Original publication date: November 12, 2023
Last Updated: April 26, 2024
Author: Max Skyler
Topic: Flight Physiology
Number of Comments: 0
Among the most important assets that every pilot possesses is their health. Physical fitness is of paramount importance to be a thriving, competent, and successful aviator.
The FAA requires that all pilots must not only successfully pass periodic medical exams in order to earn their license, and to maintain their license in good standing, but that they must also self-assess their mental and physical fitness before each and every single flight.
Physical fitness is without a doubt one of the fundamental tenets of any individual’s ability to exercise the privileges of a pilot license. Stated simply and succinctly: You cannot legally become a pilot if you are not physically fit. Furthermore, even once you have obtained your pilot license, you cannot fly if you are not in optimal physical shape.
Having said that, this begs the question: What is the FAA’s definition of “physical fitness” to fly? What are the criteria, that if you fail to meet them, you would be legally grounded from flying? Would this grounding be temporary? Would this grounding be permanent? Can you be grounded by a FAA medical examiner? A physician? Or can a pilot self-impose grounding upon themself?
Let’s start with the basic fundamentals: What are the physical fitness requirements to become a pilot in the first place?
Are there medical requirements to be a pilot?
All aspiring pilots are required to pass a medical exam as an initial prerequisite to getting their general aviation private pilot license. Furthermore, not only must you pass a medical exam before you can obtain your license, but you must also undergo subsequent medical exams every few years, in order to maintain your ability to legally fly.
The FAA provides a set of medical standards that pilots must adhere to, and which Aviation Medical Examiners (AMEs) must abide by when conducting their exams. (AMEs are doctors who are authorized to conduct medical exams on behalf of the FAA.)
These standards cover a broad swath of an individual’s general health profile, such as vision, hearing, cardiovascular health, and cognitive ability.
What medical certificate do pilots need?
All pilots are required to obtain a medical certificate in order to fly any aircraft, with the exception of those who choose to fly only ultralights.
Medical certificates come in different classes. Depending on the type of flying you intend to perform, you will need a different classification of medical certificate.
As of this writing, the FAA offers four different classes of medical certificates:
- 1st class
- 2nd class
- 3rd class
- BasicMed
Each of these classes is awarded based upon increasingly more stringent medical requirements than the next lower class. Let’s examine each of these:
What is a 3rd class FAA medical certificate?
All aspiring private pilots must obtain either a 3rd class medical certificate, or they must meet the requirements for BasicMed.
The 3rd class medical certificate is the lowest of the three classes, or tiers, of medical certification issued by the FAA.
What class medical certificate is required for a private pilot to act as PIC?
Both student pilots and private pilots are required to have a current, non-expired 3rd class medical certificate, in order to act as pilot-in-command (PIC) of an aircraft.
Technically a student pilot may start their flight training with an instructor without a medical certificate, but they would be required to obtain one before being authorized to fly solo.
As far as the requirements for obtaining a 3rd class medical certificate below, the criteria for vision and hearing are the primary differentiators between this and the other classes of medical certification. More on the specifics of these will be covered later in this resource guide.
What is the difference between Basic Med and FAA medical certifications?
In lieu of the 3rd class medical certificate, the FAA offers an alternative medical certification option, known as BasicMed. The medical requirements in order to be cleared to fly legally under BasicMed are less stringent than those of the 1st, 2nd, or 3rd class medical certificates.
Unlike the other medical certificate classes, which require you to undergo a comprehensive medical exam administered by an AME, BasicMed allows you to be seen by any general physician of your choice. The physician may conduct a general routine physical exam, after which they would be required to fill out a BasicMed form, attesting to your physical fitness to fly.
Along with that, pilots intending to fly under BasicMed are required to take an online, self-paced medical self-assessment course. This course is currently offered by two agencies:
| BasicMed Online Course Options | Course Link |
| AOPA | https://basicmedicalcourse.aopa.org |
| MayoClinic | https://basicmed.mayo.edu |
BasicMed is intended to bridge the gap and make general aviation accessible to more people who otherwise might have been disqualified from flying due to an underlying medical condition. There is a tradeoff, and flying with BasicMed does come at a price:
There are limitations imposed on pilots flying under BasicMed as opposed to one of the other three classes of medical certification, which the FAA succinctly outlines on their website:
| Aircraft Requirements For BasicMed | Operating Requirements For BasicMed |
| You may not pilot an aircraft equipped for carrying more than 6 passengers. | As the pilot, you may not carry more than 5 passengers with you on the aircraft. |
| You may not pilot an aircraft that has a maximum certified takeoff weight of more than 6,000 pounds. | You may not fly in Class A airspace (18,000 feet above sea level or higher). |
| You may not fly faster than 250 knots. | |
| You may not fly for compensation or hire. | |
| You may not fly outside of the USA to another country where BasicMed is not officially recognized. (Only Mexico and the Bahamas recognize BasicMed as of this writing. Canada does not recognize BasicMed.) |
How long is a pilot medical certificate good for?
Each class of medical certificate is issued with a different validity period. Once the validity period expires, the pilot’s medical certificate is automatically “downgraded” to the next lower class. This allows the pilot to continue flying, but with restrictions imposed upon them. To reinstate their existing class of medical certificate, they would need to undergo an updated medical exam.
| Medical Certificate | Type of Flying | Validity Period |
| 1st Class | Airline Transport Pilot | 6 months – for ages 40+ 12 months – for ages 16-40 |
| 2nd Class | Commercial Pilot | 12 months |
| 3rd Class | Private Pilot | 5 years – if less than 40 years at the time of medical exam 2 years – if 40+ years old at the time of medical exam |
| Basic Med | Private Pilot | Medical exam required every 48 months Online medical course required every 24 months |
What is the difference between Class 1 and Class 2 medical certificates?
Both the 1st class and 2nd class medical certificates allow pilots to fly commercially for compensation or hire.
The medical criteria for successfully achieving either certifications are fundamentally identical. The vision, hearing, cardiovascular, mental, and other health standards are all the same between the two.
The primary difference between the two is in terms of the frequency of the medical recertifications required.
What is the difference between Class 2 and Class 3 FAA medical?
Whereas class 1 and class 2 medical certificates are required in order for you to fly for compensation or hire, class 3 medical certificates do not.
That being the case, the medical requirements to obtain a class 3 medical certificate are less stringent than those of class 1 and class 2 medical certificates.
First and foremost, the class 3 medical certificates are valid for a longer period of time before they expire.
There are slight differences in vision acuity standards and the need for an EKG for class 1 medical certificates. But as you can see per this chart below, published by AOPA, the medical standards are fundamentally the same:
COMPARISON OF CLASSES OF MEDICAL STANDARDS
| Medical Certificate | Class I | Class II | Class III |
| Type Pilot | Airline Transport | Commercial | Private, Student,Recreational |
| Duration | 6 months if age 40 or older;12 months if under age 40 | 12 months | 2 years if age 40 or older;5 years if less than 40 at exam |
| Distant Vision | 20/20 in each eye, with or without correction | 20/40 in each eye with or without correction | |
| Intermediate Vision32 inches-panel | 50 years and older20/40 with or withoutcorrection | 50 years and older20/40 with or withoutcorrection | N/A |
| Near Vision 16 inches | 20/40 in each eye, with or without correction | ||
| Color Vision | Colors necessary for safe performance of airman duties | ||
| Hearing | Conversational voice at 6 feet with both ears, or audiometry | ||
| Blood Pressure | No standard. If medication required, will need cardiovascular workup. Current guideline maximum is 155/95. | ||
| EKG Electrocardiogram | At age 35,& yearly after 40 | N/A | N/A |
| ENT | No disease causing vertigo or disturbance of speech or equilibrium | ||
Chart furnished by The Aircraft Owners and Pilots Association (AOPA).
What disqualifies you from an FAA medical certificate?
Perhaps the most common questions that aspiring pilots ask about, when it comes to becoming a pilot, are those that pertain to eyesight, hearing, and obesity. (If you are too heavy, can the airplane even get off the ground?)
The FAA maintains a list of medically disqualifying conditions.
These conditions can be grouped by type of condition, as shown in the three tables below:
| Psychological Conditions | Nervous System Conditions |
| Bipolar disorder | Epilepsy |
| Personality disorder that is severe enough to have repeatedly manifested itself by overt acts | Transient loss of control of nervous system function(s) without satisfactory medical explanation of cause |
| Psychosis | Disturbance of consciousness without satisfactory medical explanation |
| Cardiovascular Conditions | Cardiovascular Interventions |
| Angina pectoris | Cardiac valve replacement |
| Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant | Heart replacement |
| Myocardial infarction | Permanent cardiac pacemaker |
| Conditions Involving Medication |
| Diabetes mellitus requiring insulin or other hypoglycemic medication |
| Substance abuse / substance addiction / dependence |
If one could offer a glimmer of hope, let’s be clear that these disqualifying conditions are not absolute disbarments from being able to fly. The good news is that the FAA does offer a path for pilots to overcome or keep their medical conditions in check, in which case pilots may be eligible for a special issuance medical certificate.
What is an FAA medical special issuance?
A “special issuance” FAA medical certificate, as the name implies, is a medical certificate issued to pilots that is conditional, based on the satisfactory, personalized assessment of a pilot’s medical condition that could potentially bar them from being able to fly. A special issuance certificate may come with an expiration or may be conditional upon the pilot’s ability to demonstrate continued prevention or continued maintenance of their health with respect to the disbarring condition.
What medications prevent you from being a pilot?
The FAA maintains a catalog of common medications, for the treatment of various medical conditions, and its official stance on the consumption of each with respect to the permissibility to operate an aircraft.
Additionally, the FAA maintains a list of medications which they unconditionally and categorically prohibit pilots from taking.
If you aspire to become a pilot, you must avoid taking these medications. If you are taking them, you must speak with your doctor about the feasibility of weaning yourself off of them.
What is the minimum eyesight for a pilot?
The FAA stipulates that private pilots must pass a vision test with “flying colors” (pun intended). The standard they have established is that pilots must have vision of 20/40 or better, independently in each eye. This may be achieved with or without any type of corrective vision. This means that eyeglasses, contact lenses, and even LASIK are permissible, as long as 20/40 vision is achieved.
For commercial airline pilots, the vision requirements increase to 20/20 vision, with or without correction.
So this is good news for all aspiring pilots who have less than perfect vision! If you can correct your vision to within these standards, you could be cleared for takeoff!
| 1st Class | 2nd Class | 3rd Class | BasicMed |
| 20/20 in each eye, with or without correction | 20/20 in each eye, with or without correction | 20/40 in each eye, with or without correction | Subjective, based on general physician’s assessment |
Is there a BMI Limit for Pilots?
While the FAA does not specify a weight limit or an upper limit for a pilot’s Body Mass Index (BMI), it does stipulate that if a pilot has a BMI of 40 or more (or a neck circumference of 17 inches or more), then studies show that this puts the pilot at risk for suffering from sleep apnea.
What does sleep apnea have to do with becoming a pilot? Considering that a pilot must stay awake while piloting an aircraft, this might seem incredulous. However, the fact of the matter is that studies show that people who suffer from chronic sleep apnea can suffer from detrimental effects during the waking hours. Without adequate restorative sleep, pilots suffering from sleep apnea would be prone to daytime sleepiness, lethargy, cognitive impairment, irritability, fatigue, and personality issues. It can even lead to hypertension, or worst case, even cardiac issues such as dysrhythmias, or even sudden cardiac death.
On this basis, the FAA considers obstructive sleep apnea as a disqualifying medical condition. Therefore, your BMI can indirectly impact your ability to become a pilot.
Do pilots have to pass a hearing test?
The FAA stipulates that as a pilot, you must be able to demonstrate the ability to hear and discern average conversational speech in a quiet room, using both of your ears, from a minimum of 6 feet away, while your back is turned to the medical examiner doing the speaking.
Pilots must be able to demonstrate the ability to hear an average conversational voice in a quiet room, using both ears at 6 feet, with the back turned to the medical examiner. Or alternatively, you must pass one of two audiometric discrimination tests:
Speech Discrimination: Score at least 70% reception in one ear at an intensity of no greater than 65 dB.
Pure Tone: Unaided, you should be able to hear sounds no worse than those that fall in this range below:
Sound Levels
| Ear Condition | 500 Hz | 1,000 Hz | 2,000 Hz | 3,000 Hz |
| Better Ear | 35 dB | 30 dB | 30 dB | 40 dB |
| Worst Ear | 35 dB | 50 dB | 50 dB | 60 dB |
The FAA also addresses the question of whether pilots can wear hearing aids.
What is the I am safe checklist?
The FAA strongly emphasizes pilots to always conduct a self-assessment of their fitness to fly, before each flight. Using a handy mnemonic acronym, “I AM SAFE” becomes “IMSAFE”:
| I – Illness | Am I suffering from any type of illness? Do I have the symptoms of a cold, fever, or flu? |
| M – Medication | Am I taking any medication that has any known side effects that could impair my ability to focus on flying, such as drowsiness or dizziness? |
| S – Stress | Am I undergoing any type of stress in life, be it due to personal, financial, or physical problems or pressures, which could inhibit my ability to stay attentive and focus on the flight? |
| A – Alcohol | Am I under the influence of alcohol? No pilot may operate an aircraft while under the influence of alcohol or with a blood alcohol content higher than 0.04%, or if alcohol has been consumed within 8 hours prior to the flight. |
| F – Fatigue | Am I suffering from fatigue? Lack of proper, restful sleep can lead to the inability to concentrate and stay focused and mentally alert and sharp during a flight. Also, exhaustion due to exercise, work, and other physically demanding activities can pose a risk to being able to conduct a safe flight. |
| E – Emotions | Am I under any type of emotional duress? Am I going through any emotionally upsetting issues in my life, which cloud my judgment and distract me from being able to focus on flying. Examples include an altercation with someone, the death of a family member, financial pressures, divorce, or loss of a job. |
If you find that you fail the “IMSAFE” test, then it is incumbent that you ground yourself from flying, until these issues are resolved and that you are able to keep them in check. Flying when any of these adverse conditions apply to you, can put yourself, your passengers, and even people and property on the ground at risk.