Keeping Pilots in the Air: A New Approach to Pilot Medical Certification

The process the Federal Aviation Administration (FAA) uses today to determine whether pilots are medically fit to fly looks much the same as it did a century ago. That has led to some unintended consequences, such as pilot reluctance to report or seek treatment for certain conditions. In fact, one 2022 survey of 3,765 pilots found that 56% displayed healthcare avoidance behaviors. 

Additionally, in MITRE-conducted interviews, aviation stakeholders said the current system is slow, unclear, and unfair. For example, pilots grounded for conditions such as coronary artery disease, anxiety, or vision disorders are often required to undergo multiple tests and examinations not covered by insurance to prove they are well enough to fly—even after undergoing the treatments or procedures their physicians deemed sufficient to restore health. 

“When a pilot gets grounded, they may be on the ground for 18 to 24 months, often without a clear idea of where they are in the certification process,” says MITRE’s Kunal Sarkhel, an expert in artificial intelligence and hazard identification. “Meanwhile, they’re not earning a salary. That provides a disincentive to getting care and reporting their condition.” 

The FAA understands the need for change and has begun the work of bringing its certification processes into greater alignment with advances in medicine, technology, and risk management. In doing so, the FAA needs to keep the safety of the National Airspace System paramount. At the same time, the agency is taking pilot concerns into account. 

All affected parties agree it’s time for a fresh approach—one that supports pilot health while maintaining the highest levels of safety for all who fly. The FAA asked MITRE, operator of its federally funded R&D center, to lead a collaborative research effort to achieve that goal. 

MITRE Promotes a Whole-System Approach

Building on our previous work in an FAA rulemaking committee that provided recommendations on aeromedical certification for mental health conditions, MITRE assembled a government-industry group to explore opportunities to improve the entire certification process. It’s called the Aeromedical Certification Collaborative (ACC).

“The FAA plays the primary role in re-envisioning the system, but they recognize that the airlines, pilot associations, and medical professionals can contribute in important ways as well,” says Ted Sienknecht, ACC task lead. “By bringing them together, we can take a whole-system view to identify the problems and create innovative solutions.” 

This is an area where MITRE excels. 

“We’re an independent, conflict-of-interest-free connector,” says Sarkhel, who is overseeing the research. “We’ve built credibility over many years that we can help groups with diverse interests come to agreement on what to work on and how to do it.” 

“We’ve done that for dozens of collaboratives serving the public interest,” adds Sienknecht. “Key to our success is the MITRE Assemble™ workflow, which accelerates the collaborative’s delivery of value by helping us managing everyone’s interests fairly, protecting the data they share, and fostering a safe space for collaboration.”

Collaborative Sets Its Sights on Creating a Worldwide Standard

The ACC met for the first time in March. “We asked the partners to co-design a system that supports pilots’ proactive health and career interests while ensuring safety,” Sienknecht says.  

The ACC is aiming high. 

“Within five years, the group wants to make the FAA a global leader in aeromedical certification,” Sarkhel says. “Their goal is to evolve existing policies and procedures to meet the needs of both the FAA and the industry, and to use data to allow for a risk-based approach to medical clearances and certification.”

“We want to have the healthiest pilots in the cockpit and lead the world in safety risk management,” adds Sienknecht. 

The ACC has started by identifying the research studies they believe would yield high potential value. At the top of the list are mental health issues. 

Despite medical advances in the treatment of depression and ADHD, both conditions keep pilots from flying. A 2023 Gallup poll suggested that 29% of Americans have been diagnosed with depression in their lifetimes and that the incidence of depression is increasing. “That has implications for aviation, since pilots are just as susceptible to depression as anyone else,” Sarkhel notes. 

Data-Driven Approach Seen as Crucial 

MITRE sees data as vital to the medical certification system’s transformation.  

“The FAA lacks data illuminating the extent to which medical conditions pose risks to flight safety performance,” Sienknecht explains. “As a result, there’s an urgent need for an evidence-based approach to aviation safety risk management.” 

“We know through our experience with an existing FAA-industry aviation safety data sharing and analysis initiative that such an approach can enhance overall aviation safety,” adds Sarkhel, “so we’re looking at several possible data sources that could provide insights into the safety risks associated with specific conditions or medications.” 

Innovative Partners Sought 

“The collaborative has just begun its work, but we’re off to a great start,” Sarkhel adds. “A mental health workgroup has formed to explore potential studies and we’ll reconvene the entire ACC soon to further develop our research plan.” 

In the meantime, the FAA and MITRE are open to expanding the effort even further. 

“We’re looking for innovators, organizations willing to provide us with relevant data, and research partners,” Sienknecht says. “If you’re willing to collaborate on tough problems, we want to talk with you.” 

For more information, view the Aeromedical Certification Collaboration site.