Dr. Fredrick Tilton, Federal Air Surgeon

With a new Federal Air Surgeon in office -- one who is also a pilot -- many are wondering if changes will come to the medical certification process. Bureaucracies move slowly, but AVweb's Dr. Brent Blue learned about some interesting plans when he interviewed Dr. Frederick Tilton.


The appointment of Dr. Frederick Tilton as the new Federal Air Surgeon (FAS) on January 13, 2006, may herald a new outlook on the aeromedical certification process for pilots. In a phone interview, I had the opportunity to ask Dr. Tilton questions about his new job and goals from my perspective as an Aviation Medical Examiner (AME) as well as a contributing writer for AVweb.Dr. Tilton said his most important goal is the assurance of the safety of the National Airspace System, but “once that goal is met, we want to get everyone who can get into the air safely” to be medically certified. Tilton stated that he will “continually try to certify everyone he can.” This may come from his background as a pilot as well as a physician.Being an active pilot reflects his enthusiasm for his new position. It is “the epitome of aerospace medical jobs!” Tilton commented when asked what he thought of his new position. He has gone from the military — graduating from the U.S. Military Academy and active service as a pilot and physician — to the private sector with Boeing, to working for his predecessor, Dr. Jon Jordan. Tilton stated that Jordan asked him during his interview for Deputy Federal Air Surgeon if he ever wanted Jordan’s FAS job. He responded, “Yes, after I learn more about the FAA!”

Slow Change

This new FAS stated change takes time and “it takes time to turn a battleship,” but improvements are definitely on his radar. Although there will not be any “radical changes,” he wants to get “more efficient” in the certification areas. “Senior AMEs need less direction,” while newer AMEs “may require more help.” Most significant, Tilton stated, “In the past, AMEs who were in doubt about certification were to defer. Now, I want to see them call the Regional Flight Surgeon first.” This new outlook may save many pilots from the potential nightmare of bureaucracy and delay that occurs when a medical has to be reviewed in Oklahoma City prior to certification. In what may be a first for the FAA, Tilton also stated he wants to “standardize” the job of the Regional Flight Surgeon’s involvement and decision-making process in certification review throughout the nine medical regions.Because statistics have shown that medical issues are involved in less than one-half of one percent of aviation accidents, Tilton was asked whether this was related to a good job of screening the pilots or that it is just not much of an issue for non-commercial pilots. He stated he stood “somewhere in the middle. We do screen out a small portion of the population and try to do everything we can to issue” medical certificates, but he does not see an end to medical certification regardless of this statistic.

Sport Pilots

This brought up the Sport Pilot problem, which was dropped into the lap of the Aerospace Certification Division concerning pilots who were turned down for standard medicals but still wanted to fly Sport Pilot. Tilton stated he is looking into the problem. The possibility of some type of special medical that would be easier to pass would require new rulemaking. If nothing else, Sport Pilots will be “a comparison population as a test case [on the importance of medicals], much as glider pilots have been.”

Special Issuance

The most significant delays in Aeromedical Certification come from the Special Issuance (SI) process — both initial certification and renewal. The AME Assisted Special Issuance Program (AASI) has been a great advance in renewals but regulatory language has prevented initial issuance of SI through the AME. Tilton is addressing this by considering a Notice of Proposed Rulemaking (NPRM) that would change to language to allow more involvement of the AME in initial certifications. “For lack of a better word, a ‘Super AME’ might be allowed to perform the duties” on behalf of the Federal Air Surgeon. This might be “someone like a Senior AME with lots of experience.”As far as other specific areas, Tilton stated he did not see any changes in the current rules for insulin-dependent diabetics. There will be “no relaxation of the rules ’till data show differently. If the data suggest change and we can keep the airspace safe, we will look at it.”Tilton is also looking at depression, but “this is controversial. Would you rather fly with someone is depressed or someone who is on medications? Some say neither. We need to look at this again.” He has read the Aerospace Medical Association’s article that recommended a test group for study, but Tilton felt it might be too “broad.” He said that the authors were “leaders in the field” and he will be asking his staff to visit the area for their recommendations.

Online Medical Application

As far as enhancements for the pilot without medical problems, the new FAS stated they are “close to releasing” the new program which allows the pilot to fill out the front of the 8500 Medical Form on line. This would markedly speed the exam process for both the pilot and the AME. Beta testing is complete and the FAA is planning for implementation (see sidebar at right).Tilton said there is no hiring freeze in the Aerospace Medical Certification Division and they are fully staffed. He also looking at quality assurance issues with AMEs so that AMEs with few errors on their exams would be reviewed less, leaving more time for Special Issuance reviews. “That will help Warren [Silberman, head of the Division] to apply more resources to the special issuance process.”

Find the Subtext

As with any government official and agency, one must read between the lines. From my personal perspective as a Senior AME for 20+ years, the new FAS may mean a truly positive change in the Aeromedical sections of the FAA. Being a pilot, Dr. Tilton knows and appreciates how important flying is to people but also understands the constraints of being within a federal bureaucracy. His words are measured and his interview was monitored by someone from the FAA Public Affairs department.No problems with that. I would rather have a forward-looking person who knows the rules than a “bull in the china shop” who does not know how to make the system work.Do not expect anything fast, as Tilton has said, but change does appear on the way. In my estimation, he appears more likely to let his medical staff know his biases and expect compliance, although still listening to their input. This is a distinct difference from previous administrations.Tilton is anxious to come to Sun ‘n Fun and AirVenture this year. This may be the novelty of the new position, but it appears being a pilot and getting to go to major aviation events is a great perk of the job for him, not a chore. For the pilot community, this is a huge plus.Although he has almost finished his first 100 days, he is not the President. We will have to give him more time to make his mark on aeromedical certification and judge the results.

More about aviation medicine is available in AVweb’s Aeromedical section.