What is an Aviation Medical Examiner?

I often like to remind my pilots that when Orville Wright lifted off for the first 12 seconds of documented powered flight in 1903, he did so without a valid medical!

By Dr Bjorn Buchner

In fact, civilian aviation was happily free of the burden of medical regulation (and most other regulations for that matter) for another two decades. It was only the armed forces that thought there must be some sort of standard initially, which is why the first pioneering military pilots where drawn from the cavalry. If you could ride a horse, it was reasoned, you could fly a plane. That means my chosen area of interest in medicine is only about a century old now.

For the purpose of maintaining perspective, blood pressure was discovered about three centuries ago and the ability to measure it without piercing the skin occurred about two hundred years ago! (And yet my pilots still get nervous when I put the BP cuff on.) In contrast, the field of gynaecology is considered to be about 4,000 years old and the first surgical evidence of an amputation goes back about 31,000 years. That means this flying business is basically all a bit new and we are still working out the kinks. Given that I conducted my first aviation medical examination on an SAAF pilot 20 years ago, it confounds me to think I have been around for 20% of the total history of my chosen medical field.

Aviation medicine was born out of a necessity to identify individuals who were suitable for flight training and to protect both the pilot and public, as far as is practical, from the risks of our aeronautical pursuits. It was conceived as a preventative or occupational discipline. It continues to grow, however, and the mandate is continuously evolving. Our established “standards” are actually in a continuous state of flux. It is also fair to say they are changing from traditionally onerous to more forgiving, as our understanding and experience of the field grows.

It must be said that assessing an individual’s physical traits is not very demanding. Comparing a pilot to the published standard is rather easy. Measuring, for example, visual and auditory acuity, checking for general medical fitness and excluding overt signs of obvious pathology is fairly straightforward. In fact, a senior airline captain once accused my job of being downright mind-numbingly boring. Except, it isn’t. Because this is not my real job. Although serving to uphold a published standard is part and parcel of being a designated Aviation Medical Examiner (AME), it is far more nuanced than that. While doing the “humdrum” ground work is vital and unavoidable, the bulk of my actual weekly effort is spent in providing preventative guidance and assisting in the recertification of pilots who have experienced disqualifying medical events. These events are quite often sporadic and of little chance of being pre-empted in a primary setting, irrespective of how strict the standards may be.

As the global demand for aircrew grows, the demand for suitably qualified aviation medical examiners will continue to grow as well. In the same way that the military no longer provides the bulk of initial flight training for pilots, the AMEs will need to be sourced from the civilian sector too. The doctors who make themselves available for this role need not only to understand the requirements of the environment, but also have a keen interest in aviation itself. In a similar way to a burgeoning surgeon becoming intimately familiar with abdominal anatomy through intense study and repeated clinical exposure, the proficient AME should ideally strive to be knowledgeable of the requirements of the aviation environment. This is precisely why the USAF has a pilot physician programme, where aviation qualified doctors are sent to become operational pilots. This is an extreme example of the profession, of course. Most countries do not have the financial means for such programmes, but it remains preferable that an AME has some form of exposure to the field. This is also why the initial SACAA AME course normally endeavours to expose the new AMEs to airline simulators, air traffic control and some actual operations. The more exposure to the aviation environment, the better.

There is no limit to an AME’s potential aviation involvement, though. I would say enthusiasm for flying is mandatory. Having a private pilot licence is definitely beneficial, as several of my colleagues will attest. It adds significant understanding of the physiological demands of being a pilot. Personally, I have tried to take it as far as I could. I wanted to follow in the footsteps of some amazing individuals and be a self-fashioned near equivalent of a civilian “pilot physician”. I eventually ended up in the airline environment while actively practising as an AME, for which I will be eternally grateful. I do believe that my exposure to the full experience continues to give me good perspective and understanding of the subject matter and, hopefully, the ability to exercise good judgement. It is inevitable that different AMEs have their own unique style and approach. I’ll confess that I’m probably on the stricter side of the spectrum. Aviation doesn’t suffer a fool lightly, after all. But I believe what all AMEs aim for is a reasonable standard and the knowledge that, when life happens, we are there to assist.

In my 20 years since starting out in an aviation medicine, I have never seen a greater demand for AMEs than now. The smaller towns are especially running low on suitably designated medical practices. The SACAA course is open to any registered medical doctors in South Africa. Getting a practice up and running to do flight medicals may be a little challenging at first, but us existing AMEs are here to help. After three years as a regular designated AME performing class 2 and 4 medicals, one will be entitled to apply as a senior designated AME, allowing one to performing Class 1 and 3 medicals too. Yes, class 3 is more restrictive than class 2, but that discussion is for another day.

Pull quote: I believe what all AMEs aim for is a reasonable standard and the knowledge that, when life happens, we are there to assist.

Pull quote: As the global demand for aircrew grows, the demand for suitably qualified aviation medical examiners will continue to grow as well.