The respected Mayo Clinic’s Aerospace Medicine department seems the perfect clinical advisor to the FAA, particularly at a time when the agency’s medical certification division can’t seem to keep up with demand.
Moreover, with large health care companies buying up mom-and-pop medical practices, there’s a huge shortage of AMEs available to administer exams and issue medical certificates. That’s grounding otherwise capable and fit pilots. With virtual medical visits common in the pedestrian world, why not virtual visits with AMEs, too?
The Golden Age
Mayo Clinic has played an important role in aviation medical certification since 1920, when several of the Clinic’s docs served as the first pilot medical examiners for the Civil Aeronautics Board, the precursor to the FAA. Contributions include developing the first high-altitude pressure chamber in North America, a simulator for training World War II pilots, plus the BLB supplemental oxygen mask and the A-14 mask and bailout bottle. It’s a rich heritage and while there is a lot more aeromedical research needed, the 2021 pandemic put a lot of studies on hold because pilots couldn’t come to the Clinic. That turned out to be a unique opportunity that leads to the question of whether in-person FAA medical exams are even necessary.
Today a large focus of the Mayo Clinic’s Aerospace Medicine division (in conjunction with the FAA) is developing a plan for populating the field with virtual examination kiosks, with the eventual goal of completing remote flight physicals. It’s a logical remedy to a growing problem. When I talked with the Clinic’s Doctor Clayton Cowl, a Senior AME and a HIMS (Human Intervention Monitoring Study) AME, in early 2025 there were only fewer than 2200 designated AMEs—down from over 9600 in not so distant years.
Remote Diagnoses
Through biometric software embedded in exam kiosks, the Clinic is working on a proof of concept to show that it is possible for a pilot to use an app to set up a visit and coordinate with a remote examiner. Still in a pretty rudimentary stage, the Clinic has simulated roughly 20 pilots through the kiosk concept. It uses existing electronic stethoscopes and instruments that measure vital signs and drive the biometric data electronically into the computer. There’s a visual acuity unit that the patient looks through just as they would in a medical office, but someone 1000 miles away could change the visual acuity slides.
For the first phase in proving the concept, the pilot will have come to the Mayo Clinic anyway for a regular FAA flight physical and then volunteer as a study subject for the kiosk experience. At this point the kiosk exam doesn’t count and the FAA doesn’t get any data. The plan is to publish the results of the first-phase data in medical publications in mid-2025. The second phase is what’s called a non-inferiority study with a group of patients with known physical impairments. Examples, though not necessarily to include pilots, are patients with movement disorders, ones with heart murmurs, maybe ones with scarring from a surgical sternotomy after heart surgery or perhaps a vision or hearing disorder.
“We would blind the remote providers (perhaps a half-dozen who don’t have access to one another) and have them go through the process of testing the individual and see if they could be as good or better at identifying conditions remotely as they would in a medical office,” Cowl described. Medical equipment for remote exams doesn’t appear to be an issue, at least on a basic level that might be needed for routine aeromedical certification.
Cowl pointed out that there are FDA-approved glove-like biometric testers where the patient sticks an arm in and the device measures key vitals. It’s a hardware and software market that’s advancing quickly.
A device from California-based MedWand Solutions has a multitude of clinical-grade vital sign measuring capabilities, plus an interface with MedWand’s Virtual Care Clinic software. The device monitors core temperature, blood oxygen saturation and pulse rate. The device can record medically relevant heart, lung and abdominal sounds. Caregivers can also use the device to capture real-time electrocardiograms (FDA approval was pending at press time) and otoscopic, oropharynx and dermoscopic exam images. When connected to FDA approved third-party programs, the MedWand can also report blood pressure, blood glucose level, weight, body mass and lung test results. The company has even expanded beyond equipment with an ecosystem that allows caregivers to examine patients and real-time data remotely through video feeds.
The Virtual AME
Cowl told me the ultimate vision is to take fully enclosed kiosks and position them at flight schools and pilot domiciles where pilots can schedule time with an AME through an app.
“It would also provide sort of an Uber-like service to put examiners together with pilots,” he said. The other major issue the concept is trying to address is the huge shortage of examiners. While BasicMed might be helping, it certainly isn’t the cure. Cowl pointed out that big-business health systems (even not-for-profit organizations) have changed the original concept of the AME, and you’ll recognize many of the larger health firms—HCA, Kaiser Permanente, Sanford and even Mayo Clinic—that are buying up smaller practices and the experienced AMEs who once catered to pilots in small-town U.S.A.
What that also means is that company administrators—not the doctors, who have become employees at big medical systems—are calling the shots when it comes to services. And when the company administration looks at the financials and sees the measly $150 to $300 fee charged for FAA flight physicals, they get scratched from the menu of provided care.
It’s a no-brainer because the real gravy comes from staff doctor referrals to the medical group’s associated specialties—not preparing tedious FAA paperwork. But it’s not all on the bean counters. There are also the masses of grey-beard AMEs who are at retirement age and while they enjoy doing flight physicals (many are pilots themselves and there’s a certain camaraderie involved), they might not want to support the overhead of a medical office in the later stages of their careers. Cowl pointed out that the kiosk flight physical concept could offer the perfect balance for these doctors who might only want to work a few hours per week and without having to maintain a clinical office environment. They’ll need to have a valid a medical license, stay current on FAA aeromedical regulations and maintain their AME status, of course.
“Currently, the FAA doesn’t allow remote flight physicals but our hope is that if we can demonstrate they are as good or even better than in-person exams, it can expand to other areas that are of real concern,” Cowl said. This includes catering to HIMS pilots who need the care of mental health providers—something that’s difficult to source in many regions of the country. But this concept can provide access to a lot more providers, not to mention focused support groups and occupational substance abuse treatment programs.
Who’s Eligible?
I’m not so convinced that a virtual flight physical is an across-the-board solution, especially for older pilots on the ragged edge of losing their medical certification. I asked Dr. Cowl if he sees an advantage to an in-person, one-on-one exam compared to the proposed remote kiosk concept.
“The concept of a remote flight physical will probably never fully replace an in-person exam. Using a remote income tax preparation metaphor, the kiosk concept might be the equivalent to the 1040EZ tax form,” he told me. You might first answer a series of health-related questions to see if you’re even eligible to do a remote flight physical. While it’s not necessarily limited to younger pilots, but instead healthier pilots who don’t have a long list of medical conditions (especially ones that might require an FAA Special Issuance) obviously might be a better fit the kiosk concept.
A System Imploding
Cowl pointed out that the FAA expects there to be roughly 500,000 flight physicals administered by the end of 2026, but if the number of qualified AMEs (those who complete a new examiner basic course) continues to decline, the math doesn’t work out. Having another option (like remote physicals) is perhaps the only solution. “This is a storm on the horizon that has to be addressed because there will be pilots forced off of flight lines because they won’t have valid medical certification,” he said.
There seems to be lack of accountability on the agency’s part. While there have always been at least some delays in the system that can delay issuance of pilot medical certificates (simply because of FAA staffing issues) it’s reaching a point where six- to 12-month delays are commonplace, especially when it comes to more complex mental health and drug and alcohol cases. That drives up the cost of disability insurance for those pilots who are lucky enough to have it. So-called congressional cases (where grounded pilots contact their legislature to get to the front of the line) aren’t helping an already stressed FAA, and that is creating trouble in the commercial sector.
If there aren’t new solutions and certification pathways beyond using technology, including adding private-sector centers for specialized aeromedical care as one example, the issue will get legislated around the FAA, much like BasicMed did in the GA community. It’s not perfect. There are only two aeromedical educational courses for pilots using BasicMed (AOPA offers one and Mayo Clinic the other) and AMEs I talked with all agree that some pilots who should be getting traditional flight physicals (because of existing medical conditions) are the ones using BasicMed. Doc Cowl summed it up accurately.
“Even though an undersourced FAA has done a lot to streamline the approval process for certain medical conditions, the bottom line is that we have technology that can support the remote flight physical concept, and with an FAA that’s doing the best it can, the demand has outstripped the ability for it to keep up.”
Editor’s note: This article first appeared on Aviation Consumer.
