Aviation Medical Examiner (AME): Exam, Classes, and BasicMed

An Aviation Medical Examiner, or AME, is a private physician the Federal Aviation Administration has designated to perform the exam pilots must pass to hold a medical certificate. Every pilot medical certificate in the United States is issued through one of these doctors, not through the FAA directly. If you need to fly legally, at some point you sit in an AME’s office.

The Three Medical Certificate Classes

The FAA issues three classes of medical certificate, and the class you need depends on the flying you plan to do. Airline transport pilots need a First-Class. Commercial pilots need a Second-Class. Private, recreational, and student pilots need a Third-Class.¹ Higher classes carry stricter standards and shorter renewal intervals.

How long your certificate stays valid depends on both the class and your age on exam day:

First-Class for ATP privileges: 12 months if you were under 40, 6 months if you were 40 or older.²
Second-Class for commercial privileges: 12 months at any age.²
Third-Class for private pilot privileges: 60 months if you were under 40, 24 months if you were 40 or older.²

A higher-class certificate steps down as it ages. Once a First-Class certificate passes its ATP validity window, it can still act as a Second-Class or Third-Class certificate until those longer windows close. Your First-Class can lapse for airline duty while you keep flying commercially or privately on the same piece of paper.

Standard Versus Senior AME

Not every AME can issue every certificate. A standard AME handles Second-Class and Third-Class exams. First-Class exams for airline transport pilots require a Senior AME.³

Senior designation reflects a higher level of FAA trust and generally requires at least three years of acceptable performance conducting Second-Class and Third-Class exams before it is granted, though the Regional Flight Surgeon can waive that waiting period for physicians with military flight surgeon experience, aerospace medicine training, or prior AME credentials.⁴ The Senior AME must be able to interpret and submit electrocardiograms, which First-Class applicants need at the first exam after turning 35 and annually after 40.⁵ The practical takeaway is simple: if you need a First-Class, book with a Senior AME specifically.

What Happens at the Exam

Before you walk into the office, you complete an online application through MedXPress, the FAA’s electronic filing system.⁶ It asks for your full medical history: diagnoses, hospitalizations, surgeries, and every current medication. Answer honestly. The FAA cross-references your disclosures against outside databases, and an inconsistency found later can lead to certificate revocation or enforcement action.

In the office, the examiner runs a physical covering vision, hearing, cardiovascular health, neurological function, and general fitness. Tests scale with the certificate class. First-Class applicants get the most rigorous screening, including the ECG schedule described above.⁷ The AME is looking for conditions that could cause sudden incapacitation in the cockpit: uncontrolled heart disease, seizure disorders, substance dependence, and similar risks.

The findings go electronically to the FAA’s Aerospace Medical Certification Division. If you meet the standards, many AMEs can hand you a certificate on the spot. If something raises a concern, the AME will typically defer your application to the FAA for further review rather than issue a denial.

Medications That Can Stop the Exam

Medication is where most pilots run into trouble. The FAA maintains two lists every AME must check: the Do Not Issue list and the Do Not Fly list.⁸

If you take a medication on the Do Not Issue list, the AME cannot give you a certificate. That list includes nitrates for angina, most psychiatric medications, seizure drugs (even if prescribed for migraines), centrally acting blood pressure medications like clonidine, cancer treatments, and all controlled substances including medical marijuana regardless of state legality.⁸

The Do Not Fly list covers medications you might take occasionally that impair cognition or reaction time: sedating antihistamines like diphenhydramine, muscle relaxants, narcotic pain relievers, sleep aids, and anti-anxiety drugs like alprazolam. Certain over-the-counter supplements such as kava and kratom are on the list too.⁸ Beyond the lists, any medication with a label warning about drowsiness or impaired driving is treated as incompatible with flying.

A few SSRI antidepressants can be approved through a special protocol, and some Do Not Issue conditions have pathways through the Special Issuance process. But the default answer for these medications is no.

If You Are Deferred or Have a Disqualifying Condition

An AME deferral is not a final FAA decision. You can request reconsideration by writing to the Aerospace Medical Certification Division in Oklahoma City, and cases may be referred to a Regional Flight Surgeon and, if still unfavorable, on to the Federal Air Surgeon.⁹

Many conditions that fail the standard rules can still lead to certification through a Special Issuance authorization. You have to demonstrate to the Federal Air Surgeon that you can safely perform pilot duties despite the condition for the length of the certificate.¹⁰ The first authorization has to come from an FAA physician; your AME cannot grant it initially.

Renewals often become simpler through the AME Assisted Special Issuance program. Under AASI, your AME can reissue your certificate at later exams as long as you bring the required documentation from your treating physician and your condition has not changed.¹⁰ Conditions eligible for AASI include coronary heart disease, Type II diabetes controlled with oral medication, sleep apnea, atrial fibrillation, treated hypertension, and many cancers in remission.¹¹

For static, nonprogressive conditions, the FAA may instead issue a Statement of Demonstrated Ability. A SODA does not expire.¹² Once granted, your AME can issue a certificate at future exams as long as the described condition has not worsened. The Federal Air Surgeon may attach operational limitations. This route is typical for stable vision deficits or limb impairments where you can show through a practical test that you can safely handle the aircraft.

Your Duty Between Exams

A valid certificate is not a blanket permission slip. Federal regulation prohibits you from acting as pilot in command if you know of a medical condition that would prevent you from meeting your certificate requirements, or if you are taking a medication that would have that effect.¹³ The rule applies to every class and it applies between exams. Develop a new condition or start a new medication the day after passing your AME exam, and you are expected to ground yourself until it is resolved.

BasicMed as an Alternative

Since 2017, many private pilots have been able to skip the AME process entirely by flying under BasicMed. Instead of an FAA medical certificate, you see any state-licensed physician for a physical using an FAA checklist and complete an online medical education course.¹⁴

BasicMed is not open to everyone. You must hold a valid U.S. driver’s license and must have held an FAA medical certificate issued after July 14, 2006, at some point.¹⁵ If your most recent certificate was denied or revoked, availability depends on the reason. Pilots with a history of certain mental health disorders, neurological conditions like epilepsy, or serious cardiovascular events such as a heart attack must have completed the Special Issuance process for those conditions before using BasicMed.¹⁶

The tradeoff is significant operating limits. Under BasicMed, you can fly aircraft with a maximum certificated takeoff weight of 12,500 pounds or less, carry no more than six passengers, and must stay at or below 18,000 feet MSL and 250 knots, within U.S. airspace.¹⁵ BasicMed does not substitute for a Second-Class or First-Class certificate, so commercial and airline pilots still need the traditional AME exam.

Finding an AME and What It Costs

The FAA maintains a searchable AME locator at faa.gov/pilots/amelocator.³ Each listing shows whether the physician holds a standard or Senior designation, along with contact information and languages spoken by the staff. Verify current status through the locator before scheduling, since designations can lapse if an AME misses training or activity requirements.

The FAA does not set or regulate exam fees. AMEs may charge amounts comparable to what they would charge for a similar physical for other purposes.¹⁷ Prices vary by location and examiner, and First-Class exams typically run higher than Third-Class exams because of the extra testing. Call ahead and ask.

1
Federal Aviation Administration. Guide for Aviation Medical Examiners – Standards
2
eCFR. 14 CFR 61.23 Medical Certificates Requirement and Duration
3
Federal Aviation Administration. Find an Aviation Medical Examiner (AME)
4
Federal Aviation Administration. FAA Order 8520.2G
5
Federal Aviation Administration. When Is an ECG Required
6
Federal Aviation Administration. MedXPress Users Guide
7
Federal Aviation Administration. Guide for Aviation Medical Examiners – Item 58 ECG
8
Federal Aviation Administration. Pharmaceuticals (DNI/DNF)
9
Federal Aviation Administration. Guide for Aviation Medical Examiners – Request for Reconsideration
10
Federal Aviation Administration. Guide for Aviation Medical Examiners – Authorization for Special Issuance of a Medical Certificate and AME Assisted Special Issuance (AASI)
11
Federal Aviation Administration. AASI for All Classes
12
Federal Aviation Administration. Statement of Demonstrated Ability (SODA)
13
eCFR. 14 CFR 61.53 Prohibition on Operations During Medical Deficiency
14
eCFR. 14 CFR Part 68 Requirements for Operating Certain Small Aircraft Without a Medical Certificate
15
Federal Aviation Administration. BasicMed
16
eCFR. 14 CFR Part 68 Requirements for Operating Certain Small Aircraft Without a Medical Certificate – Section 68.9
17
Federal Aviation Administration. What Does It Cost to Get a Medical Certificate