An aviation medical examiner (AME) is a physician designated by the FAA to perform medical examinations on pilots and issue the medical certificates required to fly. Every pilot who needs an FAA medical certificate must visit an AME rather than a regular doctor. These physicians hold standard medical licenses but have completed additional FAA-specific training that qualifies them to evaluate whether a pilot meets the physical and mental standards outlined in federal aviation regulations.
What an AME Actually Does
An AME’s core job is conducting pilot medical exams and deciding whether to issue, defer, or deny a medical certificate based on FAA standards laid out in 14 CFR Part 67. During a typical visit, the AME checks your vision, hearing, blood pressure, heart function, neurological status, and overall physical condition. They also review your medical history, medications, and any past surgeries or hospitalizations.
If everything checks out, the AME issues your medical certificate on the spot. If you have a condition that could be disqualifying, such as a history of heart disease, seizures, or certain mental health conditions, the AME cannot simply approve you. Instead, they defer your application to the FAA’s Aerospace Medical Certification Division, which makes the final call. In some cases, the FAA grants what’s called a Special Issuance, which is essentially a medical certificate with conditions attached. Once you’ve been granted a Special Issuance for a particular condition, your AME can reissue your certificate at future visits as long as you continue meeting the clinical criteria and provide the required documentation from your treating physicians.
Every decision an AME makes is subject to FAA review. They act as a designated representative of the agency, not as an independent authority.
Senior AMEs vs. Regular AMEs
Not all AMEs have the same authority. There are two tiers: regular AMEs and Senior AMEs. A regular AME can conduct exams and issue second-class and third-class medical certificates only. To get a first-class medical certificate, the kind required for airline transport pilots, you need to see a Senior AME. The Senior designation is a smaller, more selective group. Historically, the ratio has been roughly one Senior AME for every three or four regular AMEs in the system.
If you’re a student pilot or a private pilot, any AME will do. If you’re working toward or already hold an airline transport pilot certificate, make sure the AME you book is designated as a Senior AME.
How a Physician Becomes an AME
Any state-licensed physician can apply for AME designation, but the process involves FAA approval and specialized training. After being appointed by the FAA’s Regional Flight Surgeon, a new AME must attend a week-long Basic AME Seminar, typically held in Oklahoma City. This seminar covers aviation-specific medical standards, the certification process, and the regulatory framework the AME will work within.
Maintaining the designation requires ongoing education. AMEs must complete refresher training every 36 months, which can be done through an online course called MAMERC if they’ve attended an in-person seminar within the previous three years. Regardless of online training, attendance at a full AME seminar is required at least every six years. This training counts toward the physician’s continuing medical education credits.
Three Classes of Medical Certificates
AMEs issue three classes of medical certificates, each tied to different pilot privileges. The higher the class, the stricter the medical standards and the shorter the validity period.
- First-class: Required for airline transport pilots. Valid for 12 months if you’re under 40, or 6 months if you’re 40 or older.
- Second-class: Required for commercial pilots. Valid for 12 months regardless of age.
- Third-class: Required for private and recreational pilots. Valid for 60 months (5 years) if you’re under 40, or 24 months if you’re 40 or older.
Here’s a detail many pilots miss: a higher-class certificate automatically covers the privileges of lower classes, but the validity periods shift accordingly. For example, if you hold a first-class certificate and you’re over 40, it functions as a first-class certificate for only 6 months, then downgrades to second-class privileges for the next 6 months, and then covers third-class privileges for an additional 12 months before expiring entirely. All validity periods are measured from the end of the month in which the exam took place.
BasicMed as an Alternative
Since 2017, not every pilot needs to visit an AME. BasicMed is a congressional program that lets certain pilots fly without holding a traditional FAA medical certificate. Under BasicMed, you visit any state-licensed physician (not necessarily an AME), complete a physical using the FAA’s Comprehensive Medical Examination Checklist, and then pass an online medical education course.
BasicMed comes with significant limitations, though. You can only fly aircraft with a maximum takeoff weight of 12,500 pounds or less, carrying no more than six passengers. Flights must stay at or below 18,000 feet, at speeds of 250 knots or less, within the United States, and cannot be for compensation or hire. You also need to have held at least one FAA medical certificate issued after July 14, 2006, and possess a valid U.S. driver’s license.
Certain medical conditions require you to obtain at least one Special Issuance through the traditional AME process before you can fly under BasicMed. These include a history of psychosis, bipolar disorder, substance dependence within the past two years, epilepsy, unexplained loss of consciousness, heart attack, coronary heart disease requiring treatment, cardiac valve replacement, and heart replacement. Congress updated the BasicMed rules in the FAA Reauthorization Act of 2024, so the specifics may continue to evolve.
How to Find an AME
The FAA maintains a searchable directory of designated AMEs on its website, filterable by location and designation level. When choosing an AME, check whether they’re designated as a Senior AME if you need a first-class certificate. Many pilots also prefer AMEs who have aviation experience themselves, since they tend to understand the practical implications of medical findings and can be more helpful in navigating the Special Issuance process if a deferral comes up.
Pricing varies by examiner and region, and the exam is typically an out-of-pocket expense not covered by health insurance. A straightforward third-class exam generally runs between $100 and $200, while first-class exams with additional testing can cost more. Call ahead to confirm fees and what to bring, especially if you have a medical history that might complicate the process.