AircraftOwner Online

Many pilots ask what the different criterions are for First, Second, and Third Class Pilot Medical Certificates. Interestingly, there are not very many. In fact, for healthy individuals, there are basically three—vision standards, the electrocardiogram (EKG) requirement, and the frequency of the exams.

The main purpose of the pilot medical exam is to predict sudden medical incapacitation. Since the world wide medical community has never been successful predicting incapacitation or death, the FAA does not have a chance. Thus, the medical exam is really a method of screening out pilots who have already had medical issues.

First Class Medicals are required for the pilot in command of a scheduled airline or in other words, a pilot exercising the privileges of an airline transport rating. A Second Class Medical is required for pilots who fly aircraft for hire including passenger transport but not on a scheduled basis, thus exercising commercial pilot privileges. This also includes freight dogs and sprayers. Third Class is for pilots who are not being paid for any
pilot services.

First Class Medicals are good for one year for pilots under age 40 and six months for pilots over 40. Second Class Medicals are good for one year regardless of age. Third Class Medicals are good for five years for those under 40 and two years for those above 40.

The distant vision required for First and Second Class is 20/20 in each eye with or without correction but Third Class only requires 20/40 in each eye with or without correction. Near vision is the same for all classes—20/40 corrected or uncorrected. However, for First Class Medicals, pilots over 50 have to have 20/40 corrected or uncorrected vision at the intermediate range o f 32 inches while there are no intermediate requirements for the other class medicals.

The only other difference between medicals is the requirement for resting electrocardiograms for First Class Medical Certificates for pilots once at 35 years of age and annually starting at 40. This rule dates from an age when EKGs were the only objective way to evaluate the heart and the requirement persists only because no one has the guts to stop it. Resting EKGs have no predictive value for sudden incapacitation. Stress (otherwise known as treadmill) electrocardiograms are far better. However, stress tests are more expensive and require more time. The FAA has yet to move to require stress testing and probably never will due to all the flak it gets for requiring anything that costs more money and time.

An interesting fact is although First Class Medical certificates are the most stringent, sudden incapacitation has not been an issue given almost all circumstances where a First Class Certificate is required also requires a second crew member. The most risky area for medicals may actually be a Second Class pilot who may be flying single pilot charters without the benefit of crew time limits and other organized labor efforts.

The number of medical related accidents is so small that there have been proposals to drop the medical requirement for Third Class similar to the Sport Pilot situation which does not require medicals. My prediction is that once Sport Pilot has ten or so years under its belt, the medical related accident rate will be similar to the third class private pilot experience and may spur the FAA to drop requirement for Third Class Medicals completely.

We now have a more “enlighten” aeromedical certification group in Oklahoma City, so only a minute portion of pilot applicants with medical problems that are turned down permanently. There are various hoops to jump through and more stringent testing requirements for pilots with health for First and Second Class Medicals than Third, but in the end, most pilots get their medical back.

One brief note about drug testing-- The FAA only looks at urine glucose and protein during a FAA physical. However, for Second and First Class, the DOT requires drug testing on a random basis. The logistics of this testing can be nightmarish so many single pilot and other small operations use third parties to administer their drug test “program.” I do not see this changing anytime soon so if you are flying for hire, avoid those trips to Amsterdam!