Risk Management – The Pilot Physician’s Perspective

Medical Risk and Flying: Perspective and Management

Matthew M. Cooper, MD MBA FACS FAsMA FCAMA CPL

Medical conditions affect all of us at one time or another – rare is the exception. As pilots, we react especially because we grow concerned that our medical, our ticket to fly, may be jeopardized. The specter of “Special Issuance” and long periods without flying make us hesitant to report to our AME or to engage with the FAA at all if it is avoidable (e.g., BasicMed).  This reaction is certainly understandable. However, let’s put a couple of things into perspective.

The first consideration should truly be your overall health, long-term survival, and quality of life. The ability to fly is a secondary consideration. Usually, if the former are assured, the latter follows.  The statistics indicate that less than one half of one percent of all pilots applying to the FAA are ultimately and finally denied. The motivation and perspective of the FAA is safety of the air transport system. As such, their focus is on the statistical risk of a pilot sustaining acute total or partial incapacitation. It is true, as in many cases, the outcome of statistical analyses must be combined with a healthy dose of common sense. This perspective differs in some regards from that of the individual pilot. The FAA has pathways that may require the pilot to jump through additional hoops to potentially be granted a Special Issuance. This is best viewed as a time limited, able to be renewed, health monitoring program.

The relevant epidemiologic data available are limited. However, while one could argue about methodologic nuances, there are some striking findings in the data that should make us all take notice:

1. FAA aeromedical waivers were associated with a 33% lower odds of death while holding a medical certificate and a 35% increased odds of death within 4 years after expiration of a medical certificate (1).
2. With respect to medically related deaths, BasicMed pilots have an adjusted 53% higher mortality risk than the Third Class medical group (2).
3. The adjusted risk of death from stroke or MI (myocardial infarction = heart attack) in BasicMed airmen was three times that of Third Class airmen; the risk of cancer-related death was two times higher among BasicMed pilots (2).

Yes, it is true that the average age of airmen flying under BasicMed is currently older than that of Third Class pilots. This post is not intended to argue either Pro or Con for BasicMed. Rather, it is intended to highlight the value in disciplined scrutiny, management, and surveillance of potential and actual medical issues.

As with health care in general, our system is so fragmented and otherwise challenging that it requires a savvy, persistent navigator to help make sure we get the right care in timely fashion. So too, a Senior AME with relevant medical specialty expertise and abundant experience consulting for, and working with the FAA, can most expeditiously assist the airman in maintaining their overall health while successfully navigating the path to maintaining their medical flight status.  If a disqualifying medical condition exists, this may be managed with granting of a Special Issuance which then allows consideration of BasicMed in lieu of a Third Class medical if the airman so chooses. The caveat, as explained above, is that BasicMed requires an enhanced level of pilot-driven and managed surveillance to maintain health.

Reference

1. Mills WD and Greenshaw RM. Association of Medical Certification Factors with All-Cause Mortality in U.S. Aviators. Aerospace Medicine and Human Performance. 2019; 90(11):938-944.
2. Norris A et al. Assess Mortality Between the BasicMed Population and Third-Class Medically Certified Pilots. Report No. DOT/FAA/AM-22-03. FAA. March 2022

Contact Dr. Cooper at drcooper@leftseat.com or 405-787-0303

December 25, 2025