Smooth is Fast

By James Williams

There is an idiom that says, “Slow is smooth. Smooth is fast.” The expression was made famous by special operations soldiers to emphasize that slowing down to smooth out the process will paradoxically often lead to a faster end result. As Tolkien said, “the hasty stroke oft goes astray.” Both sayings are very relevant to our medical certification.

So by rushing the process, you may find yourself in a far more frustrating ordeal than is necessary. In fact, the vast majority of medical certificate applications that are not issued are based on a lack of response from the airman with the requested information, not a denial by the FAA.

So, in a very real way, taking some time to slow down and ensure a smooth process could make a huge difference.

Smoothing Out the Process

“There are some very simple things a pilot can do to streamline the process,” explains Federal Air Surgeon (FAS) Dr. Susan Northrup. “First, make sure any documents you submit to the FAA are legible and have your name, a date, and any identification numbers that you may have on them.” She continued, “Make sure all letters, including summaries from physicians, are signed and dated. Ensure that your package includes all information requested by the FAA and keep a copy of what you’ve submitted for your records. Also, make sure your contact information is current in MedXPress.” These tips help any pilot looking for a medical, whether for a renewal or an initial application (for more on what to expect from your first medical exam, see the article “What to Expect From an FAA Medical Exam” here:

Dr. Northrup also has another piece of good advice. “The Guide for Aviation Medical Examiners (AME) is a great resource for pilots to see what the FAA requires to certify a pilot with any given condition.” The Guide for Aviation Medical Examiners is the AME’s manual for the medical certification of pilots. While the AME Guide was written for doctors, it is available to anyone online at ™漋
So if you want to know what your AME is going to be looking for, the guide is a great place to start.

“If you have any questions, or need more help, reach out to your AME, Regional Flight Surgeon (RFS), or one of the pilot advocacy groups that can provide more information,” said Dr. Northrup. If you have a condition listed in the AME guide, you can work with your primary care doctor to make sure that you have current copies of all of the reports and test results. It’s also essential to ensure that any tests ordered are correct, and in the format the FAA needs for certification. When in doubt, your doctor may contact your AME or RFS’s office. This ensures that you don’t have to repeat tests and are ready to be certificated when you walk into your AME’s office. But what if you don’t meet the medical standards?


If you haven’t had a medical certificate before or haven’t had one in a while, you probably don’t know what a CACI is. Conditions AMEs Can Issue (CACI) is a program that allows AMEs to issue medical certificates to pilots that would usually have to be deferred to the FAA so long as they meet specific requirements. That means that you walk out of your AME’s office with a medical certificate without having to wait for the FAA to review and approve your medical. Also, these are regular medical certificates, not Special Issuance certificates, that usually come with limited durations or additional requirements. These conditions include arthritis, asthma, hypertension, migraines, pre-diabetes, several forms of cancer, and more. For a complete list of conditions and the applicable worksheets, visit

Special Issuance, SODAs, and More

If you don’t meet the regular medical standards, there are a few other options. The most common would be a Special Issuance (SI). Broadly, SIs are performed when a pilot doesn’t meet the medical standards. Still, through some alternate means like additional documentation, shorter duration certificates, additional monitoring, or other mitigations, the FAA can issue an SI so the pilot can fly. Unlike a CACI, these medical exams must be initially deferred to the FAA and reviewed by the Aerospace Medical Certification Division (AMCD). Under the AME Assisted Special Issuance (AASI) program, some SI renewals may be handled by selected AMEs without first deferring to the AMCD, assuming specific criteria are met. AASI saves time by not processing on the front end and gets you back to flying status faster. Please see our Jan/Feb 2009 issue for the article “Getting your Special Issuance Medical” for a more detailed look at the SI process.

A Statement of Demonstrated Ability (SODA) is a process that allows a pilot with a static, non-progressive condition that might otherwise be disqualifying to demonstrate that they are capable of operating an aircraft safely despite the disqualifying condition. The scope for a SODA is more limited than an SI, as the condition must be static but is valid until the condition changes or is revoked by the FAA.

This process may require a special medical test flight (this might not actually include a flight) to determine that the pilot can operate safely and what, if any, limitations must be placed on the medical certificate. These tests are requested by the AMCD or RFS and generally carried out by the local Flight Standards District Office (FSDO).

Other means of medical compliance include BasicMed, Sport Pilot, and aircraft operations that don’t require a medical certificate. Each of those categories is an article in its own right, but it’s important to remember that Title 14 Code of Federal Regulations (14 CFR) section 61.53 still applies. This means that you must still ensure that you are fit for flight as pilot in command before each flight.

Regardless of what certification path you end up taking, slowing down to ensure a smooth process will likely deliver the best results. If you think you may have difficulty with the process, check the AME guide to see what the FAA needs. This is especially true if you have a CACI condition.

Work with your personal doctor and AME to make sure everything is in hand, and be sure that’s what the FAA needs to see. If you have questions, ask your AME or RFS. Also, consider contacting a pilot advocacy group. Many have excellent advice for navigating the process.

Remember your medical exam doesn’t start until the AME pulls up the MedXPress application at your office visit, so there’s no penalty for asking questions before that process begins. Hopefully, by knowing what to expect and being ready with any additional information, you can reduce a maddening waiting game of frustration to an easy visit to your AME that ends with a medical certificate in your hand. Even if that isn’t possible, having that additional information in hand and ready to send to the AMCD should reduce the need for time-consuming back and forth. This is where a good AME can make a big difference. 

A smooth and fast certification process is what everyone wants, and hopefully, this helps you get there.

James Williams is FAA Safety Briefing’s associate editor and photo editor. He is also a pilot and ground instructor.

Ryan Mason
Ryan Mason
Ryan is an accomplished writer and aerial photographer that has worked in the aviation industry for over a decade before co-founding AerialFire Magazine. Originally from Melbourne, Australia, Ryan is a former police officer that focuses his writing and photography efforts on para-public operations and agricultural aviation.

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