Personal Doc/AME?

[jsstevens]

So again we have lovely sound bites "no pilot is his right mind combines them". But no examples of why it's a bad idea. Where does this conflict of interest arise?

First, I'm not trying to make a living as a pilot so risking my medical does not risk my livelihood. Perhaps that allows me to be a little more cavalier or objective, take your pick.

I want to 1) be healthy, 2) fly. IN THAT ORDER. Where is this mysterious, ominous, conflict of interest that my doctor has? If I have a disqualifying condition, I want to know it and NOT FLY. If I have a condition which can be controlled or cured and keep me flying, I want a physician who I don't have to educate and/or argue with.

As far as I'm concerned until somebody explains (specifically, preferably with an example) how this "conflict of interest" is a problem, it's all just a bogeyman propagated by folks who either don't know any better or want to hide conditions that should ground them from someone who can ground them.

Edit: I'll add: if you already have a difficult issue like SSRI, substance abuse or other SI requirements, by all means go to an AME who knows the ins and outs of dealing with this issues. But that's not the same thing we're talking about here.

John

 

[sferguson524]

My PCP is a retired air force flight surgeon. I feel confident going to him that he won't put me afoul of the FAA.

 

[Henning]

I posted this over on the red board, but wanted to ask here also.
.
What are the thoughts of the collective on having your personal Doc also be your AME? I find my self in the position of needing to find a new Doc and a new AME, there are a couple of options locally where I can get both. Good idea? Bad idea? Doesn't matter?

It depends, I've done both with no ill effect, and in some ways, using the AME is advantageous as they are sensitive to your situation re: being an airman and use permitted rather than prohibited medications when the option exists. Also filling out the application for visits can be done from his records. In the end though, you need the doctor who is best for your medical situation first, and if the AME isn't that person, they should be different. If you're like me with no major medical issues, then using the AME as your GP can make sense if the fee structure makes sense. Last few years though a better deal on a GP has showed up so now I have separate ones again.

As for the typical arguments against, they are basically irrelevant. If I need to cheat the medical system to fly, I will just fly without a medical rather than try to cheat the system, the consequences are less severe. Fly without a medical and you get a talking to where they tell you don't do that anymore. If you game the system to get a medical, you are committing a felony.

 

[Comanche flyer]

So again we have lovely sound bites "no pilot is his right mind combines them". But no examples of why it's a bad idea. Where does this conflict of interest arise?

First, I'm not trying to make a living as a pilot so risking my medical does not risk my livelihood. Perhaps that allows me to be a little more cavalier or objective, take your pick.

I want to 1) be healthy, 2) fly. IN THAT ORDER. Where is this mysterious, ominous, conflict of interest that my doctor has? If I have a disqualifying condition, I want to know it and NOT FLY. If I have a condition which can be controlled or cured and keep me flying, I want a physician who I don't have to educate and/or argue with.

As far as I'm concerned until somebody explains (specifically, preferably with an example) how this "conflict of interest" is a problem, it's all just a bogeyman propagated by folks who either don't know any better or want to hide conditions that should ground them from someone who can ground them.

Edit: I'll add: if you already have a difficult issue like SSRI, substance abuse or other SI requirements, by all means go to an AME who knows the ins and outs of dealing with this issues. But that's not the same thing we're talking about here.

John

Easy example, you get diagnose adhd add or other of those new age bullcrap we use to call add being a jerk now your doctor knows and you go under the microscope. My point is with all this new conditions sooner or later we all going to get hammer, being distracted and don't have focus used to be call being stupid, now is a condition, not advocating to stupid people flying, just saying. Some new condition can screw your flying. For me is a no no
Being using same AME great old guy quick in and out

 

[Henning]

Easy example, you get diagnose adhd add or other of those new age bullcrap we use to call add being a jerk now your doctor knows and you go under the microscope. For me is a no no
Being using same AME great old guy quick in and out

I don't see where it matters. Only a doctor can make that diagnosis, and if you get that diagnosis, you have to tell the AME. Whether the AME makes the diagnosis or finds out from you is irrelevant to the process. Since the ACA came into effect, trying to hide a diagnosis is no longer an option according to Bruce, they have access to all the insurance databases now as well as prescription/pharmacy databases. Like I said before, gaming a medical now is a high risk proposition with more to lose than if one just flies without a medical. If you know you won't pass and there is any evidence to substantiate it, it's best not to play inside the system and commit a felony. Anything happens and you will be hung out either way, but if you gamed a medical, you get it worse than not having one. Unless your medical care and prescriptions are anonymous and in cash, the FAA will find the evidence.

 

[Comanche flyer]

I don't see where it matters. Only a doctor can make that diagnosis, and if you get that diagnosis, you have to tell the AME. Whether the AME makes the diagnosis or finds out from you is irrelevant to the process. Since the ACA came into effect, trying to hide a diagnosis is no longer an option according to Bruce, they have access to all the insurance databases now as well as prescription/pharmacy databases. Like I said before, gaming a medical now is a high risk proposition with more to lose than if one just flies without a medical. If you know you won't pass and there is any evidence to substantiate it, it's best not to play inside the system and commit a felony. Anything happens and you will be hung out either way, but if you gamed a medical, you get it worse than not having one.

I'm good I don't have any. Just saying is a guy on other forum fighting adhd and he say he's fine, he never felt better just got diagnosed but he fits the bill.
I'm 37 and in good shape that's what the wife say

 

[Henning]

I'm good I don't have any. Just saying is a guy on other forum fighting adhd and he say he's fine, he never felt better just got diagnosed but he fits the bill.
I'm 37 and in good shape that's what the wife say

I'm 49 and breezed honestly through a fresh second class the other day. A life of hedonism has left me in surprisingly decent condition and on no medications, I may smoke all the way to extinction.

As for ADHD afflicted complainers, they make the same claims as the SSRI people used to, everyone is always'just fine'. Probably go the same way except it's more difficult.

 

[Comanche flyer]

i found DOT physical harder than 3rd class medical, they still make cough graving your jewels not funny not funny

 

[bluerooster]

PCP and AME same person, I see as a plus. Any doc half worth his/her salt, would not immediately run blabbing to the FAA about something that comes up during a routine physical, (not related to aviation medical exam). And will do what he/she can to provide treatment which would pacify the FAA. And if something comes up such as a TIA, he/she, would expect you to allow your medical to lapse, and not apply the next time. Thus allowing you still fly under the sport pilot rules.
An AME is under no obligation to submit any information to the FAA unless the paper work has been started. Especially when the AME is acting as a PCP.
But when your PCP is also your AME he/she, can, throughout the time between FAA medicals, see to it that you have no issues come next FAA medical exam.

 

[ClimbnSink]

What would the liability be if a pilot croaks under the care of a combo doc 'under prescribing' treatment to keep a pilot legal? The Rx may be what the pilot wanted, assume a widow with a different opinion.

 

[Rigged4Flight]

Martha Lunken, a Flying magazine contributing editor, DPE, retired FAA Aviation Safety Inspector, CFI and ATP says this about having your personal doctor also be your AME: "Bill is a physician in the very best sense of the word and would be my "real" doctor in a heartbeat except no pilot in his right mind combines both!" (link)

To add another well known aviation name, Patty Wagstaff says in the June edition of Plane & Pilot: "I say never trust your AME with anything other than what's routine and what they legally need to know."

Two extremely experienced experts in both the regulatory and pilot side of the aviation world, and they both agree in a healthy (pun intended) separation of the AME and personal physician roles.

 

[jsstevens]

To add another well known aviation name, Patty Wagstaff says in the June edition of Plane & Pilot: "I say never trust your AME with anything other than what's routine and what they legally need to know."

Two extremely experienced experts in both the regulatory and pilot side of the aviation world, and they both agree in a healthy (pun intended) separation of the AME and personal physician roles.

I'd still like to understand what this supposed conflict of interest is. I get that people have said "Dr=AME Bad!" as long as I've been around aviation. But nobody has any examples (preferably real, but even made up) as to what can go wrong - assuming you're not trying to keep something from your AME that you SHOULDN'T be keeping from your AME. (And there is some evidence that Ms. Wagstaff may have been. She did have a pretty dramatic alcohol related incident at Oshkosh.)

This is apparently moot for me as I got a letter that my Dr. is retiring next month. I haven't heard whether he's keeping his AME practice or not.

John

 

[Matthew]

I don't know how realistic this scenario is:

Patient - Doc, I've been trying pot and it seems to be helping with what I think are migraines.

Doc - don't do that. FAA has a bug up its butt about migraines and pot is still illegal.

Patient - by the way are you still good with that AME appointment for this afternoon? I marked "NO" on all the boxes asking about drug use.

--

I'm sure someone can come up with something better.

I don't think it's the worst thing in the world to have a PCP and AME be the same person. I just, personally, would rather keep the two separate.

 

[Everskyward]

I don't know how realistic this scenario is:

Patient - Doc, I've been trying pot and it seems to be helping with what I think are migraines.

Doc - don't do that. FAA has a bug up its butt about migraines and pot is still illegal.

Of course it would be easier to hide if your AME was not your PCP, but you are supposed to report those items and you would be falsifying the application if you didn't report them.

 

[Stewartb]

The whole premise of maintaining separate docs is to make it easier to lie, isn't it?

 

[Henning]

The whole premise of maintaining separate docs is to make it easier to lie, isn't it?

Kind of, it's always easy to lie, it's about not getting caught in the lie. Anymore since ACA opened up all the records to all government agencies, it is a false belief.

 

[Matthew]

Of course it would be easier to hide if your AME was not your PCP, but you are supposed to report those items and you would be falsifying the application if you didn't report them.

But the AME would know - what does he do then? He is bound by patient/doctor privilege to keep what you just told him to himself, isn't he? Or would that influence how he approaches the exam and what questions or notes he might make?

 

[ClimbnSink]

The whole premise of maintaining separate docs is to make it easier to lie, isn't it?

It also gives you time to self ground and review options without the machine knowing. Can a doc/Ame say you are safe to fly sport pilot if you have a disqualifying condition? Morally and worse legally? Sounds like a liability nightmare to me.

 

[Stewartb]

It isn't a flight physical until YOU make it one by filing an 8500-8 in advance of the appointment. You guys sit and dream up silly circumstances to support a silly position. Your health is your problem to manage. Your pilot cert is yours to manage. If you prefer to blindly leave those responsibilities to others you'll get what you deserve. If you manage your resources with knowledge of self and the system it's pretty simple to get by whether you use one doctor or two. The lines drawn in this thread pretty much identify the dreamers from the experienced in my view.

 

[RJM62]

I think it best to keep these roles separate, mainly to avoid even an unintentional reluctance to be open with one's doctor when that person is also one's AME.

Many symptoms can suggest problems ranging from the trivial to the life- (and certificate-) threatening. I can't help but think that some pilots might be less-inclined to discuss these symptoms with their doctors if they might indicate a grounding condition.

Rich

 

[ClimbnSink]

It isn't a flight physical until YOU make it one by filing an 8500-8 in advance of the appointment. You guys sit and dream up silly circumstances to support a silly position. Your health is your problem to manage. Your pilot cert is yours to manage. If you prefer to blindly leave those responsibilities to others you'll get what you deserve. If you manage your resources with knowledge of self and the system it's pretty simple to get by whether you use one doctor or two. The lines drawn in this thread pretty much identify the dreamers from the experienced in my view.

Say you wake up with chest pain tomorrow, not unbearable, but close. Whats you gonna do?

 

[Stewartb]

What I did do. I've had a cardiac-related SI for several years and a thyroid-related SI for many years prior to that. I know the aeromedical system pretty well. My cardiologist provides me required info my SI maintenance every 6 months. I deal directly with my RFS for those as well as my required annual renewal of my third class certificate. My AME sees me every 2 years for AME stuff and in between for regular health care maintenance.

 

[jsstevens]

Say you wake up with chest pain tomorrow, not unbearable, but close. Whats you gonna do?

I went to the emergency room and spent most of a week in the hospital before they figured out it was gall-bladder pain. All duly reported on my next medical application.

John

 

[Mike Smith]

This thread has been interesting and has provided me with all the info I was looking for. Thank you to everyone. I have decided that for me, keeping them separate will keep me healthier. I know me, and I know I would be reluctant to be completely open to the doc/ame without knowing the ramifications for my honesty. Everyone has been dancing around it but, the truth is, there may be things I wouldn't tell. After reading all of this and letting it digest I have come to the conclusion that the only reason to not combine the two is if you need to deceive one or the other.

 

[Stewartb]

You guys need to seek out an AME that you trust. Mine is a great guy. I like the way he practices medicine and the way he approaches Aeromedical issues. My attitudes are a direct reflection on him. Some of you seem to assume all AMEs are equal.Trust me, they are not. If you don't trust yours, find a better one.

 

[garyb]

I'd still like to understand what this supposed conflict of interest is.

I can't believe I have to point out something so obvious, but you asked for it:

The doc is a PCP. He works for you.
The doc is an AME. He works for the state, against you.

It really is like having an IRS auditor be your personal accountant. Sure it's convenient - he has all your info right there, but would you really be that foolish? No one is suggesting that you lie or hide anything, but just like the auditor, you don't volunteer extra information. The information you give to the AME is on a 'need to know' basis and just like the auditor, you only supply the information that he 'needs to know.' You really have put this guy in a quandary.

There are some people who believe they can run their own lives better than the government, and understand that volunteering too much personal information invites government control. I know a guy, who when renewing his driver license, was asked if he had any medical conditions that would prevent him from operating a motor vehicle. He put down diabetes. Bureaucracies being what they are where i's have to be dotted and t's have to be crossed, he now has to get a letter from a physician every 3 months stating he is OK for driving. If he's stopped and doesn't have the letter, he faces arrest.

I said it before and I'll say it again: If you feel you need to go to someone who understands aviation, then go to an AME, but get your medical somewhere else.

As someone who makes a living having Dr. in front of his name, I'll bet the PCP, unless he's hard up for cash, would say the same thing.

 

[SbestCFII]

Ideally that would be the best case, your PCP is your AME. Certainly in that case, your doctor could anticipate issues that could impact your flying and deal with those before they become an issue (i.e. the way medicine is supposed to work). However, then you have the other end of the spectrum, where pilots avoid this and chose not to disclose issues that could potentially impact their ability to fly (i.e. lie). That's an issue for the ethically challenged. Just by virtue of being human, people are going to find a way to do what they want, even when they shouldn't. If you read enough accident reports, you'll find that prohibited medications are not that infrequent an occurrence. My AME is my PCP and it works well. He helps me stay healthy and therefore to continue flying. It's a great situation.

 

[azure]

I can think of a scenario where you could get bitten, although if you REALLY trust your guy to keep his two roles separate you might be okay, but personally I would never trust anyone that much.

Here's the scenario: you have an SI that requires reporting of any adverse change. You have an adverse change, your condition worsens or a new one crops up. Left to yourself, you wouldn't report it because you expect this will be your time to just ground yourself, let your medical expire, and go LSA. But your doc puts on his AME hat and reports it anyway, or someone in his office does. The FAA revokes your SI. Now you are screwed unless you can satisfy the FAA and get a new medical at least one more time.

Now a GOOD AME would never do that, since the pilot is the one who is supposed to do the reporting, but many problem case AMEs communicate directly with FAA and will do that without being asked to - my AME works that way. There have also been posts where an AME's office staff sends stuff in against the wishes of the airman.

So it's really a matter of trustworthiness and professionalism. But personally, I would always have enough of a nagging doubt about which hat my doc was wearing at a given time (between visits, of course) that I'd rather not take the chance.

 

[Henning]

I can't believe I have to point out something so obvious, but you asked for it:

The doc is a PCP. He works for you.
The doc is an AME. He works for the state, against you.

It really is like having an IRS auditor be your personal accountant. Sure it's convenient - he has all your info right there, but would you really be that foolish? No one is suggesting that you lie or hide anything, but just like the auditor, you don't volunteer extra information. The information you give to the AME is on a 'need to know' basis and just like the auditor, you only supply the information that he 'needs to know.' You really have put this guy in a quandary.

There are some people who believe they can run their own lives better than the government, and understand that volunteering too much personal information invites government control. I know a guy, who when renewing his driver license, was asked if he had any medical conditions that would prevent him from operating a motor vehicle. He put down diabetes. Bureaucracies being what they are where i's have to be dotted and t's have to be crossed, he now has to get a letter from a physician every 3 months stating he is OK for driving. If he's stopped and doesn't have the letter, he faces arrest.

I said it before and I'll say it again: If you feel you need to go to someone who understands aviation, then go to an AME, but get your medical somewhere else.

As someone who makes a living having Dr. in front of his name, I'll bet the PCP, unless he's hard up for cash, would say the same thing.

In all my dealings with the FAA including post accident (my fault) never have I once felt they were "against me". In fact, the inspector who did my 44709 ride went above and beyond to find a retract plane to do my ride in after the FBO screwed up and dispatched out the plane I had reserved. Never once have I come across an AME who was trying to deny me a medical.

In fact, if you use the same MD as AME, when you see them as an MD, there are legal restrictions that prevent them from divulging that information in other ways. Also there is the advantage that as an AME they will understand the consequences of the various treatments and be more apt to providing one that does not conflict with your FAA medical.

 

[jsstevens]

I can't believe I have to point out something so obvious, but you asked for it:

The doc is a PCP. He works for you.
The doc is an AME. He works for the state, against you.

It really is like having an IRS auditor be your personal accountant. Sure it's convenient - he has all your info right there, but would you really be that foolish? No one is suggesting that you lie or hide anything, but just like the auditor, you don't volunteer extra information. The information you give to the AME is on a 'need to know' basis and just like the auditor, you only supply the information that he 'needs to know.' You really have put this guy in a quandary.

There are some people who believe they can run their own lives better than the government, and understand that volunteering too much personal information invites government control. I know a guy, who when renewing his driver license, was asked if he had any medical conditions that would prevent him from operating a motor vehicle. He put down diabetes. Bureaucracies being what they are where i's have to be dotted and t's have to be crossed, he now has to get a letter from a physician every 3 months stating he is OK for driving. If he's stopped and doesn't have the letter, he faces arrest.

I said it before and I'll say it again: If you feel you need to go to someone who understands aviation, then go to an AME, but get your medical somewhere else.

As someone who makes a living having Dr. in front of his name, I'll bet the PCP, unless he's hard up for cash, would say the same thing.

I've read your post twice. I understand that the AME "works" for the FAA (and has specific requirements because of that). I understand that my PCP "works" for me (or more accurately for the conglomerate that swallowed his practice and the insurance company). The IRS/accountant is an interesting sound bite, visceral reaction analogy, but I don't think it's very relevant.

Again, my goals are to 1) be healthy, 2) keep flying. IN THAT ORDER. Given those goals and that order, what is it that I report to my PCP that I can't report to my AME? (Also understand that my Dr's AME practice was separate, in a separate facility and it was very clear which "hat" he had on by which facility he was in.)

After 11 years (6 medicals) of having the same doctor for both, and (other than during his divorce) he's never given any indication that he's in any financial difficulty. He has also never given me any indication that he is uncomfortable at all with the dual hats. And his candor and directness are the reason I chose him in the first place.

It still seems to me that if there is going to be an issue it is because you either have something you're supposed to report and don't want to or your AME/PCP is not doing their job properly.

For me it's now moot because my Dr. just retired from both practices. I'll be shopping for a new AME next summer.

John

 

[SbestCFII]

The AME performs an exam conforming to the FAA's specifications for level of medical being sought. The patient pays a fee. They aren't paid anything by the FAA and many are pilots themselves. The AME does not work for or in the interest of the FAA and has no vested interest in whether or not you meet or do not meet the standard being sought. Their role is impartial. There seems to be some misconceptions among some pilots on this subject. Some apparently bordering on paranoia as noted above. My PCP is an AME. Because we have an established relationship, and since he is also a pilot, he is much more apt to help me avoid or mitigate issues that would affect my flying.

 

[ClimbnSink]

All the docs have said it isn't a good idea, should we weigh their votes more?

 

[Henning]

All the docs have said it isn't a good idea, should we weigh their votes more?

The docs don't like it because it introduces the dilemma I addressed. There are conflicting legal issues introduced through doctor patient confidentiality laws. If I fail to report something he diagnosed, if he tells the FAA, I can sue him, and win. If he doesn't he can lose his designee status.

 

[Stewartb]

Internet AME advice has been quite bad in my own experience. I pay less attention to them than most posters on aviation forums. Doesn't matter. This is a discussion to share ideas and experiences, not a debate to convince anyone to change their ways.

 

[Hank S]

In all my dealings with the FAA including post accident (my fault) never have I once felt they were "against me". In fact, the inspector who did my 44709 ride went above and beyond to find a retract plane to do my ride in after the FBO screwed up and dispatched out the plane I had reserved. Never once have I come across an AME who was trying to deny me a medical.

In fact, if you use the same MD as AME, when you see them as an MD, there are legal restrictions that prevent them from divulging that information in other ways. Also there is the advantage that as an AME they will understand the consequences of the various treatments and be more apt to providing one that does not conflict with your FAA medical.

Yeah, that. Mine were the same man, same staff, same office, for seven years. Then I relocated, and now visit a pediatrician who is a CPL. It works, but I preferred the other way. At least I knew he considered the FAA no-fly medication list whenever I needed anything.

Many of the FAA limits that I've seen are well above the concern levels published by other arms of the government. Like blood pressure. Mild uncontrolled high BP will still pass the Class III, but there are noises about further lowering the point at which medication is recommended from 140/90 down towards 130/80; unless I'm mistaken, I think the Class III limit is 150-155 over I forget what. If your doc doesn't worry about your health, the AME won't either, and your doc should become concerned first.

 

[Rigged4Flight]

In all my dealings with the FAA including post accident (my fault) never have I once felt they were "against me".

When I went to get my sport pilot student certificate I was told by the nice FAA man that I needed to acknowledge that I was aware that I was under investigation. I asked for what, and he replied "anything that I may find out about you".

It didn't upset me - most of my details are easily found, especially for a government investigator - but it did seem overly dramatic.

 

[SbestCFII]

That scenario is, at best, a very long stretch beyond what would be medically reasonable. Also, since in the fictitious scenario, the borderline to mild hypertension, occurs in the course of a non-aviation exam, your insurance would certainly pay the non-deductible portion of any follow-up visits. And incidentally, a single elevated BP reading is not diagnostic of hypertension (according to the FAA) and your AME couldn't "ground" you in this type of scenario.