Aeromedical Advisor Offers Health Advice on ALPA Podcast

During a recent episode of the Air Line Pilot Podcast, Capt. Jason Ambrosi, ALPA’s president, talked with Dr. Quay Snyder, president and CEO of the Aviation Medicine Advisory Service (AMAS), the union’s Aeromedical Office, and the Association’s aeromedical advisor. The two discussed how, since 1969, the office has provided one of the most valuable benefits available to ALPA members by helping them stay healthy and maintain their medical certification. Listen now on your favorite podcast platform or keep reading for an abbreviated excerpt.

Ambrosi: Tell our listeners a little about AMAS and what you do for ALPA members.

Snyder: AMAS is a team of 14 physicians and 12 nurses—with a total staff of about 38—whose full-time job is to respond to pilots and assist them with medical certification issues, reporting questions, and to serve as their advocate between the FAA, their aviation medical examiner [AME], and their private physicians. We make sure we do everything we can to keep your members healthy, certified, and flying.

Ambrosi: What’s the biggest challenge you face in performing these services?

Snyder: The challenge really falls into two areas. The first is making sure we’re advocating for the pilots in the best manner possible so that they can keep their certificates. Pilots must share this responsibility by making sure they get all appropriate medical records and test results to us.

But what concerns me even more is convincing pilots that taking care of their health is the most important thing they can do. On occasion, we encounter some individuals who are willing to forego medical evaluations or appropriate medical treatments for fear that they might lose their medical certification. In doing so, they’re undermining their health and potentially shortening their careers.

Ambrosi: What’s the most frequently asked question you get when the phone rings?

Snyder: Probably the most frequently asked question is: “Can I take this medication and fly?” and the answer isn’t always “yes” or “no.” The underlying condition is also an important consideration. A pilot might be asking about a medication the FAA actually approves, even though the underlying condition dictates that the pilot isn’t safe to fly.

Ambrosi: You’ve recently mentioned that mental health remains at the forefront of pilot wellness concerns. The FAA continues to introduce significantly liberalized mental-health policy changes. What are the agency’s latest priorities?

Snyder: Most of the new policies and changes are the result of the 2024 Mental Health and Aviation Medical Clearances Aviation Rulemaking Committee [ARC] recommendations. Capt. Travis Ludwig (United), ALPA’s Pilot Assistance Group chair, served as one of the ARC cochairs. The group presented 24 recommendations, which were very specific about the actions that should be taken, and the FAA was charged with implementing them to the best of its ability.

The FAA has done a wonderful job as far as addressing the low-hanging fruit, given the regulatory process and the resources it has. Certainly, the most recent government shutdown complicated the process and delayed the agency’s action on some of the issues.

We’re getting rid of the barriers, the stigma, and the financial challenges created by the old ways of looking at pilot mental-health issues, and ALPA has played a huge role in that. I’ll say that the FAA has been receptive. There are some limitations given the politics, the resources, and the existing regulations, but my feeling is that U.S. Federal Air Surgeon Dr. Susan Northrup and her staff are fully committed to making positive changes.

Ambrosi: That’s certainly good to hear. Another aspect of this positive change has been the Mental Health and Aviation Act that ALPA continues to champion. While the bill is still before Congress, what’s your impression at this point?

Snyder: I think it’s an important piece of legislation. It’s passed through the House of Representatives and sits with the Senate right now, and there seems to be strong support within the Senate for it. ALPA has certainly been a strong proponent, but the legislation’s proposed actions exceed those of the ARC recommendations.

The bill also provides resources to the FAA for additional AME training, for promoting the many mental-health changes that have been made to date, and for making clear the medications that pilots can take when they fly.

New medications are being introduced nearly every day, so it continues to be quite a challenge for the FAA to maintain an appropriate list that gives complete guidance to pilots.

Ambrosi: Pilots complain about the time it takes to process medical certifications, especially in the case of special issuances. I know it’s a priority for the FAA to expedite this process and improve how the system works, but where are we at this point? What steps can pilots take to try to make the certification process easier and quicker?

Snyder: For the FAA, this is a shared responsibility with the pilots, and Dr. Northrup has run a very public campaign about preflighting your medical exam. She points out that as aircraft owners and pilots, we go through checklists all the time before we take our flights. However, many pilots don’t apply that same level of diligence before taking physicals, despite the very clear guidance about what’s required.

The process is outlined in the Guide for Aviation Medical Examiners, and if pilots are fully prepared to address all the conditions they have and the medications they’re taking—in other words, all their reporting responsibilities for the physical as well as the appropriate documentation—certification should sail through smoothly.

The FAA has made great strides, and recently Dr. Northrup told us that the turnaround times for deferred medical certificates—those the AME can’t issue—is less than 30 days if all required documents are provided. In addition, the FAA put a team together to accelerate the review process. The updated Guide for Aviation Medical Examiners has subsequently delegated a lot of the decision-making that used to be at the FAA or medical-certification-division level to the AME.

Ambrosi: What do pilots need to know about GLP-1 weight-loss drugs to keep their medical certificates current?

Snyder: Pilots need to know that most of the GLP-1 medications are authorized by the FAA right now according to a CACI [Conditions AMEs Can Issue] protocol. Pilots also need to be aware that a substantial portion of the weight loss comes from muscle. Consequently, they need to increase their protein intake and engage in high-resistance activity to minimize any muscle loss. Pilots also need to keep in mind that it they start taking the medication, there’s a grounding period of two weeks—and possibly longer if they’re experiencing adverse side effects.

Ambrosi: If you could share a single recommendation to help pilots stay healthy, what would it be? Do 10,000 steps a day really make a difference? What would you say?

Snyder: If you’re getting 10,000 steps a day, that’s a great start; but I’d say, overall, look at the bigger picture—are you getting enough sleep, do you eat right, and are you routinely exercising?

Don’t ignore your health. If you have symptoms or there’s anything you’re concerned about, immediately seek the help you need, and don’t be afraid of losing your medical certificate. If anything, be afraid of compromising the longevity of your quality of life.

Ambrosi: How do pilots pick their AMEs? Many might be inclined to choose the quickest one who gets the pilot in and out, and who doesn’t ask too many questions—versus somebody who might be a little more engaged and inquisitive.

Snyder: That’s a very important question because pilots’ careers depend upon their ability to hold medical certificates. You wouldn’t go to an accountant who only glances at your taxes or an auto mechanic who always shortcuts car repairs. You need to look at your AME the same way. Find one who’s knowledgeable and willing to sit down and listen to you—someone who has regular contact with the FAA.

Choose an AME who has a positive reputation and a strong work ethic. An AME with a good knowledge of current FAA policies is worth their weight in gold and is well worth your career. Keep in mind that AMAS can make recommendations.