The special issuance process may require additional  medical information and evaluations from, for example, a primary care  physician or medical specialist. However, FAA officials have said that  they do not convene such roundtables frequently due to time and cost  constraints. FAA developed the program by identifying medical conditions that,  in most cases, did not pose a safety risk, based on FAA analysis of  historic medical and accident data. Agency officials expect the program to  allow more applicants to be certified at the time of their AME visit while  freeing resources at FAA to focus on medically complex applicants with  multiple conditions or medical conditions that may pose a greater risk to  flight safety, such as applicants who have had coronary artery bypass  surgery. FAA authorization for a special issuance that they believe should be  considered under the CACI program. FAA Has Identified Technical Solutions to Improve Its Medical Certification Systems, but Has Not Set Time Frames for Implementation

Although most medical certification determinations are made by one of  the approximately 3,300 FAA-designated AMEs at the time of an  applicant’s medical exam, approximately 10 percent of applications—or  nearly 40,000 annually—are deferred to FAA for further medical  evaluation if the applicant does not meet FAA’s medical standards or has  a disqualifying medical condition. According to FAA officials, the 10  percent of applicants who are deferred requires a significant amount of  resources from FAA’s medical certification division, which in recent years,  has experienced a backlog of special issuance applications in need of  review. Accordingly, technical  working groups at AMCD have identified more than 50 problems and  potential technological solutions to enhance their systems, including the  special issuance processes, of which about 20 have been identified as  high-priority, including improvements to the online application system,  AMCS, DIWS, and the ECG transmittal and review process. A timeline  to guide the implementation of the highest-priority enhancements would  help the agency take another step toward reducing the delays and  bottlenecks in the special issuance process related to FAA’s technology  issues. FAA Could Enhance its Online Application System and the Clarity of its Medical Application Form for Private Pilots

		FAA Could Enhance Usability of its Online Medical Application System

One of FAA’s main tools to communicate its medical standards directly to  applicants, and to solicit medical information from them, is its online  medical application system. In addition, two pilot associations stated that a specific Web  page or website for applicants with links to information on various medical  conditions, their risks to flight safety, and additional medical evaluations  that might be needed for applicants with those conditions would be  helpful. 2). More specifically, FAA’s Writing Standards also recommend using active  voice and active verbs to emphasize the doer of the action. Conclusions

Aerospace medical experts we interviewed generally agreed that FAA’s  current medical standards are appropriate and supported FAA’s recent  effort to authorize its AMEs to certify a greater number of applicants by  using a data-driven approach to assessing risk through the CACI  program. FAA has identified approximately 50 potential technological  enhancements to its computer systems that support its certification  process, including adding new functionality to facilitate the process and  provide applicants with more information about medical requirements. Efforts to  provide applicants with useful and relevant information and improve the  clarity of the questions and instructions contained in the online application  system and form could allow FAA to more clearly communicate medical  requirements to applicants. These improvements could not only aid an  applicant’s understanding of the medical standards and requirements, but  also may result in more accurate and complete information provided by  applicants to better inform FAA’s certification decisions. Recommendations for Executive Action

To improve the applicants’ understanding of the medical standards and  the information required to complete FAA’s medical certification process,  the Secretary of Transportation should direct the Administrator of FAA to  1.  develop a timeline for implementing the highest-priority technological  improvements to the internal-computer systems that support the  medical-certification process, and  2.  enhance the online medical-application system by clarifying  instructions and questions on the medical application form and  providing useful information to applicants. Contact information and major contributors  to this report are listed in appendix V.

Appendix I: Objectives, Scope, and Methodology

The objectives of this report are to provide information on (1) FAA’s  medical standards and policies and certification processes, along with  medical experts’ views on them, and (2) steps that could be taken to  promote private pilot applicants’ understanding of FAA’s medical  requirements, including potential revisions to the medical application  form. To obtain expert opinions on FAA’s medical standards,  we collaborated with the National Academies’ Institute of Medicine to  identify aviation medical experts. We reviewed the Pilots Bill of Rights  Notification and Terms of Service Agreement, Form 8500-8 (medical  application form) and instructions, and links within the online application  system, evaluating that information against federal government website- usability guidelines and against FAA’s plain language guidelines.
Why GAO Did This Study

FAA developed its medical standards and pilot's medical-certification process to identify pilot applicants with medical conditions that may pose a risk to flight safety. The Pilot's Bill of Rights (P.L. 112-153) mandated GAO to assess FAA's medical certification standards, process, and forms.
This report addresses: (1) FAA's medical standards, policies, and certification processes, along with medical experts' views on them, and (2) steps that FAA could take to promote private pilots' understanding of its medical requirements. GAO reviewed statutes, regulations, FAA documents, and interviewed officials from FAA, NTSB, pilot associations, and 20 aviation medical experts primarily identified by the National Academies' Institute of Medicine. Experts were selected based on their type and depth of experience, including recognition in the aerospace-medicine professional community. GAO also interviewed FAA's medical certification division and evaluated the usability of FAA's online application system and the clarity of its application form against federal writing guidelines and best practices in website usability.

What GAO Found

Aerospace medical experts GAO interviewed generally agreed that the Federal Aviation Administration's (FAA) medical standards are appropriate and supported FAA's recent data-driven efforts to improve its pilot medical-certification process. Each year, about 400,000 candidates apply for a pilot's medical certificate and complete a medical exam to determine whether they meet FAA's medical standards. From 2008 through 2012, on average, about 90 percent of applicants have been medically certified by an FAA-designated aviation medical examiner (AME) at the time of their medical exam or by a Regional Flight Surgeon. Of the remaining applicants, about 8.5 percent have received a special issuance medical certificate (special issuance) after providing additional medical information to FAA. Approximately 1.2 percent were not medically certified to fly. According to an industry association, the special issuance process adds time and costs to the application process, in part, because applicants might not understand what additional medical information they need to provide to FAA. Officials from FAA's medical certification division have said that technological problems with the aging computer systems that support the medical certification process have contributed to delays in the special issuance process. FAA's medical certification division has identified about 50 potential technological enhancements to its internal computer systems that support the medical certification process, of which about 20 have been identified as high priority, but the division has not yet implemented them or developed a timeline to do so. By developing a timeline to implement the highest-priority enhancements, FAA would take another step toward expediting the certification process for many applicants hoping to obtain a special issuance. FAA recently established a datadriven process using historic medical and accident data that authorizes AMEs to certify a greater number of applicants with medical conditions who had previously required a special issuance. Officials expect this effort to allow more applicants to be certified at the time of their AME visit and to free resources at FAA to focus on applicants with higher-risk medical conditions.
GAO's analysis and medical experts' opinions indicate that FAA could improve its communication with applicants by making its online application system--part of FAA's internal computer systems discussed above--more user-friendly and improving the clarity of the medical application form. Specifically, GAO found that the online application system requires applicants to scroll through a lengthy terms-of-service agreement and does not provide clear instructions, and that the application form contained unclear questions and terms that could be misinterpreted by the applicant. FAA could enhance its online application system by using links to improve navigability of the system and providing information that is more useful to applicants--for example, links to information about the risk that specific medical conditions pose to flight safety and any additional medical information applicants with those conditions would need to provide to FAA. FAA could also improve the clarity of its medical application form by incorporating guidelines established in FAA's Writing Standards, including shorter sentences and paragraphs, active voice, and clear terms and questions. These clarifications could not only aid an applicant's understanding of the medical standards and requirements, but also may result in more accurate and complete information provided by applicants to better inform FAA's certification decisions.

What GAO Recommends

GAO recommends that FAA (1) develop a timeline for implementing high-priority technological improvements to the internal computer systems that support the medical certification process, and (2) enhance the online medical-application system by clarifying instructions and questions on the form and providing useful information. The Department of Transportation agreed to consider the recommendations.