Basic Med Three Year Report Card Has It Worked?


Basic Med went into effect in May 2017 with high hopes. A recent FAA analysis of the program reveals that some 40,000 pilots have taken advantage of it. But the report also shows that Basic Med hasn’t really revitalized aviation in ways that some of hoped for. Veteran Aviation Medical Examiner Bill Blank wrote a report for MidWest Flyer Magazine and in this video, AVweb’s Paul Bertorelli talks to him about the analysis.


  1. Basic med hasn’t revitalized aviation because it only addresses one problem. Jumping through hoops to comply with the regulations. It does little with the bigger issues. Mainly, the costs to fly. Yes, every other year it was a pain to find a FAA doctor, get a physical, and fill out paperwork. Especially if one has a medical condition. However, it’s more of an issue every time one has to find the cash to get airborne. The FBO I used raised the rates $30.00 an hour from 2 years ago. Have I have a $30.00 an hour pay raise in these last 2 years?

    • That’s an absolutely absurd comparison of apples and oranges. Presumably you work 40 hours a week – your whining is only valid if you are renting the airplane for 40 hours a week. If you rent an airplane for hour a week – a $30.00 /hr increase per hour would cost you 75 cents more of each hour’s pay for the week.

      • “ That’s an absolutely absurd comparison of apples and oranges.”

        If it’s not an apples to apples comparison, it’s at least a grape to raisins comparison.

        What that aircraft is expected to earn per hour has gone up $30 in the last 2 years.

        What the OP is expected to earn per hour has not gone up $30 in the last 2 years.

        The owner of that aircraft wants it to “work” 40 hours per week. And in doing so, it will bring in an extra $30 per hour.

        The OP wants to work 40 hours per week. And in doing so, will not bring in an extra $30 per hour.

        Two years ago, the aircraft performed the same amount of work per hour as it does today. Yet today, that aircraft earns $30 more per hour for the same amount of work.

        Two years ago, the OP performed the same amount of work as he does today. Yet today, he does not earn $30 more per hour for the same amount of work.

  2. You talk as if most BasicMed-compliant pilots are going to an AME for their BasicMed exam. I’d question whether or not this is true. I thought the intent was that the BasicMed exam would typically be performed by the pilot’s primary care physician, the doctor who (at least in theory) best knows the pilot and their medical issues. That’s certainly the way I do it.

    Of course, it’s possible that a pilot could go shopping around to different doctors until they find one who will pass them, and perhaps this happens, but if it does, it doesn’t seem to be having an impact on safety.

    I also wanted to comment on your confusion about why BasicMed recipients might have generally higher death rates than third class medical recipients. That didn’t surprise me, as I am sure that many BasicMed applicants are pilots who do have a health issue of some kind – perhaps one where they’re worried about approval of a third class medical, or perhaps one where they’ve just tired of the time, significant expense, and stress of having to reapply for special issuance every two years.

    Pilots with no underlying issues of concern to the FAA might find it just as cheap and easy to keep going the third class medical route. But pilots on special issuance are probably crazy to stay on that hamster wheel if their flying needs will be met by BasicMed.

    • With the recent fix of BasicMed pilots being able to act as safety pilots normally, there is almost no reason why any pilot with a 3rd class medical should continue to keep getting a 3rd class, and should instead switch to BasicMed.

      And for those pilots who are apparently having difficulty getting their PCP to sign the BM form, I suggest going to AOPA’s website where they have an excellent write-up of how BasicMed works, and a short printout that can be given to their doctor. It seems the key point to make is that it’s like any other medical waiver that doctors regularly sign, and leave any discussion about the FAA out of it.

      • I’ll give you one reason, mentioned by Dr Blank in the video, that I have personally encountered.

        I asked my primary physician at two different routine exams if he participated in Basic Med, or if not, was he interested. He isn’t. Dr Blank mentioned a reason–it adds a layer of paperwork that reduces his productivity.

        So I’ll keep getting the 3rd class as long as I can.

        • Basic Med does NOT “add a layer of paperwork OR reduce a doctor’s productivity.” The checklist in AC68-1A, Appendix A, is a 22 item checklist. There is no ‘pass’ or ‘fail.’ The column says, “Examined.” The doctor checks each of the 22 items and if he/she/it feels comfortable signing it, they’re done. And the pilot THEN goes home, takes the medical course and the exam. After passing, the physician’s name/number is added and the pilot is done. It couldn’t be any simpler! Within days, the pilot’s FAA record reflects this info and that’s that.

          What you’re talking about, John, is the stupid 3rd class physical process which DOES take extra steps. I know MANY doctors who are AME’s merely to add a revenue stream to their practice and don’t give a hoot about whether the pilot passes or not … either way, they get their bucks. Any pilot who goes to such an AME needs to have their sanity questioned. For me — personally — being able to have a frank and honest medical relationship with my physician is perhaps the very best advantage of using basic med. In fact, prior to Basic Med, I didn’t have a personal physician … didn’t need one and feared having one. I no longer hold back on any issues fearing having to later admit to same on an aeromedical 3rd class exam’s paperwork.

  3. For my last 2 BasicMed physical exams, I ended up going back to my AME who issued my 3rd class medicals. My primary physician didn’t seem interested when I broached the subject. My AME guessed that something like 90% of primary care docs wouldn’t sign off on the BasicMed checklist due to fears of unknown liability. As an AME, he thinks he’s not liable for any issues that may get missed on the checklist since he doesn’t have a “clinical relationship” with the pilots (e.g. he’s not responsible for treatment or providing medical care).

    I live near the border with Canada, so there is a plausible reason to keep getting 3rd class medical since Canada does not recognize BasicMed.

  4. My question is “is even Basic Med necessary”? Glider pilots and Sport pilots have self certified for years and as far as I know, there is no difference in medical related accidents or incidents.

    • This is a VERY fair question to ask, glider cfi. I talked to Sen. Inhofe two different years at Airventure … one-on-one. One year, I walked with him for 15 minutes. He told me that his original intent with Basic Med was that if you have a driver’s license, you’d meet the Basic Med litmus test and you’d be able to fly low end recreational GA. What happened during that time in 2016 when the FAA Reauthorization Act was being worked was that MY FL Senator wouldn’t sign onto that idea and took six other Senators with him fighting against the idea. So, to assuage those people, Sen. Inhofe came up with a simple test. Unfortunately, in conference, even that was bastardized and the 22 item checklist had ‘pass/fail’ on it. Sen. Inhofe then went ballistic and had it changed to “examined.” The intent is that if there’s some issue a physician isn’t comfy with, that item is discussed, possible additional tests are conducted to satisfy the doctor and that’s it. There are only three specifically defined medical issues which would require a one-time special issuance 3rd class physical to be performed after which the pilot could revert to using Basic Med.

      What I’ve been hearing / seeing is that pilots themselves are making this process WAY harder than it needs to be. We all pee’d and moaned about medical reform for years, listened to Michael Huerta ‘spew’ for years about reform being ‘ex parte’ and nothing happened. Along comes the perfect storm opportunity for a proactive Senator pilot — Sen Inhofe (thanks, Jim) — to shove it up the aeromedical divisions you know what during a FAA Reauthorization period and suddenly, Basic Med popped out. We ALL owe Sen. Inhofe a big pat on his back!

      But — yes — it should have been a driver’s license medical but is darn near that anyways. And … it’s likely SAVING LIVES because pilots are seeing doctors again … not fearing the FAA Aeromedical bureaucracy.

  5. Here in northern California, the 800-pound gorilla in the medical space is Kaiser-Permanente. They have a “medical secretaries” department that does forms for the doctors. Nope, they don’t do BasicMed. At least, that was the case the last time I asked.

    I asked my AME – he didn’t want to do it, but would do it if I greased his palm enough.

    There are also independent docs who do DOT medicals for the truckers.

    • Jerry
      Actually there are 3 gorillas in northern california. They are Kaiser-Permanente, Dignity Health and Sutter Health. I don’t know the actual numbers but it would not surprise me if they controlled 90%+ of outpatient and inpatient medical care in the SF Bay/Central Valley area.
      Between micro managed physician workload and the organization’s risk management departments good luck finding a provider willing/able to sign off on Basic Med. There may be an occasional independent urgent care clinic that do DOT exams willing to do basic med but I have not found one yet.

      And also properly done the basic med exam is much more extensive than the class 3 medical.

      If you are on SI then basic med might make sense otherwise it is more of a problem than FAA class 3.

  6. This issue is a MAJOR personal pet peeve of mine. For years — decades, even — pilots have been clamoring for aeromedical reform for recreational pilots using the 3rd class medical process. AOPA, EAA and other groups have been pushing for same but nothing but hot air from the FAA appeared. Between the aeromedical people in OKC and the lawyers in DC plus maybe the senior FAA people, they had no vested interest in reform. It wasn’t until the perfect storm opportunity of FAA Reauthorization came in 2016 that an activist Senator Inhofe (R-OK) took it on and made it happen. For several years at Airventure, I listened to Michael Huerta ‘spew’ about medical reform being ‘in work’ but he couldn’t discuss it for reasons of ‘ex parte.’ What hogwash … aka known as ‘oral gratification!

    I took note of the fact that the required report to Congress by the FAA / NTSB on the impact of Basic Med covered the period from inception on May 1, 2017 to April 30, 2020 (Pub. L. 114-190), Section 2307 (h) of the FAA Extension, Safety, and Security Act of
    2016 (FESSA) was a year overdue; their mandate was ‘NLT five years.’ So the FAA couldn’t even get THAT right despite assembling something they’re calling the BasicMed Reporting and Analysis Working Group (BRAWG), assembled in June 2018 with members
    from the Flight Standards Service, the Office of Aerospace Medicine, and the Office of Accident Investigation and Prevention.

    Anyways, that report is now available and I’d urge ALL pilots to spend some time reading the 32 page report at:

    There are some easily glossed over innocuous statements in there worth remembering. Among them … “the FAA is unable to revoke an airmen’s BasicMed registration because, unlike a Part 67 medical certificate, BasicMed is not a certificate and cannot be suspended or revoked.” Read that again!

    And, from Dr Blank’s comments in the video, I learned that the cardiac committee only meets twice per year … this is NUTS !!! It’s no damn wonder the pilot community views the aeromedical community with enmity and fear. It’s too darned bad the aeromedical folks don’t apply this level of service to the very constituent population they serve. Dr. Northrup’s statements notwithstanding, they have a helluva long way to go IMHO.

    Two last points: I summer not 100 miles east of where Dr Blank is. Right in this area, an AME was initially willing to do Basic Med exams until the first AME conference put on by the central region AME group in Des Plaines. THEY put the ‘liability fear of God’ into the attendees and suddenly, that AME would no longer do Basic Med. At Airventure, I confronted the Sr AME from the FAA about this; he tap danced around it. So MY takeaway is that if we pilots don’t USE Basic Med, THEY will try to find a way to kill it. So anyone who doesn’t need a class II or III physical should be flying under Basic Med unless the equipment they’re flying requires a higher class III physical OR they’re flying in a country that doesn’t recognize it. Basically … USE IT OR LOSE IT !!

    BTW: Another great videography job, Paul.

    • I believe from the video that it’s the Psychological Committee that meets only twice a year, while the Cardiac Commiteee meets every other month.

      But committee meeting frequency aside, it makes me wonder what it takes for the committee to approve or deny medical requests. How many members does it consist of, and how many members does it take to approve or deny a request? For instance, if it’s a commitee of 5 and it’s a simple major is required for approval, it would take 3 to approve it, or 3 to deny it. And do all requests have to go through those committees, or just the more “serious” ones?

      And I agree, it sounds like the FAA would be perfectly happy to kill BasicMed and is fishing for reasons to do so.

  7. I’ve been on Basic Med for three years. A physician friend suggested I make an appointment with his office and, since I had a minor problem that needed to be looked at, my insurance paid for the visit. Last time I visited my PCP, I asked her if she would do the Basic Med for me and, after explaining it to her, she said, “Sure!”. So, from now on, when I go in for an annual visit and it’s time for the Basic Med forms, I’ll take them along and have them checked off and signed.

    • That’s EXACTLY what I did and I wrote about it mere days after Basic Med was instituted:

      I do one other thing … every other year — OR less — I take the forms with me to my personal physician who includes it as part of the exam. In this way, I ‘push out’ the end date for four more years. As a side advantage, I’m proving to my insurance company that a doctor found me safe to operate a simple GA airplane. I just did my fourth exam using this strategy. Nothing says you HAVE to wait four years.

  8. Larry S.
    That’s an excellent strategy. Especially since the insurance premiums continue to climb for the us older guys. The over 40 but less than 60 pilots can go 4 years with out worrying (to much) about increasing insurance costs. Thanks for bring that up. J.R.

    • MY pleasure to ‘school’ everyone, Raf. As I said, this was a gigantic pet peeve of mine so I followed its gestation all along its path to implementation by Congress. How said that ‘we’ have to force the FAA to do its reasonable job that way. There’s more that I’m holding back in this public record.

      I say again to all pilots … IF you can accomodate your ‘mission’ via BasicMed … you need to do it! And … I hope and pray that MOSAIC is announced in a form that is useful to raise the weight of an LSA compliant aircraft to something more usable AND safe this Airventure, too. If not, the airlines better fire up their “Ab Initio” schools pronto.

  9. Honestly I don’t see why more pilots don’t avail themselves of the BasicMed option. It costs WAY less, lasts twice as long, is much easier to use and eliminates exposure to the potential of an overly enthusiastic AME. If the limitations don’t effect you, I do not see the downside.

    Regarding non-AME doctors being reticent; a rational discussion and a few minutes research ought to do it. My doctor originally was not on board, but promised to look into it. That was four years ago. He told me the other day he now has about 4 or 5 of us in the area that he does this for.

  10. I’m fortunate to have had the same GP for the past 24 years. He knows more about my health practices to include exercise, food consumption and overall mental health than an AME can ascertain in a 30 minute visit. I visit with him at least once a year covered by my UnitedHealthcare plan which covers the cost of the exam. While I haven’t sent him on an expensive vacation to the Creek Isles, like some Justices have, I did send a thank you card and cash for a dinner for he and his wife.

  11. Funny how the FAA demands all this data to show that Basicmed and LSA aren’t impacting “safety”… but where was the data that drove the purported need for medical certificates in the first place?

    • The FAA didn’t “demand” this report, Bob. The Senators who fought against BasicMed drove how it finally shook out. To gain their support, this requirement was drawn up. In fact, the Aeromed folks don’t have anything to do with BasicMed. The FAA was REQUIRED to provide this data as part of the agreement to put BasicMed into the 2016 FAA Reauthorization Bill.

      But you ask a fair question. Now that this report shows that BasicMed didn’t impact safety … where is the data that shows that medical certificates do anything. Dead airline pilots in the pointy end of those big aluminum things show that they really don’t do anything.

  12. Bottom line is that general aviation regulations are to a large extent driven by the public’s illogical perception of GA as dangerous and as a consequence there can be illogical requirements set by their bureaucracies.
    Atrial fibrillation requires a special issuance for 3rd class but isn’t a factor for BasicMed so that leaves little option for us elders.
    I suspect that ICAO over regulation is a significant driver of 3rd Class Medical requirement while US pragmatism is the determinant for BasicMed.
    As was pointed out a GA pilot self regulates every time they leave the ground.
    So the US, Mexico and to some extent NZ think BasicMed is fine but Canada and the rest of the world don’t. Can’t have much respect for strict rules with that kind of uncertainty.
    Interesting to see that total number of “medicals” is constant with 3rd Class decreasing and BasicMed increasing by the same amount.

  13. I jumped on BasicMed as soon as it was offered. I don’t fly for a living, and never will. I just sprung it on my doctor one day. He thought a medical checklist for my physical was a great idea and took to the form immediately. I think it broke up the mundane checkups for him. He never once asked me about any liability. He just read through the forms and said let’s get to it. But then he’s always been fascinated by aviation and a good portion of my visits are talking airplanes. Bottom line is that my doctor and I both like BasicMed. AME’s are getting hard to find in my area.

  14. Can there be any substantial reason that a person can fly under Basic Med taking a med that is disqualifying under a third class rules? I think not.

    AOPA EAA etc should bring a lawsuit against the FAA based upon the denial of equal protection as required by the Constitution. You or I cannot undertake the case but they could and should. I feel they are letting us down by not fighting this irrational approach to medical certification.

  15. Paul – Very interesting interview. One quick correction….the number of pilots actually bottomed out in 2016 and has been slowly, but steadily INCREASING since then! I appreciate your efforts to carefully use statistics, so here’s the FAA data (if the comments will let me post a link)….

    Lots of interesting data, which should entertain you for a while. Obviously, Basic Med isn’t the only factor in the change in the pilot population, but I don’t think it hurt. Keep up the great work supporting GA. Cheers!

    • Very interesting Tom.
      It’s interesting to see the steady increase in ATPs through the years relative to the Private. And that the number of CFIs has been on a steady increase.
      I’d love to see a line showing the number of DPEs through the years.
      I think Dr. Blank’s assessment of Basic Med is correct. The largest benefit is for non-commercial pilots that in the past needed a special issuance. The FAA seems to be fond of saying that over 90% of pilots that apply for a special issuance, get it. What the FAA doesn’t say is all the money these pilots spend on tests that need to be submitted. And then the anxious months (and months) of waiting for Ok City to render a verdict.

  16. “The FAA can’t revoke your Basic Med certification” tells you EVERTHING you need to know about the FAA, and how our government views you as a pilot and a citizen.

  17. For anyone to claim basic med has had little impact seems …absurd.
    What, now over 75,000 GA pilots under basic med?
    Can all 75,000+ GA pilots be wrong?

    Paul, you nailed the underlying question, “Did the 3rd class really do anything for safety?”

    The fact that those 75,000+ GA pilots (and light sport pilots too) are NOT falling out of the sky seems to be scientifically-sound evidence that the 3rd class medical accomplished little to nothing, if anything, and at an immense cost, both in $$$ and to freedom.

    The doctor expressed frustration that they could not run the other income-generating tests they might otherwise get with other patients… well, what need I say to that? 🙂

    I am sure that out of the hundreds of thousands of pilots ground through the 3rd class mill over the years, a few patients finally got flagged for the medical attention they needed.

    I also speculate that whatever might have tripped them up with 3rd class with FAA would probably have soon been picked up by other symptoms.

    The 3rd class cost and negative impacts to the industry greatly outweighed any benefits.

    As to basic med’s economic impact to the industry, I speculate a significant percentage of those 75,000 under basic med (and Light Sport too!) would no longer be flying under the traditional 3rd class medical. As result, there are probably tens of thousands of MORE pilots still flying than would be otherwise, which increases demand for the existing fleet, at all price points.

    So take a breath and enjoy your freedom!