The aviation medical examination determines whether you’re physically and mentally fit to fly. Understanding what the Aviation Medical Examiner (AME) evaluates, how to prepare, and what conditions might cause issues helps you approach the exam confidently.
Medical Certificate Classes
The FAA issues three classes of medical certificates, each with different requirements and privileges.
Third Class
Required for private pilot privileges. Valid for 60 months if under 40, 24 months if 40 or older. This is the least restrictive class and sufficient for recreational flying.
Second Class
Required for commercial pilot privileges. Valid for 12 months at second class standards, then reverts to third class validity. Commercial pilots need regular second class exams to maintain commercial privileges.
First Class
Required for ATP privileges. Valid for 12 months (6 months if over 40) at first class standards, then reverts to second and eventually third class validity. Airline pilots require current first class medicals.
BasicMed Alternative
BasicMed provides an alternative to third class medicals for certain operations. Pilots who held a valid medical certificate after July 14, 2006, may fly under BasicMed without a current FAA medical, if they complete an online medical education course and obtain a physical examination from any state-licensed physician every 48 months.
BasicMed Limitations
BasicMed restricts operations to aircraft under 6,000 pounds, no more than 6 passengers, flights below 18,000 feet, and speeds below 250 knots. Commercial operations and operations requiring a second or first class medical don’t qualify for BasicMed.
What the AME Evaluates
The medical examination assesses whether you meet FAA standards for safe flight. Different classes have different standards, but all evaluate similar areas.
Vision
Vision must meet specific standards for each class. For all classes, distant vision must be 20/40 or better in each eye, with or without correction. Near vision must also be 20/40 or better. Color vision must be sufficient to identify aviation signal light colors.
If you wear corrective lenses, bring them. If your vision doesn’t meet standards with your current prescription, get an updated prescription before the exam. Contact lenses are acceptable if you’ve worn them successfully.
Hearing
Hearing must be sufficient for normal conversation. Formal audiometric testing is required for first class and may be required for other classes if the conversational test is failed. Hearing aids are acceptable if they restore adequate hearing.
Cardiovascular
The exam includes blood pressure measurement and may include ECG for first class applicants over certain ages. History of heart disease, heart surgery, or significant arrhythmias requires documentation and may require additional testing for certification.
Mental Health
The application asks about mental health history including depression, anxiety, and other conditions. Many mental health conditions are certifiable with appropriate treatment and documentation. The key is disclosure—hidden conditions discovered later create problems that disclosed conditions often don’t.
Neurological
History of seizures, loss of consciousness, or other neurological conditions requires evaluation. Many conditions are certifiable after appropriate observation periods, but undisclosed conditions can result in certificate revocation.
General Health
The examination includes assessment of general health, metabolic conditions, and any medications you take. The goal is identifying conditions that might cause sudden incapacitation in flight.
The Application Process
Medical applications now begin online through MedXPress before the AME visit.
MedXPress
Complete FAA Form 8500-8 through the MedXPress system (medxpress.faa.gov) before your appointment. The system generates a confirmation number the AME needs to access your application.
Application Accuracy
Answer all questions truthfully. The FAA has access to various databases and may discover discrepancies. Intentional falsification is a federal offense that can result in certificate revocation and criminal prosecution. Honest disclosure of conditions—even potentially disqualifying ones—is always better than falsification.
What to Bring
Bring government-issued ID, your glasses or contacts if used, any special issuance paperwork if you have existing medical conditions, and a list of medications you take. If you’ve had recent procedures or hospitalizations, bring records.
Common Conditions and Issues
Certain conditions frequently cause applicant concern.
ADHD and Medications
History of ADHD requires evaluation but is generally certifiable. Use of certain ADHD medications requires a waiting period after discontinuation. Work with the AME on documentation requirements.
Depression and Antidepressants
Treated depression using certain SSRIs is certifiable through the HIMS SSRI pathway. The process requires evaluation by a HIMS AME and potentially additional testing. Untreated or unstable depression is disqualifying.
Sleep Apnea
Diagnosed sleep apnea requires documentation of treatment and compliance. CPAP users must demonstrate adequate treatment. The condition itself isn’t disqualifying if controlled.
Diabetes
Type 2 diabetes controlled by diet, exercise, or certain oral medications is certifiable with periodic testing. Insulin-dependent diabetes requires special issuance with extensive documentation and monitoring.
Prior Medical Conditions
History of cancer, heart procedures, or other significant medical events requires documentation showing recovery and current stability. Many conditions that would have been permanently disqualifying years ago are now certifiable after appropriate healing periods.
If Problems Arise
If the AME cannot issue a medical, your application goes to the FAA for review.
Deferral
Some conditions require additional documentation that the AME cannot evaluate. The application is deferred to the FAA, which requests additional records or testing. This extends the process but doesn’t mean denial.
Special Issuance
Conditions that don’t meet standard certification criteria may qualify for special issuance—a conditional medical with ongoing monitoring requirements. Many pilots fly safely under special issuance authorizations.
Denial
If the FAA denies your application, you can appeal or work with medical consultants to address the deficiency. The Aircraft Owners and Pilots Association (AOPA) offers medical certification services to help pilots navigate complex cases.
Preparation Tips
Maximize your chances of smooth certification:
Get enough sleep: Fatigue affects blood pressure and mental acuity.
Avoid alcohol: No alcohol for at least 24 hours before the exam.
Limit caffeine: Excessive caffeine can elevate blood pressure.
Know your medications: Bring a complete list of all medications and supplements.
Bring documentation: If you have any medical history that might raise questions, bring supporting records.
Disclose honestly: The risk of falsification far outweighs the inconvenience of disclosure.
Choosing an AME
AMEs are physicians authorized by the FAA to conduct aviation medical examinations. Find an AME through the FAA’s AME locator. Consider choosing an AME familiar with aviation—some are pilots themselves and may be more understanding of how to work within the system while maintaining safety standards.
For complex cases, HIMS AMEs (Human Intervention Motivation Study) have additional training for psychiatric and substance-related issues. Senior AMEs can perform all medical classes; regular AMEs may be limited to certain classes.
The medical examination exists to ensure pilots can fly safely. Approach it prepared, answer honestly, and most pilots find the process straightforward. Even when conditions exist, working within the system usually leads to certification that allows you to pursue your flying goals.
