FAA Flight Physicals - With Basic Med, Why Bother?

Dan Monlux, FAA Senior HIMS AME

March 2024

We have written several posts about Basic Med and how it stacks up against the traditional AME-issued FAA medical certificate and sport pilot rule. This one looks at the issues from a slightly different perspective. 

Forget the differences between the privileges you can exercise with a Basic Med certificate and a traditional FAA medical certificate and ignore that the sport pilot rule even exists. For the sake of discussion, assume the differences do not matter. Why bother with AMEs and the stress of the FAA reviewing your medical certificate application? Moreover, why do a flight physical at all? Why not just do Basic Med?

The answer to those questions fundamentally rests on two factors: convenience and risk. On the surface, Basic Med might seem like the clear choice. Rather than scheduling a flight physical with an FAA-designated examiner, you are free to have your medical evaluation signed by any state-licensed physician. That certainly seems more convenient. 

Not only that, once a state-licensed physician signs your Basic Med certificate, the FAA does not perform an additional review of your medical history. If you are concerned about being grounded, that definitely seems less risky. 

Who needs a flight physical?

The choice between an FAA medical certificate and Basic Med is not available to everyone. If you have never had a medical certificate or your most recent one was issued before July 14, 2006, you will need to visit an AME before you fly. The same thing if you withdrew your last medical certification or your most recently issued certificate was revoked or suspended. 

You will also be required to obtain a special issuance by visiting an AME if you are newly diagnosed with a personality disorder, psychosis, bipolar disease, substance dependence, epilepsy, unexplained loss or disturbance of consciousness, heart attack, coronary heart disease, cardiac valve replacement, or heart replacement. 

If none of those criteria apply to you, you can use Basic Med.

Is Basic Med more convenient than an FAA flight physical?

Let’s start with the similarities. You must visit a doctor if you use Basic Med or an FAA flight physical to satisfy the FAA’s medical requirement. 

For Basic Med, any state-licensed physician can complete your medical evaluation, and you are only required to complete an assessment every four years. Basic Med also requires that you complete an online course every two years that details how to keep adverse health conditions from affecting aviation safety. 

If you choose to maintain a medical certificate, you must schedule a flight physical with an FAA-designated AME. For pilots under 40 on the day of their exam, a 3rd class medical certificate is good for five years. Those 40 or older need to renew their certifications every two years. No matter how old you are, there is no online course requirement to maintain a 3rd class medical certificate. 

Based on those differences, it may be much easier for younger pilots with good access to an AME to fly with a medical certificate. You only have to visit a doctor every five years and do not have to worry about completing the online course requirement. 

Once you turn 40, Basic Med probably starts to look more attractive. You can stretch out your required medical exams to every four years. And depending on where you live, it may be much easier to schedule the appointment. The online training requirement might take longer than going to an AME, but the convenience of doing it from home may tip the scales in favor of Basic Med. 

There is no clear winner when it comes to convenience. Basic Med has a few more administrative requirements but saves older pilots a few trips to the doctor and might be easier to schedule.    

Understanding the risks

No pilot looks forward to their flight physical. Whether fact or fiction, many perceive the FAA medical certification process as unpredictable. For pilots with that view, any chance to avoid the FAA scrutiny that comes with a visit to the AME is a welcome opportunity. After all, if you never apply for a medical certificate, there is no way the FAA can revoke or suspend it. 

Basic Med might seem like the safest route to meet the medical requirements to continue flying. For pilots without medical issues, it is a moot point. It is only when you start developing significant medical conditions that it makes a difference. 

When that happens, the less-defined physical standards of Basic Med can work for or against you. Many doctors might be unfamiliar with aviation, much less the finer points of FAA medical standards. Assuming they are willing to certify that you are safe to fly based on that incomplete understanding, Basic Med may make it easier to stay in the air. 

On the other hand, many doctors might be unfamiliar with aviation in general, much less the finer points of FAA medical standards. Yes, you read that right. For the same reason that one doctor might sign your Basic Med paperwork when an AME would not issue a certificate, another might refuse to sign your paperwork when an AME would issue your certificate on the spot.  

Deciding which risk to take

The fact is that your own honest self-assessment is better than either standard for determining if you are safe to fly. 14 CFR 61.53 clarifies that flying with a “medical deficiency” is prohibited no matter which subsection you follow.

If you are safe to fly, there are very few circumstances when you could complete the Basic Med requirements honestly, and the FAA would deny your 3rd class medical certificate application. If you are thinking about Basic Med because you do not think you would qualify for a medical certificate, you may want to think again. FAA medical certificate standards are much more permissive than many pilots think. Without formal AME training, many state-licensed physicians may be less likely to take on the liability of vouching for pilots in less-than-pristine health.

If you are forthcoming during either process, there are very few cases when you could fly under Basic Med but not with a 3rd class medical certificate. For pilots with significant medical issues, getting a traditional medical certificate will probably require that you submit a significant number of medical records. If you opt for Basic Med, you may have to visit several doctors before you find one who is comfortable fulfilling your request. There is no way to tell which will be easier before you start. 

Basic Med or Flight Physical?

Having flown under Basic Med and with traditional medical certificates, for me, the differences between them come out to a resounding “meh.” One AME that I use has a streamlined process that gets me in and out of the office on schedule in no time flat. One gets side-tracked telling airplane stories and has some excellent aviation paraphernalia for office décor. I prefer either experience to sitting through online training. Above all, I also like that neither AME requires me to explain the process to them – finding a doctor proficient in Basic Med can be challenging.

I like the AME experience. However, I’m an AME. Basic Med is an excellent option if scheduling or geography makes it more convenient. For pilots honest about their medical history, it seldom makes a difference which one you use.


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Dan is a FAA Senior HIMS AME who is board certified in Family Medicine and Aerospace Medicine. He has helped thousands to maintain their flight medicine certifications. He started his career in the U.S. Navy and has more than 2500 flight hours including combat service in the F/A-18. A commercial pilot for more than 20 years, he is also a certified flight instructor for single engine, multi-engine, and instrument flight. wingmanmed.com


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