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Features February 2018 Issue

BasicMed Status Report

It was rolled out with great fanfare. Then the reality set in and some folks say it’s not what we wanted. But BasicMed seems to be useful and is working for a lot of us.

After about eight months, as of early November, according to AOPA, approximately 25,000 pilots had taken advantage of BasicMed since the official roll-out on May 1, 2017. Since the FAA does not track this, we don’t know the exact percentage of pilots who did not have a current medical after a multi-year hiatus from flying and decided to get back into flying with BasicMed, as opposed to pilots with medicals who renewed expiring medicals with BasicMed. AOPA estimates about 50% for each group. It will probably take at least two years for the BasicMed numbers to stabilize as pilots with current medicals decide to renew with BasicMed, but at this time it seems to be working. 

A Fresh Look

While the BasicMed roll out is still at its infancy, I have heard comments and observations from fellow pilots and CFIs that perhaps reflect a lack of full understanding of BasicMed. But first, let me be clear: BasicMed is not for every pilot, just like a First Class FAA medical is not for every pilot. Some pilots might find it stressful to search for a doctor willing to do a BasicMed exam or explain BasicMed to a doctor. It is simply another option for pilots who fly powered aircraft. If you prefer to get an FAA physical, there is nothing in BasicMed that would prevent you from doing so. 

I also realize that perhaps some of us expected to be able to fly with only a driver’s license much like what is allowed to fly light sport aircraft. Given all the bumps along the legislative road over many years, I don’t expect that we will be able to fly BasicMed-compliant aircraft using just driver’s license. I’m not going to relive how BasicMed was created through legislation instead of through the regulatory process and the trade-offs that Congress made to come to a resolution given the many headwinds faced by the framers of the legislation. 

BasicMed Requirements

You probably know this by now, but a quick review is in order. Any pilot flying as PIC with private or recreational pilot privileges regardless of pilot certificate level, including CFIs providing flight instruction, can take advantage of BasicMed. The aircraft must have six or fewer certificated seats, and weigh no more than 6,000 lbs. maximum certificated take-off weight. Operationally, IFR and VFR is permitted below the flight levels, with no more than five passengers and at an indicated airspeed not exceeding 250 KIAS. The aircraft can be capable of flying faster than 250 knots indicated but cannot be flown faster than 250. Most, but certainly not all, general aviation aircraft meet these requirements.

Pilots flying for hire and revenue flights would still require a Second Class medical. There is also a glitch in the original legislation which is then reflected in the regulations. BasicMed applies only to PIC. A safety pilot not acting as a PIC but as a required flight crew member (FAR 61.23(a)) would require a minimum of a Third Class medical. 

There’s a way that this can be circumvented if the two pilots agree the safety pilot is acting as PIC under the definitions, by being given “final authority and responsibility for the operation and safety of the flight.” The pilot under the hood, of course, logs PIC under 61.51(e) as “sole manipulator of the controls.”

Since BasicMed is not recognized by ICAO, pilots are not permitted to fly internationally using BasicMed. However, the Bahamas is allowing pilots to fly with BasicMed. Canada and Mexico have not made a decision yet.

The Doctors Are Out There

When BasicMed regulations were issued by the FAA in early Jan 2017, there was a feeling that it might be difficult to find doctors willing to sign the Comprehensive Medical Examination Checklist (CMEC FAA Form 8700-2). Indications to date suggest that we should not have any problem finding a doctor willing to do a BasicMed exam. (See “Find a BasicMed Physician” on the next page.)

There are four groups of doctors to consider: Aviation Medical Examiners (AMEs), private/personal physicians, physicians who are pilots but not AMEs, and doctors in Walk-in or Urgent Care clinics who offer DOT physicals for truck drivers, and physicals for schools, workers compensation, employment, sports and other types of exams, so the BasicMed exam should not be unusual. 

BasicMed Exam

There are significant differences between an FAA physical and a BasicMed exam. Since we have been using MedXPress, we no longer see what the AME fills out. The old FAA Form 8500-8 that we filled out by hand at the AME’s office included the doctor’s notes on the back. The AME must determine and record in MedXPress electronic records if body parts/systems are normal and which are abnormal. The CMEC also requires that the doctor examine the same body parts and systems with one key difference. 

In an FAA physical, the AME is making diagnoses. Pilots and physicians should be aware that BasicMed does not ask the examining physician to make any diagnoses; it’s just asking for a determination using medical judgement that the pilot can “…safely operate an aircraft or motor vehicle” at the time of the exam. This might also have medical liability implications. This is especially relevant for AMEs since in an FAA physical, AMEs are required to make diagnoses and they might not be aware of the differences between an FAA physical and a BasicMed exam. 

FAA physicals have medical standards that the pilot needs to meet. With BasicMed, the doctor, using his/her medical judgment, determines the pilot’s holistic medical fitness to fly. If the doctor decides in the negative, he/she does not sign the CMEC form but the pilot is not otherwise grounded. Indeed, there’s no record the physician declined to certify the pilot, so another physician can be seen hoping for better results.

Finally, note that BasicMed falls under FAA Flight Standards, not FAA Civil Aeromedical Institute (CAMI).

Pilots need to take a BasicMed online course available now from AOPA and Mayo Clinic in the future. I completed the AOPA course in about 45 minutes. However, to obtain the Certificate of Completion, the pilot needs to have a completed BasicMed exam because it asks for the date of the exam and information on the doctor who performed the exam. Anyone can take the course, perhaps consider going through it even if you don’t plan to fly with BasicMed.

An additional requirement is that a pilot must have had a valid FAA medical after July 14, 2006; it can be expired but not denied or withdrawn.

 

Is BasicMed Enough?

We hoped to be able to fly using private pilot privileges with only a driver’s license, much like what we can do flying light sport aircraft (LSA). But a more valid comparison is to consider the initial regulatory proposal for Third Class medical reform that the FAA was considering.

The proposal would have allowed us to fly with a driver’s license in single-engine fixed-gear, four-seat airplanes, with no more than 180 HP, day VFR only, at or below 10,000 feet MSL (or 2000 feet AGL in mountainous areas higher than 10,000 feet MSL) and with constant visual reference to the surface. It would also have required a medical education course every 24 months. 

For a number of reasons, the FAA delayed taking action on this proposal, but had it been codified into regulations, it would only have expanded the definition of an LSA. But more importantly, it would not have allowed BasicMed to come forward. Given this difficult choice, BasicMed does appear to be the better outcome. —LBT

Find a BAsicMed Physician

I have heard anecdotal comments that it’s difficult to find doctors willing to sign the CMEC, given liability issues and lack of knowledge. My experience having done a WINGS program with an AME on BasicMed in Broward County (Fort Lauderdale) Florida is that there is no problem finding a doctor. I’ve easily identified several physicians willing to do BasicMed exams. 

If you have a good relationship with your AME, start there. Some AMEs only do FAA physicals and typically do not carry liability insurance as they are protected by the FAA. (Note: FAA physicals are not issued by AMEs, they are issued by the FAA.) Plus, there are AMEs who do FAA physicals as part of their own broader medical practice; they usually carry liability insurance. 

We need to address the liability issue head on. There are three basic differences from a medical perspective between FAA physicals and BasicMed. First, FAA physicals are based on standards and medical judgement; whereas BasicMed is only based on medical judgement for fitness to fly. Secondly, FAA physicals require making diagnoses, which could otherwise be subject to malpractice; BasicMed does not require making diagnoses. Last, the customer of an AME acting as an AME is the FAA; the same AME doing a BasicMed exam, the customer is the pilot. If you decide to use an AME be aware of the above and perhaps share your thoughts with the AME.

There is an advantage using an AME. Let’s say you handily pass the BasicMed exam and perhaps you would consider making that annual flight to Canada. Ask the doctor if you could be qualified for a Third Class medical. The objective here is finding out if you can pass the FAA medical without actually taking the exam and risking failure, immediate grounding, and months to review. The cost for a BasicMed exam should not be more than the cost of a Third Class medical. 

The second option could be your primary care physician (PCP), and if combined with a periodic physical, maybe there would be no additional cost. Additionally, the physical might be covered by insurance.

Lastly, consider Walk-In / Urgent Care clinics. These doctors are used to giving physical exams to qualify the walk-in customers for anything from being a truck driver to playing high-school football.

Regardless of the path you choose, you need to understand BasicMed and be willing to explain it to the physician. And don’t be surprised if your AME is not familiar with BasicMed—you would be doing her or him, as well as fellow pilots, a favor by explaining BasicMed. Also share the name of doctors willing to do BasicMed exams with fellow pilots and let AOPA Medical know. They are in the process of compiling a list of doctors willing to do BasicMed exams. 

BasicMed Challenges

Some pilots—especially those who are in superb health—have concluded that the BasicMed on-line course followed by the possible difficulty of finding a physician to give a BasicMed exam actually makes the BasicMed process more onerous than an FAA medical exam. That might be true for some and there’s no reason they shouldn’t continue getting their FAA medicals from their AME.

Pilots should be intimately familiar with the CMEC (FAA 8700-2) and be able to explain BasicMed to physicians and, ironically, especially to AME’s. Being able to explain BasicMed is also important because according to FAA Notice N8900.420 (May 3rd 2017) FAA Aviation Safety Inspectors, Designated Pilot Examiners, CFIs and others cannot ask to see the Comprehensive Medical Examination Checklist (CMEC). Nor can they see the CMEC even if voluntarily provided by the pilot. While not required to be carried during flying, they can ask, given a reasonable time frame, to see the certificate of completion of an authorized BasicMed Online Medical education course. They may also ask the airman to describe how he or she is eligible to act as PIC under BasicMed. This would be a fair question during a ramp check, a practical test or a flight review.

A valid driver’s license issued by a U.S. state (not a foreign country) is required not just because it is a U.S. government-issued photo-id document but because any limitations applicable to driving might also be applicable to flying. For example, “corrective lenses required” would apply to flying but not “automatic transmission only.” Each state has a different set of potential driving limitations and FAA Flight Standards is not willing to state which limitations would apply to flying. A limitation from one state might be “no passengers allowed.” Would that limitation be applicable to flying? According to the FAA, it is up to the pilot. If I were faced with such an ambiguity I’d consider sticking with FAA medicals to be confident in the answer.

BasicMed has clear benefits. The exam is good for 48 calendar months; the on-line course is good for exactly two years from the date completed. If a doctor does not sign the CMEC, the pilot is not immediately grounded pending FAA Medical review. The handling of a special issuance is a lot simpler and Conditions AMEs Can Issue (CACI) no longer apply. If all this appears burdensome and stressful – continue to get FAA physicals.

Regardless of whether you think BasicMed is for you, the bottom line remains that we are responsible for our health and fitness to fly. In no way are we suggesting that any pilot fly with a medical deficiency. According to 14 CFR §61.53 we still must self-certify before every flight. 


Luca F Bencini-Tibo, given his flying needs, is having a hard time finding reasons not to fly with BasicMed going forward. 

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