this speculation stuff has gone on far enough?

 

I'd like to relate two points that are non-speculative:

1)  Many if not most all malpractice insurance providers will state that they don't cover aviation medical certification except for aerospace medicine specialists.  This historically is not an issue for AMEs as AMEs simply strictly follow FAA guidelines and are thus practically shielded from liability.  

2)  The PBOR2 language, as it currently is written in the various bills that it has been attached to, essentially precludes the ability of AMEs to "certify" exams unless the patient/examinee meets 3rd class criteria.  Do we really think that an AME is going to sign off a private pilot with a medical history that the physician (and incidental AME) knows is disqualifying for a 3rd physical?  No way.    Do we really think that regular physicians are going to "certify" pilots for flight without malpractice coverage???

It needs to he understood that PBOR2 does not do away with 3rd class physical, rather it makes it non-compulsory.  It should probably be assumed that to maintain your current liability/hull coverage that you'll need to maintain a 3rd class (at least at current premium levels).  It should also be understood that 98-99% of people with a third class can keep it even with serious medical problems (though FAA has some wonky mandatory grounding periods for some conditions).  

My take is that, in a PBOR2 world, most GA pilots will keep their 3rd class except after certain medical events that FAA considers to be "groundable."  The GA pilot might elect to fly signed off by a non-AME, though the pilot later will want the 3rd class back.  

[Andy95W]

2 hours ago, Tom said:

I'd like to relate two points that are non-speculative:

1)  Many if not most all malpractice insurance providers will state that they don't cover aviation medical certification except for aerospace medicine specialists.  This historically is not an issue for AMEs as AMEs simply strictly follow FAA guidelines and are thus practically shielded from liability.  

2)  The PBOR2 language, as it currently is written in the various bills that it has been attached to, essentially precludes the ability of AMEs to "certify" exams unless the patient/examinee meets 3rd class criteria.  Do we really think that an AME is going to sign off a private pilot with a medical history that the physician (and incidental AME) knows is disqualifying for a 3rd physical?  No way.    Do we really think that regular physicians are going to "certify" pilots for flight without malpractice coverage???

It needs to he understood that PBOR2 does not do away with 3rd class physical, rather it makes it non-compulsory.  It should probably be assumed that to maintain your current liability/hull coverage that you'll need to maintain a 3rd class (at least at current premium levels).  It should also be understood that 98-99% of people with a third class can keep it even with serious medical problems (though FAA has some wonky mandatory grounding periods for some conditions).  

My take is that, in a PBOR2 world, most GA pilots will keep their 3rd class except after certain medical events that FAA considers to be "groundable."  The GA pilot might elect to fly signed off by a non-AME, though the pilot later will want the 3rd class back.  

Excellent points, especially that the insurance industry will probably dictate reality.  Just because I can legally jump in and fly a Beech Duke, doesn't mean I will be covered by insurance without training and dual with an instructor.

What worries me is what will happen to special issuances for medical conditions.  The FAA could say no to a special issuance, since you don't need a 3rd class medical, but your insurance company won't cover you to fly your airplane without a 3rd class medical.  Classic Catch-22.

Be careful what you wish for, you just might get it.

Edited June 26, 2016 by N1395W

[Jeff_S]

I don't recall ever having to give out my medical certificate during any insurance purchasing procedure. And when I fill out the form every year for renewing coverage, it never asks about the date of last medical, only flying experience. Also, I have read in numerous spots that even in the case of an accident, insurers are not likely to deny coverage if a medical is out of date. And they have been covering LSA for 10 years now, with no increase in risk exposure due to medical issues. So this is the first I've heard about the insurers having any real influence in this area.

Tom, what are your credentials that lead you to have this opinion? Are you in the insurance industry? Any facts to back this up?

[Tom]

5 hours ago, N1395W said:

What worries me is what will happen to special issuances for medical conditions.  The FAA could say no to a special issuance, since you don't need a 3rd class medical....

In this instance we can use the word never.  This will never happen.  FAA will continue to issue Special Issuances to pilots, including 3rd class.  FAA/NTSB philosophically doesn't like the idea of pilots flying around without medicals and technically FAA is obligated to certify pilots who meet medical criteria (even if by special issuance). I would be wrong on this if FAA unilaterally did away with the 3rd class, but this is regulatorially (if that's a word) unfathomable.  Look at the truck driver world...they now let chiropractors do DOT physicals, but they did not get rid of the DOT physical requirement.  

57 minutes ago, Jeff_S said:

I don't recall ever having to give out my medical certificate during any insurance purchasing procedure. And when I fill out the form every year for renewing coverage, it never asks about the date of last medical, only flying experience. Also, I have read in numerous spots that even in the case of an accident, insurers are not likely to deny coverage if a medical is out of date. And they have been covering LSA for 10 years now, with no increase in risk exposure due to medical issues. So this is the first I've heard about the insurers having any real influence in this area.

Tom, what are your credentials that lead you to have this opinion? Are you in the insurance industry? Any facts to back this up?

-I'm medical, not legal.  Somewhere in the bowels of your insurance policy are requirements that you have a valid medical.

-If an accident occurs where medical factors were not contributory, and the required (contracted) medical is out of date, case law seems to differ in different states regarding insurance company's abilities to get out of paying (many aviation attorney webpages have info on this).  Some states abhor insurance "gotchas" while others see a contract as a contract and don't require causality findings to allow denials of coverage.  

-Obviously if there is any medical concern in an accident and the insured did not have the medical that the policy required, good luck

-The LSA analogy is quite dynamic and I think too often over-simplified.  LSA can't fly at night, can't make flights associated with business, are limited to slow and simple planes, and at least in early days were ranks full of seasoned pilots.  I don't think it fair to compare the LSA plane/pilot risk pool to the plane/pilot/operational risk pool that PBOR2 affords.  I'm not an actuary, but that's my strong impression.

[Ron McBride]

When I did my SI 3rd class several weeks ago, I asked what the effect of the PBOR2 would be on me.  I was told that the FAA hasn't figured out how they are going to handle SI.

My SI is for a mild heart attack 8 years ago, and now diabetes.   I have no heart symptoms at all, and am very active still.   Diabetes is being controlled with diet.   My personal Dr. is not a fan of my flying, but she does realize that I am doing regular medical check ups to keep my medical, will I be seeing her as much without a medical hanging over my head and wings??

Time will tell.   With all of this, ADS-B and other regulations, retirement will probably not happen unless I sell the plane.  Expenses are just getting to high.

Ron

[Hank]

Ron, don't sell the plane. Retire anyway and move somewhere that ADSB isn't required. This will bring a new doctor, too, hopefully less opinionated than your current one. Just another option . . .

[ArtVandelay]

My current Doc is a nonactive pilot, if looking for a new doc, go into waiting room, check the magazines, if any flying magazines around, that's the doc you want.