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The Three Types of AMEs – Choosing Wisely

Choosing an AME

For pilots without any medical issues, the choice of AME isn’t much of a problem. If you take no medications, mark “no” to all of the other questions and have no concerning surgeries in your past, then it really doesn’t matter which AME you go to. We have discussed this before. But once you start listing medications, marking “yes” to some of the medical condition questions, or to the other questions, the situation becomes a bit more complex. 

Some medical conditions will prevent your AME from issuing your medical certificate at your exam. Meanwhile many medical conditions, with the right paperwork, can have a certificate issued at the exam provided your AME knows what they are doing and has the time to do it! And some medical conditions that technically require a deferral can still be issued at the exam if:

  1. You have excellent paperwork
  2. Your AME really understands the process
  3. Your AME is willing to contact the FAA to discuss your case and request over the phone approval

But are all AMEs capable of doing this? Sadly, no. Just like not every pilot you know is a truly amazing pilot, the same holds true for AMEs – not all of them are created equal. After years of working almost exclusively on complex cases we have noticed that AMEs generally fall into one of three categories.

The Casual AME

Most of the AMEs in the country actually do very few exams. They may be in a rural location, or perhaps just a location that doesn’t have a lot of flying. Maybe they got the qualification hoping to fill some slots on their schedule with non-insurance paid patients. Maybe they have a friend who is a pilot that asked them to get the qualification. This AME is likely a primary care physician with a fairly large patient load. 

This AME may be a very good doctor. But you get good at things by doing them regularly. If they only do a minimum number of exams and only attend the FAA required refresher training every three years, how good of an AME are they when it comes to a complicated case? 

The FAA puts out new guidelines 11 times a year. If an AME isn’t intentionally keeping up to date on these changes, they may not even know the current certification standards or will be unfamiliar with applying them. They can miss 33 changes to policy between refresher courses. And if the vast majority of their pilots don’t have any issues, it isn’t a big deal. But if you have an issue and you expect this AME to be able to help you, they may not be up to the task.

If your AME is not familiar with your particular medical issue and the FAA requirements, they may just defer your case to the FAA for disposition. But for a condition that could have resulted in certification on the day of the exam, this represents an unnecessary delay of six months or more. We have seen this exact issue countless times.

The High Volume AME

Some AME practices are dedicated to churning out exams. They don’t do any other medicine. They only do FAA exams. There are a handful of these AMEs scattered around the country. We have met several of them and they are amazed that we have time to do the consultation work that we offer. Why is this?

High volume AMEs may do three or four exams per hour for eight hours a day, five days a week. This business model is focused on efficiency and volume. What do you think will happen if you bring in 20 pages of medical records showing you have two CACI conditions and an AASI? How much time do you think it takes to review that paperwork, compare it against the requirements, scan it and upload it to the FAA system? You can bet it’s a lot longer than the 15-20 minutes that your exam was scheduled for. 

Faced with this scenario, getting deferred is a likely outcome. This high volume AME simply doesn’t have the time to deal with the extra issues you brought to the exam. And their business model does not support giving you the extra time that you need. 

Not only that, but some of the high volume AME practices that seem so appealing to a certain segment of pilots can cost you significant time and trouble later. Skipping the exam and urine test may sound expedient, but it won’t seem that way when the AME loses their qualification and you receive a letter from the FAA giving you 60 days to get a new exam. 

The Passionate AME

Somewhere in the middle, and what seems to be the smallest in number, is the passionate AME. This physician is primarily focused on aviation medicine. They tend to be aviation enthusiasts of some kind or may even be pilots themselves. Because of their passion, their focus is on aviation medicine – actual aviation medicine. They are not just cranking out high volume exam numbers. 

These AMEs are likely members of the Civil Aviation Medical Association and/or the Aerospace Medical Association. They keep up on the regular changes to the AME Guide. They likely attend at least one training seminar per year. And they have structured their businesses to actually help pilots with medical issues navigate the certification process successfully. 

When you have a medical issue and someone recommends you get a “consult with an AME,” this is the type of AME they mean whether or not they know to say it. But as we have described here, not all AMEs are created equal. If you are a Wingman Med client, you might have heard “you should be able to be issued at your exam with the right AME.” This is the type of AME we are referring to. We happen to have a Wingman Med in person office as well. 

Expectations

Keep in mind that no matter what AME you use, your exam fee typically pays for 20 minutes of their time that is dedicated to assessing your health status and reporting to the FAA. Reviewing paperwork and physician notes, advising you on the FAA’s certification standards, and helping you to meet those requirements takes way more than 20 minutes. If your expectation is that an AME – a highly educated and trained professional – will give you an unlimited amount of their time for no extra money, then you will likely be disappointed.

If you are young and completely healthy, it probably doesn’t matter that much. When faced with a new medical issue, you should start preparing for your certification exam well before your AME appointment. Whether you choose to look for AME reviews online or decide that maybe your regular doctor would be a good choice, choosing the right AME can heavily influence when you actually receive your medical certificate.