An Aviation Medical Examination (AME) is a mandatory health certification process required by the Federal Aviation Administration (FAA) for all pilots and air traffic controllers. The AME establishes that the airman meets the necessary medical standards for their duties. Its primary purpose is to ensure aviation safety by confirming the physical and mental fitness of individuals who hold privileges to fly. This highly regulated process is codified within the federal rules under 14 CFR Part 67.
Categorization of Medical Certificates
The FAA issues three distinct classes of medical certificates, each corresponding to the level of operational privileges the airman intends to exercise. The First-Class Medical Certificate imposes the most stringent requirements and is necessary for pilots exercising Airline Transport Pilot (ATP) privileges, such as captains and first officers flying for major airlines. For airmen under age 40, this certificate is valid for 12 calendar months when flying under ATP privileges, dropping to six calendar months for those 40 years old and older.
A Second-Class Medical Certificate is required for all other commercial operations. This includes corporate pilots, commercial drone operators, crop dusters, and individuals who fly for hire but not as an airline pilot. The medical standards for this class are less demanding than the First-Class. The certificate is valid for 12 calendar months for exercising commercial privileges, regardless of the pilot’s age. Once commercial privileges expire, the certificate automatically functions as a Third-Class Medical until its expiration date.
The Third-Class Medical Certificate applies to student pilots, private pilots, and recreational pilots who fly solely for pleasure or personal business. This class has the least restrictive medical standards. For pilots under age 40, the certificate is valid for 60 calendar months (five years). For pilots 40 years old or older at the time of the examination, the certificate is valid for 24 calendar months (two years).
The Role of the Aviation Medical Examiner
The medical examination is performed by an Aviation Medical Examiner (AME). An AME is a licensed Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) specially designated and trained by the FAA. These physicians complete specialized training in aviation medicine, focusing on the unique physiological and psychological demands of flight. AMEs are private practitioners authorized to perform these regulatory exams in their own offices.
The AME’s function is to objectively determine if an applicant meets the specific health standards detailed in 14 CFR Part 67. They review the applicant’s detailed medical history, which is submitted electronically via the FAA’s MedXPress system prior to the appointment. The examiner assesses fitness for flight duties, but does not provide treatment for any discovered medical conditions. Their determination is based strictly on the airman’s ability to perform duties safely without the risk of sudden incapacitation.
Components of the Examination
The AME appointment involves a detailed physical evaluation and several specific tests, regardless of the certificate class sought. The examiner reviews the applicant’s completed medical history form, discussing past or current medical conditions, medications, and substance use history. A general physical assessment is then conducted, including checking vital signs such as blood pressure and pulse to screen for cardiovascular issues.
Vision testing is a significant component, assessing distant, near, and intermediate visual acuity, with specific standards varying by certificate class. The examination also includes color vision testing to ensure the pilot can distinguish the colors necessary for safe operation (such as those used in cockpit displays and airport light signals). Hearing is tested by requiring the applicant to hear an average conversational voice from six feet away or by passing a standardized audiometric test.
For First-Class applicants, an electrocardiogram (ECG) is required at the initial examination and then annually starting at age 40 to screen for heart rhythm or function abnormalities. A urine sample is collected from all applicants primarily to test for protein or glucose, which can indicate kidney disease or undiagnosed diabetes. The comprehensive physical assessment also includes a check of the nose, throat, balance, and general neurological and mental health status.
Outcomes and Special Issuance
Following the examination, the AME determines one of three outcomes: Issuance, Deferral, or Denial.
Issuance
Issuance means the applicant meets all applicable medical standards, and the AME grants the certificate immediately.
Deferral
Deferral occurs when the AME cannot issue the certificate due to a complex or potentially disqualifying condition. This requires a formal review by the FAA’s central medical office.
Denial
Denial is a rare outcome, reserved for applicants who fail to meet a clear, non-negotiable medical standard and for whom no immediate path to certification exists.
A pathway for airmen with chronic or complex medical conditions is the “Special Issuance” process, authorized under 14 CFR 67.401. This process allows the Federal Air Surgeon to grant an Authorization for a medical certificate even if the applicant does not meet the standard requirements. Conditions such as controlled diabetes, certain heart conditions (e.g., post-myocardial infarction), or specific neurological disorders are managed through this route.
To obtain a Special Issuance, the airman must provide extensive additional medical documentation and often undergo specialized testing. This documentation must demonstrate that the condition is stable and controlled. The FAA must be satisfied that the authorized duties can be performed without compromising public safety. Once the initial Authorization is granted, the AME can re-issue the certificate in subsequent examinations, a process known as AME-Assisted Special Issuance.