New Study Looks At Why Pilots Withhold Health Information


According to a recent study by the University of North Dakota (UND), 56 percent of U.S. pilots said that they had avoided some form of health care for fear of losing their flying privileges. Now, the university and the National Business Aviation Association are asking pilots to participate in a new study designed to assess pilots’ “knowledge of healthcare services and procedures and how that could impact aviation safety.”

The new study is designed to determine if a lack of information on healthcare practices and the healthcare system had “a meaningful impact” on pilots who chose to withhold information.

Mark Larsen, CAM, NBAA’s director of safety and flight operations, said, “UND’s research raises important questions and NBAA is proud to be part of this effort to gain insights into a critical aviation issue. We recommend that every pilot member take part in this study to further our community’s understanding and appreciation of how mental and physical health impact aviation operations.”

According to NBAA, “UND’s survey takes five to 10 minutes to complete and does not ask for any information that would identify who the responses belong to. All responses are treated confidentially and are stored on a secure server.” Larsen added, “Culturally, we are changing our perceptions in a very positive way of how our mental and physical well-being can impact performance. Through studies like UND’s review of health systems literacy, we will be better able to define practices and that will improve our culture and the health of everyone in business aviation.”

Mark Phelps
Mark Phelps is a senior editor at AVweb. He is an instrument rated private pilot and former owner of a Grumman American AA1B and a V-tail Bonanza.

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  1. The current situation is pilots won’t get medical testing BECAUSE then they will have to report any condition that is found. It’s not about nice words like “culture”; it’s about a system that actually discourages pilots from perusing any medical testing that might find problems.

    • And this is the question they did not ask. Survey seemed senseless if they were looking for reasons pilots may delay exams/testing.

  2. It shouldn’t take a study to figure that dealing with the FAA’s glacial bureaucracy and trying to get a SI or waiver is an absolute nightmare. N. S. Sherlock! Keep it under wraps unless you want to be waiting on Oklahoma City until the next ice age.

  3. They should also look at why FAA doctors will require tests or procedures that are against the advice of cardiologists.

  4. IMHO, it would have been more valuable if, among all the slightly rephrased similar questions, they had simply asked, “Has your FAA medical status affected your health care choices?”

    That’s certainly true in my case. My PCP knows this and advises and prescribes accordingly. For my part (now in my 80th decade, 60 years flying) I go to the gym regularly, eat healthily, and have a checkup quarterly to stay on top of anything that might have to be reported on my next FAA medical. It’s cheap insurance against a nasty surprise, no different from doing an owner-assisted annual, a thorough preflight, and flying with a multi-probe engine monitor.

    • “80 decades” Wow!! I have been flying more than 45 years, but only 6 decades.

      But seriously, I had cancer at 30 (bladder cancer). I reported it and was “benched for two weeks” until they got ALL the paperwork. Even got a call from my chief pilot asking why I had been out sick. I told him to call OKC and speed up the process. You would think cancer was going to kill me in the next few days. The tumor was removed, no more cancer!

  5. I took the survey. There were zero questions that related to concerns on healthcare as it relates to the FAA and protecting flying privileges. Senseless survey.

  6. True story… a local pilot was prescribed an anti-anxiety medication to deal with a sleep issue after a family member had passed. The pilot did not take the medication, but being an honest sort, reported it on his next 3rd class medical application. It took 6 years and $15,000 of his own money for numerous psychological tests (fortunately, he could afford the psychological testing… ) before he was finally able to get a special issuance. The prescribing physician tried to help as did the AME. Other than the requirements for more psych testing, crickets from Oklahoma. I don’t have his financial means, so my flying would have been done forever.

    If I had a legally disqualifying health issue and my own physician(s) aren’t concerned that it will affect my ability to pilot an aircraft: 1) Why should the FAA be concerned, and 2) Other than a small risk of a perjury charge, why should I report it?

    Those are rhetorical questions, of course. I’m still young and healthy… but I won’t always be that way.

    As a topic for another discussion, all of the hoopla over the supposedly upcoming changes to the LSA rules could be eliminated by extending basic med to ALL individuals… or by completely eliminating the need for a 3rd class medical. Where is the data that indicates SPORT pilots are dying or having incapacitating medical conditions above and beyond the general population while flying? That data doesn’t exist.

    • “Other than a small risk of a perjury charge, why should I report it?”

      Because it’s not a “small risk of a perjury charge”. Rather, it’s a “non-insignificant risk of losing all flying privileges”, as the FAA has done to some individuals who were caught witholding information on their medical form. Nevermind that it may be something as insignificant as a one-time life event like the local pilot you know.

    • This almost happened to me. I have a sleep disorder and my doctor wanted to prescribe off-label a med commonly used for anxiety. I asked him if it was listed by the FAA as a drug which would disqualify me from flying and he had no knowledge of any such list. On his desktop computer we searched faa dot gov until we found it and he said “Try a good grade of melatonin.”

  7. It COULD have something to do distrust of the health care industry’s motives. What with the health care industry’s colossal level of denial, blind to its own practice of trying to make people into perpetual patients, which, as a single example, often includes prescribed pharmaceutical products which are designed to be a permanent feature of a patient’s personal health regimen. And then these products could be on the FAA’s list of substances which would disqualify a pilot from flying while taking these products. Or the health care industry could be totally aware of this practice and just wants Those Little People to accept it, because Cash Flow. Just sayin’…

    • I’m much less concerned about the health care industry than I am about the FAA applying inconsistent and unknowable requirements for deeming someone with any reportable conditions as medically fit to fly. Quite often, the health care industry thinks the FAA’s test requirements are unnecessary.

  8. “The new study is designed to determine if a lack of information on healthcare practices and the healthcare system had “a meaningful impact” on pilots who chose to withhold information.”

    It’s not the healthcare system that’s the problem, it’s the FAA’s medical requirements that are the problem. Sounds like another useless study that’s looking at the wrong question.

  9. The FAA inserts itself into your medical process adding no value. I see my doctor on a regular basis and we converse about my issues. When reported to the FAA, this information is gone over by someone in an office who has never seen me and doesn’t know my general health. How can they be in a better position to determine my suitability to pilot an aircraft?

  10. The FAA has done some things that help, such as the “CACI” conditions an AME can issue, many more have been reserved to OKC, and once in that path, the FAA has stated that their requirements are their requirements, and if people want to fly, they will pay whatever price necessary to get that medical.

    Kevin P noted that Regional or OKC will nearly always require extra and sometimes very expensive tests to keep a medical, including in some instances, where what today we would consider benign conditions requiring no treatment, 20-30 years ago we didn’t know and over-treated or we treat differently today. Some of the testing required runs upwards of $5-10k and may be required at every renewal. As a result, some, perhaps many pilots, defer or worse ignore impending problems.

    This is a very pertinent study given that modern medical practice will quickly dispense medications that are potentially disqualifying to relieve stress and anxiety. COVID-19 and the national response was a dramatic increase in prescribing and use of anti-anxiety drugs which are an FAA show stopper and will require extensive and expensive testing to get a special issuance. The questionaire is a starting point to get baseline data. Undoubtedly the UND will have follow on surveys that are more directed based on review of the first survey.

  11. Lipstick on a pig cooperation between two entrenched bureaucracies: government and the academic industry. Nothing will come of it. In other news, water is wet.


    1. Bureaucratic indifference to change. When did you ever hear of any government function (needed or not) getting smaller? Or, unless at the point of legislation (Pilot’s Bill of Rights, Basic Med, etc) NOT dragging their feet until they are being dangled over the edge of a cliff by legal directive? Same with Oak City. WE are not the customers, WE are the product. Oak City’s customers are located within the beltway. WE just get in the way. For once, Congress forced FAA’s hand with Basic Med (and they did NOT like it but had no choice) to our benefit.

    2. We have seen what the collusion between industrialized medicine, pharma, and the government has wrought over the last three years. You think the FAA medical branch is free of being manipulated in the same way?

    3. There’s lies, damn lies, and statistics. I’m thinking they don’t WANT to know the truth; the questions are framed to get the results that they can publish in support of their thesis. The elephant in the room: since the introduction of Basic Med, has the result of medical incapacitation causing incidents increased, decreased, or stayed the same? My own opinion? Basic Med (which I fly under, even as a CFI) has caused me to be MORE engaged with my PCP than before and have discussions with him as to how to best deal with any issues without feeding the pharma hogs rather than seeing a flight surgeon every 2 years for a cursory examination who isn’t involved in my regular care. Who is the better judge of my fitness to fly? It’s basically the same exam. My PCP or a flight physical mill in a spare office at the airport once a month?

    4. Change in LSA rules to encompass up to the 172 class of ride? That would be nice. But, probably not in my lifetime. Look how long it took to accomplish the medical changes. Heck, they were talking about that in the mid 80s when I started flying. We’re talking decades before the feds will do anything (again, unless they’re dangled over a cliff) about that.

    Just my $.03.

    • Where I live Basic Med is not a real solution. When I checked about a year ago there were not physicians who did Basic Med within 250NM.

      Why? Because active physicians are liable for signing off on Basic Med. Many times their insurer or health care organization do not allow Basic Med. The AME is not open to any liability when operating as an AME.

      • I have heard others say that, even in my local area, and I’m not really sure where that notion comes from. Physcians are no more liable signing a Basic Med form than they are any number of medical waivers (such as for motorsports or even CDL medicals), and I have had absolutely no problem getting my PCP to sign the BM form every few years. The BM form even specifically says that it’s the pilot who ultimately is held responsible.

        • I have a strong hypothesis where that notion comes from: AMEs. Many AMEs are really, really opposed to BasicMed. I don’t know why: medicals can hardly be a major part of their business. Maybe they feel it’s an assault on their expertise. In any case, they seem to have started this liability talk. A few scary words in the ear of the local large medical group’s attorney and – shazam! – no doctors will do BM.

        • It’s because airplanes are scary.

          Look at how law enforcement reacts whenever a plane is involved.

          The fact a truck hitting a bus full of kids will be more deadly than a light plane hitting the same bus just isn’t something anyone thinks about.

          In fact, that might be a way to talk a physician past his reluctance. They sign off on truckers with much less concern, and that’s really much more liability.

  12. My concern is that the FAA will see this “study” from UND as a means to become more restrictive. If they suspect the vast majority of us are withholding medical information, what other ridiculous rules will they come up with to resolve that?

  13. It’s all about CAMI. Don’t let them get involved if at all possible. I had a bypass. No heart attack, just blockage. Vandy reported me healthy as can be following that. Go do any activity you wish. My cardiac doctor said, “you’re healthier than me now”. Foolishly, I wrote CAMI a message saying what I had done and how would I go about getting a SI. They wrote back saying that I couldn’t because of the med I now had to use. They did say they had notified my AME and made a record of my issues. Fortunately, I had not officially been denied a medical because I had not actually asked for one. So I just said screw it and flew light sport for the next 8 years until I finally hung it up. My hanger neighbor, retired FedEx, during that period of time, while having a current class II, fell over dead in his truck while waiting for an oil change.

  14. My family doctor once ask me if I snored. I answered “My wife says I do”. The result was a diagnosis of sleep apnea, and a never-ending journey through a quagmire of FAA regulations and sleep studies. It resulted in the denial of my medical certification, which permanently short-circuited my flying. It turns out that my doctor had recently made a substantial investment in a sleep disorders clinical practice, and I had unwittingly stumbled into his web. I found out later that he did FAA medical exams, so this aspect of my medical history made its way onto my exam questionnaire, and never left. For the record, I have never once fallen asleep in an inappropriate place. If I had it to do over, I would have protected my private medical history MUCH more zealously.

  15. Why do pilots hide medical data?
    The short answer is simply pilots don’t trust the FAA.
    The mandate of the FAA is to promote and regulate aviation, with safety being the underlying concern. What could be safer than all planes being on the ground and the only thing being burned were airworthiness certificates.

  16. The larger problem with all of this is the inability to discuss things that are in the realm of possibility without falling into absolutes.

    In a culture of judgment the absolutes dominate followed by the dismiss. Once one is judged by the system the game is over. YOU! You have crossed a non repairable, unforgivable line! Dismissed. Berried. Bye, bye.

    As hard as it is to admit, yes, it is cultural.

  17. The FAA’s Mission is to prevent pilots from killing themselves in airplanes. They’ve figured out that the best way to do that is to keep us from flying!

  18. I’ve been a physician for 36 years, a pilot 25 years, and an AME 22 years so I have something to bring to the conversation.

    I took the survey and I do not think it will bring valuable information, but perhaps a follow up will.

    I think more pilots had died of suffered medical catastrophes due to reluctance to jeopardize their medicals than have been ‘helped’ by an adversarial government bureaucratic system of certification.

    • “I think more pilots had died [or] suffered medical catastrophes…than have been ‘helped’…”

      I agree with that 100%. If the medical certification system truly did prevent deaths, than ALL motorists would be required to submit to a government-approved medical exam every few years. There are far more motor vehicle accidents and deaths from driver incapacitation than aviation accidents (“citation needed”, but I seem to recall seeing numbers that support this assumption of mine).

      In any case, I would wager that if the Germanwings second officer was able to get the treatment he needed without fear of permanently losing his job, that accident never would have happened. European vs US aeromedical certification, but my understanding is that their commercial pilots have similar medical standards to us.

  19. There are many potentially disqualifying conditions that trap pilots, some of whom know some of them and others who find out the hard way. There are also misunderstandings about those conditions within the pilot community. But, the alphabet organizations could help if they just would. Publish a list of conditions and options, so we can make proper decisions.
    Sleep apnea = disqualification?
    Diabetes = disqualification?
    Anti-depressants = disqualification?
    Hypertension = disqualification?
    What should be widely available is a site where each common specifically potentially disqualifying issue is explained, and what options are available and potential consequences. Some feared conditions that if left untreated can lead to serious conditions, especially with age. Uncontrolled high blood pressure = kidney disease. But one can take certain BP meds without disqualification. If we know the facts we could make safer decisions and maybe avoid FAA interference.

    • One problem is that the letter groups repeat the FAA assertion that a very high percentage of medicals ultimately get issued, AS LONG AS THE APPLICANT COMPLETES THE PROCESS.

      They don’t report how many applications are dropped because the applicant couldn’t afford the massive time and financial commitment to medically unnecessary testing.

      So their answer to your list will be “yes, you can get a medical with any of those conditions”. And in theory it’s true. In practice, maybe not.

  20. I suggest that all my pilots switch to me as their primary physician so they can be steered free of such trapdoors as I know where they all are.

  21. As a non-professional pilot, I would just resort to basic med or go LSA. At least you’re still flying. As a pro, you’re kind of stuck as an untruthful answer can/will cost you a lot. Anyone over 60 is probably going to have some disqualifying disorder that will render them retired and most likely grounded. Even doing LSA will be off the table if the FAA is aware of your status. So I feel sorry for a lot of pilots that find themselves on the fence about whether to be 100% honest about some seemingly insignificant health issue that the FAA considers to be a BIG deal.

  22. So many different issues I’ve encountered. In 1968 I had a melanoma which started in a mole in my chest. Not many available options in those days. Ended up with a partial mastectomy. Fast forward to 2007 when I went for my first third class medical. The AME had to send it off to OKC for approval. He told me I was probably OK since it had been 39 years but I wouldn’t stand a chance if it had been less than 10. I told him that my oncologist had said after two years the chances of a related recurrence were virtually nil, and that they found nothing during the surgery (lymph nodes, etc.) and that they probably got everything when they removed the mole.

    Fast forward again to 2000. Trying to get Basic Med, my PCP refused, although not over liability, so I had to change doctors.

    Finally, every time I go to the hospital, among the little bracelets the put on me is one which says “sleep apnea risk” because I said yes to two questions. One, as pointed out above was “Do you snore”, and the other was “Do you wake up at night?” It was irrelevant that I told them it was to pee, since I was (at that time) almost 70 with an enlarged prostate. (Thanks, dad). Once these things get in the computer, they never leave.

  23. The survey is not well done and should be revised. Many duplicate questions, However, Avweb should request to publish the results.

    The FAA medical system is completely broken and non-sensical. If it were not for basic med, the aviation industry would be dead.

    See if this makes sense. You have a medical condition which is disqualifying and will impact 85% of the male population at some point in their lives. The medical condition is resolved through surgery, meaning you don’t have the condition any longer. If you apply for a 3rd class medical and list the medical condition, you will be disqualified. Wait, you don’t have the medical condition why are you disqualified? Because you HAD the medical condition not because you HAVE the medical condition.

  24. Maybe if the FAA limited its assessments to “these things are shown to present a known or substantial risk” instead of some OKC desk jockey coming up with “we think it maybe possibly just might cause some sort of minor problem” or even just “well, we just figured it was a good idea to check” like getting the “turn your head and cough” treatment like my last third-class…

    Maybe if the FAA stuck to generally accepted standards for assessing conditions instead of insisting on coming up with its own requirements far beyond those standards…

    Maybe if they looked at your current health, and didn’t go digging in your past to see if you were (for example) diagnosed with ADHD in elementary school…

    Maybe if they didn’t get a bug up their collective butt about the latest fad (sleep apnea anyone?) and come up with arbitrary standards regardless of any reported impacts…

    Maybe if a certain pilots’ union hadn’t sold out on its members and the rest of the aviation community…

    Maybe if the system weren’t set up to be so adversarial with so many “gotcha” traps, pilots would be more forthcoming with AMEs and be willing to work with them instead of going into it like a police interrogation.

  25. “..all responses are treated confidentially and are stored on a secure server.” Oh really? I’m sure there a several banks, credit card companies and government agencies that would tell you there is no such thing. Even if hackers don’t get to it, the FAA can always subpoena the information if they feel it is “relevant” to any investigation they might do.

  26. Like several other responders, I wound up on the Special Issuance merry go round because of heart surgery. Never had a heart attack and never had high cholesterol, but did have open heart surgery more than a decade before I got back into flying. So the AME kicked the application for a 3rd class up to OKC, where it languished for several weeks, followed by a request for multiple tests up to and including a radiographic stress test. I was finally given the SI, but had to repeat the process several time before Basic Med came available. I was an early adopter of Basic Med, not so much to avoid all the paperwork, but to preempt the FAA from denying the application, thus keeping me from even flying LSA. My PCP has no problem doing the BM paperwork, saying it is no more liability than signing off on a CDL, or clearing some teenager to play high school sports. He knows my medical history and condition far better than any AME I might see once every two years. By the way, in the time I was fiddling with the SI paperwork, the then Continental airlines had two captains suffer heart attacks while at the controls of a flight. One unfortunately died, while the other survived, but lost his medical. So much for the efficacy of the FAA medical.

  27. Since the Covid vaxes are EUA, how can the FAA issue medical certificates which is contrary to FAA aeromedical rules?

  28. LOOK at this collection of respondents with a (deservingly) negative opinion of the FAA medical issues! And the FAA WONDERS WHY THEY AREN’T TRUSTED?

    Does anyone have any data on the number of medical incapacitations? Better yet, the number of incapacitations by medical certificate holders versus BasicMed, LSAs, ultralights, gliders, and balloon pilots that DON’T need medicals? How do those occurrences measure against the population of non-pilots?

    UND could better use their time and funding to measure the efficacy of WHETHER THE FAA IMPROVES SAFETY BY HAVING SPECIAL FAA MEDICALS!

  29. The people running the bureaucracy are all the type of people inclined to work in a bureaucracy. Otherwise, the institution would reject them like a virus. Only a small percentage of people inclined to do well as pilots share the personality traits the bureaucrats have.

    That may sound obvious and unimportant, but I challenge everyone to think about that whenever these issues come up. The military has spent a LOT of money trying to to figure out its own version of this problem but cannot get itself to change. There’s actually a type of personality nicknamed “Field Marshal” by psychologists which the US Army manages to weed out or transform early in their careers. Oops.

    To put it simply, even the pilot population we have has been shaped by the system through culling and grooming to be compliant with bureaucracy. The bureaucrats have in no significant way been affected by the needs of aviation. They think many of us are simply wrong headed and see no reason we shouldn’t just be weeded out. Pointing out how the system doesn’t work right just shows them that pilots are problematic, not that they are incompetent.

  30. IMHO, the FAA has created a real mess and are not equipped to deal with it. Maybe I’m just new to this issue, but it’s a real pain in the patootie. I’ve been flying for 52 years. I don’t know how many medicals that is.

    The FAA is all “…oh my why don’t you trust us. We just want all the stuff that you only share with your personal physician. We just want to know about every time you ever saw a doctor for anything.” Not in the last 5 years, forever.

    OK, 20 years ago I had an eye surgery. Surgery went fine, no problems. So, there’s this now online form and no limit on the length the responses can be, so I put in the knee operation I had when i was 14 and worked my way to my 76th birthday. I see my AME, he puts me through my paces and sighs me off and i leave with my 3rd Class medical in my pocket. I get a Registered letter from the FAA. “…Oh, we need some tests done. here’s the list.” Kind of late for this but, whatever. $3,000 worth of tests. My doctor says, “What the hell do they want that for. That problem was fixed 20 years ago.” I get my eyes checked every year. Some of the tests were on my previous check up. “Oh, no! They have to be new tests. Within the last 60 days. Those 4 month old tests just won’t do.” So we redo all the tests, the doctor writes up the results on FAA provided form and sends it all in. Then I get back by Registered Mail “Sorry we can’t tell if you qualify for a 3rd Class medical. We’ll give you a Special Issuance for a year and you can just have all the tests done again before you go to your AME.”

    They want me to be prompt and on time and follow all their guidance. So, I do the acrobatics to get an appointment with the eye doctor (different one this time since I moved) and an appointment with the AME so that the eye doctor’s tests are still fresh. The new eye doctor says “What do they want all this stuff for. Some of these tests are for conditions that would never have come out of a condition like that. Your eyes are fine.”

    All this goes to the FAA and since I’m on a special the AME doesn’t issue me a new medical. It has to go to Oak City for review. That was going on 5 months ago. No “Here’s your 3rd class medical, sorry for the fire drill.” No “Oh heavens you’re so sick we can’t issue you a 3rd class medical and you should see a doctor right away.” I try to contact them to find out if they are missing something that’s keeping them from moving on this. My District FAA Medical folks are pretty responsive, but they can only look in the computer to see what the last status was. They tried putting through a query. They got no response.

    They want us to be all open and responsive and trust them and tell them everything. But, it’s a one way commitment. They don’t seem to feel any responsibility to pilots to share information in return or try to collaborate on solutions when a snag happens. I guess it’s the way things are set up. I’ve never gotten a response from an FAA doctor. Everything is some illegible signature for Dr. Somebody. I am beginning to think there aren’t really any doctors working for the FAA, just clerks signing for Dr. Somebody. They don’t behave like any doctor I’ve ever had. Or at least no doctor I ever went back to again after the first time.

    The FAA Medical branch needs to take a Human Factors course so they can understand why people might be reluctant to share with them when they operate this way. Then take a look at how to be more like doctors and less like prosecutors. The FAA Aerospace Medicine Branch is broken from the top down, And, restructuring and refocusing from the top down is the only way they are ever going to get the trust they want/demand.