#67 - Protecting Your Wings: What Pilots Need to Know with Dr. Dan Monlux

[00:00:00] Hey, welcome back to Passive Income Pilots. I'm Tait Duryea here with Ryan Gibson. What's up man? Not much. I love this episode because it doesn't necessarily talk about financial advice, but we get into protecting your medical because

[00:00:14] as pilots if we lose our medical, guess what? You lose your income. So if you're listening to this podcast, we have a great episode that aired last week. We have another one coming up this week that talk about financial independence and building passive income.

[00:00:29] This one is all about AME, Aviation Medical Examiner and going in for your medical and how to protect your medical and all the ins and outs of that. So if you're looking for financial

[00:00:40] advice, we typically have that on the show, but today we're going to help our pilot community in the flying community with some ins and outs and it'll peek behind the curtain out what

[00:00:47] the FAA looks at. I think the coolest thing is at the end of this show where there's like a medical simulator that we're going to talk about. But Tait, I know you're

[00:00:57] going to jump in and talk about Dan. Yeah, Dan is a guy as I alluded to on the show that ran into it at an aviation conference. And I just think after learning about his company

[00:01:08] and what he does, he is an AME, but he focuses more on helping pilots get through issues that would otherwise preclude them from passing a medical. So he is the founder of Wingman Med. He combines unique medical credentials and his knowledge of aviation

[00:01:27] to provide aviation medical consulting services. He's a senior HIMS AME and board certified family and aerospace medicine doctor. He is an XF-18 pilot. He's logged 2,800 hours in that thing. And overall, just an amazing person to have in your contact list because if you ever

[00:01:48] run up against a wall with the FAA and getting your medical, this is a guy that you want to reach out to. Yeah, most importantly, if you're afraid of going in for your medical because you think

[00:01:57] there might be something that prevents you from getting it, this guy will actually help screen that out, simulate if you will not qualify. So really great consultation. I actually got a personal consultation from him because I'm actually on a special issuance and it was

[00:02:13] super helpful and he like was extremely knowledgeable. So if you have any consultation needs for your AME, this guy is the guy you need to call. With that, let's get to the show. Welcome to passive income pilots where pilots upgrade their money. This is the definitive

[00:02:30] source for personal finance and investment tactics for aviators. We interview world-renowned experts and share these lessons with a flying community. So if you're ready for practical knowledge and insights, let's roll. Dan, thank you so much for joining us. We appreciate

[00:02:45] you coming on the show. It is a pleasure to be here. Thanks for having me. We met at the pilot network conference. You had a booth there and I stopped by and we had a really nice conversation about the aviation medical landscape and your background and

[00:03:00] everything. So thought this would just be a wealth of information for our listener group. Before we get into the medical stuff, let's hear about who is Dan Monlux and what's your background? So I'm recently retired from the Navy after about 26 years. I actually started my

[00:03:13] professional career as an F-18 pilot. I came in way back in 1998, flew the legacy model of the F-18 Charlie, flew an operation Southern watch and Iraqi freedom. So I have some combat experience

[00:03:26] mixed in there and then lots of instructor time going back from fairly early on in that part of my career. Also I went to med school after that and being a an instructor pilot in the

[00:03:37] F-18. Med school family medicine residency then became a Navy flight surgeon. I had the opportunity to be a pilot physician in the Navy so got a fair amount of time flying citations around Southeast

[00:03:49] Asia and also did an aerospace medicine residency and along with a master's in public health. And so currently started to end up other ratings, commercial and instrument rated, CFI, CFI, MEI and then I'm also dual board certified in family medicine, aerospace medicine,

[00:04:08] master's in public health and the senior HINZ AME for the FAA as well. And so I've been doing mostly aviation medicine with the focus on complex medical certification for about the last six, seven years anyway. Complete slacker. Can you tell us some

[00:04:24] cool stories about the F-18? What were your favorite times there? People ask that. I always have trouble with it because that's a job that is just every bit as cool as you think it is going

[00:04:32] into it. So certainly the first carrier landing stands out pretty dramatically. I think taking an airplane and going from landing speed somewhere around something approaching 150 knots to zero in the kind of short space of time is pretty interesting. Some of the combat stories in

[00:04:50] Iraq and being able to help Marines and Army soldiers on the ground with with delivered ordinances. There's a few missions like that really, really stand out. And then there's this low

[00:05:00] level flying. I think people have seen that it's maybe like probably the most one of the most relatable parts of flying the F-18 but some of those low level scenes in Top Gun where you see the

[00:05:09] physicality of just the jet back and forth being under G. We got to do all that stuff for real. There's so many, I think low level flying is definitely one of the most memorable things

[00:05:19] about flying the jet. And just a great community of people that you get to be involved with too. So you get on and on but those are some of the highlights. That's so cool. So what drew you to medicine leaving the military and deciding to go into medicine?

[00:05:34] I had always considered flight school versus medical school from the time I was in high school and early childhood and eventually gravitated toward aviation first. But I actually really got interested in medicine again after I got into a skiing accident right after I finished

[00:05:52] Hornet training and got to my first operational assignment out of Japan. And so I was met back from Japan back to the medical center in San Diego where I had the floor of my orbit reconstructed

[00:06:04] and it was seeing double vision for a period of weeks. And a matter of fact, the attending who supervised my surgery at the time had been an F-14 driver before he went to medical school.

[00:06:15] And so that really got the wheels turning again and made me realize it was a possibility. And that interest just never really went away. So I think when I was getting to the end of my aviation

[00:06:24] career and I at the time didn't want to be an airline pilot, I didn't want to be a defense contractor. I didn't want to be an admiral medical school seemed like a pretty something

[00:06:33] I'd always wanted to do seemed like a pretty worthy ambition. What's something that every pilot should know but they don't know about getting a medical? I think the biggest thing that people should know is that your medical certification exam is a check right. No different than if you're

[00:06:49] doing a line check or going to do an upgrade with a DBE. That aviation medical examiner is an FAA designee and they are not your treating doctor. They are not there to help you through

[00:07:02] the process. They have one job and that is to evaluate you as you sit there in front of them and either give you a certificate if you're qualified or tell you that you don't meet the standard.

[00:07:14] And I think that piece is probably the most important thing. Yeah, and it's not an AQP program where you can retry that maneuver three times. It's old school check right. It's pass fail. That's exactly right. You better memorize every square inch of the plane or you're not going

[00:07:30] to pass kind of thing right? You're running the gauntlet as they used to say. That's exactly right. And a lot of A&Es are not trained to coach you through the process even if

[00:07:39] they wanted to. And if you think about it from just an economic standpoint, you're paying for that exam which is maybe a 15-20 minute block of that A&E's time. You are not paying them.

[00:07:50] That allows them to make that certification decision. But you're not paying them to help you collect records and review things and optimize your high blood pressure treatment that you should have done before you get in there. But you're paying them to just look at you and

[00:08:04] give you a thumbs up or thumbs down. Yeah, show up and shut up kind of thing. Just get in there, get your medical and get moving on. And if you've got things to talk about, you can talk about that with your regular doctor. That's a good point.

[00:08:13] Or at least, you don't necessarily have to... There's a lot of A&Es who maybe will help you through the process but you can't expect them to do that. After you give them that confirmation number from MedExpress, that's it. And they have to submit your exam within

[00:08:25] a couple of weeks. So if you do want to get some advice from them, the time to do it is before you schedule the certification exam. And there's... That's important. I didn't know that. I didn't know that. But yeah. So if you have your medical scheduled,

[00:08:39] let's say it expires at the end of June and you have your medical scheduled for the middle of June and you have something you want to talk to them about and you're thinking, I'll talk to them when I get there for my appointment.

[00:08:52] You maybe should think about not doing the MedExpress stuff and talk to them ahead of time. Or what would your recommendation be in terms of talking to your AME versus some other doctor that

[00:09:03] is not part of the FAA? So the some other doctor, I think every pilot should have a good relationship with the primary care doctor. And if you have a medical condition, you should make sure that you're being treated and that condition as well under control.

[00:09:17] As far... But that treating doctor might be a very good doctor. They're not going to know much about FAA certification standards. So if you want to run something by your AME, the best way to do it is

[00:09:29] by scheduling an appointment with them to just talk about the issue and let them know upfront, hey, I am not interested in sitting for my certification exam right now. I just want to get your input on this issue. That's such good advice. And I think

[00:09:45] I'm sure most of you listeners are probably pretty familiar with the medical certification process, but just a very basic level that the application starts with an online application through MedExpress. And after pilots finish that, they get a confirmation code. That confirmation

[00:10:00] code is what your AME is going to use to import that exam and start reviewing it and entering your physical exam information. Once you hand over that confirmation code and your AME

[00:10:13] issues it or enters it, even if they want to pull it back, they can't. At that point, they're on a clock to submit your exam to the FAA. And so I think it's important for people to know

[00:10:25] that if you have... If you had a new issue and something's going to affect your exam, don't hand over that confirmation number until you have a pretty good idea of how things are

[00:10:34] going to flow. And AMEs are a good resource for that. We also at Wingman Men offer free consults to people with new medical issues or really any concerns affected in their medical

[00:10:45] certificate. And we could help talk through those things and provide the scope of how it might affect their certification. How do you prepare for a medical? Depends on the issue. It really... It comes down to bureaucracy. I call myself an aerospace medicine physician. I've done the

[00:10:59] residency and have the board for certification to prove it. But when it comes to FAA medical certification, what that means is I'm a really good accountant rather than a really good physician. And the FAA for any condition, whether that be sleep apnea, whether that be

[00:11:15] high blood pressure, whether that be a history of cancer, for most of these conditions they have a set of protocols that has step-by-step checklist. And when you come in, if they're deciding whether or not you're going to get a certificate with one of those, they're looking to say,

[00:11:29] okay, do you have a good detailed clinical progress note from your training position? Check. Do you have a current EKG check? Do you have a status report related to your sleep apnea

[00:11:40] check? And it's just... It's that simple. So if you go in and there's a 10-item checklist and you have eight of those things, you're not getting your certificate. If you go in and you have all

[00:11:49] 10, you're getting your certificate. And so it's really the best thing is if there's anything that comes up, you want to make sure you consult with an expert and have a lot of your doctorate of road administratively before you show up. What happens if someone shows up for medical?

[00:12:03] I love that, that you should treat it like a checkride. It's so true. I think so many of us, especially those of us who are young, just like, yeah, yeah, flight physical, whatever.

[00:12:11] You got to go in and check the box. Ryan just turned 40, right? So the next time you got to go, you're going to be on the six-month schedule. I'm still luckily on the once a year. I'm

[00:12:20] healthy, other all around in shape, workout, whatever. But so I really don't put much thought into it. But what should the average pilot be doing to prepare to go in and punch

[00:12:32] that ticket? Because we talk about this on the show all the time, that you're one failed medical away from this wonderful stream of income stopping. And that's the whole premise of this show is like,

[00:12:42] hey, how do we get smarter with our money so that we can mitigate the effects, the devastating effects that that can have on you and your family if that paycheck stops coming in? So

[00:12:51] how do we make sure that on the way into that appointment, we're doing everything we can, maybe for people that don't have any sort of underlying condition or issues. But what can you do to make sure that you show up and you're prepared for that checkride?

[00:13:04] That's a great question. And I think the premise really touches on a super important point, which is most pilots start out their aviation career young and healthy. And you go to your

[00:13:15] AME and it's no big deal. You just pass, you pass. And I don't think many people really consider what happens if you have a new issue that prevents your AME from issuing that certificate.

[00:13:25] And so I think I'll just walk through that process a little bit. If you show up and you don't have the right preparation or you have a disqualifying medical condition, your AME cannot issue your certificate at the exam in most cases. And what they're going to do

[00:13:39] instead is defer your applications to the FAA. What that means is they basically, you know, provide their amplification to some of the questions that you answered, describe your physical exam, but then just forward that application on to the

[00:13:55] Aromethical Certification Division in Oklahoma City. Once that happens, you're into the bureaucracy. And so typically you leave without your certificate. It's going to take the FAA sometimes a month, often longer. I usually tell clients somewhere in the one to three month range,

[00:14:13] but you're just waiting for the FAA to give you a response and tell you what to do next. You'll get a letter back that usually opens with, thank you for your application for, you know, medical certification, but due to your history of high blood pressure or sleep apnea

[00:14:28] or whatever the case may be, we cannot determine your eligibility to hold a medical certificate. And then they'll outline a bunch of information that you need to supply. And that's usually clinical studies, medical documentation can be pretty wide ranging.

[00:14:43] And they'll usually give you 60 days to respond to that. So now you're, let's say, by the time you get that letter, let's say two, three months past your application cycle, right? Now you gather up all that stuff that they asked you to get. Maybe that takes you

[00:14:57] at it depending on how quickly you're able to schedule appointments with your doctors. That might maybe take another month or two. And then you mail that information back to the FAA. If you're lucky, now your five months or so past your application,

[00:15:10] if you're lucky that response answers the mail, that's what you all hope for. But if it doesn't, or there's other stuff in your medical record that you forgot to disclose in your application or your doctors didn't answer the questions completely that the FAA was looking

[00:15:25] for, you may get another letter saying, hey, thank you for this supplemental information. However, we still can't determine your eligibility for a medical certificate. And that process can repeat for months on end at some point. So that's really how that snowball

[00:15:40] grows is as you go in with kind of a small problem that maybe you can get a bit addressed at the exam, it gets deferred. But then your answers to the FAA's inquiries are complete or raise

[00:15:51] more questions. And that turns up into several months of six months, let's say, of record collection before it even gets into their queue. And right now they're so backlogged, from the time you have a complete package in front of them until the time they actually rule on your

[00:16:07] certificate is about six months. And so it's six months plus however much time you spend getting that patch together. And that's where you hear those horse demerits of people who have been back and forth with the FAA for a year or two or more.

[00:16:21] What's the most common reason someone gets blindsided and walks out without a certificate? The most common reason for denials ends up being cardio-asper conditions and strokes. And so I don't think people are blindsided by the decision in that case. I think most people,

[00:16:39] if they went to an A&E with a heart attack would expect that it's going to be some time. But I do think people, I think what really blindsides people, if they had a condition

[00:16:48] since their last certification that was transient and has gone away, I think many times they'll expect to get a certification. Let's say that you developed a couple episodes of vertigo. That's when the FAA recently changed their policies on that. There's forms of vertigo that

[00:17:05] can be very self-limited. And that's an example where an A&E could issue your certificate right at the exam. But if you don't have the right documentation, it's going to get that deferral process I described. But from a pilot perspective, okay, I had one or two episodes

[00:17:20] of vertigo. It's all better now. Why don't you just take my word for it? And that's the piece that people miss. And so the FAA on the MedExpress application is really asking about your medical

[00:17:32] history. It is asking, have you ever in your life had any disability surgery or illness? And so it's pretty comprehensive. And they're going to ask about things that maybe just affected you for a few months and then went away. I think pain conditions,

[00:17:48] surgeries that it resolves are falling to that category. But really any change in your medical history from one medical exam to the other can cause this. I have a personal question. I have a special issuance actually. And it's related to a procedure

[00:18:05] I had in my eyes like, I don't know, I guess now 14 years ago maybe. How do I wiggle out of that special issuance and get that cleared? And I know it's probably specific to the position, but is there an administrative process to or someone who I

[00:18:21] can work with or hire to help potentially show that, hey, I haven't had any issues and it's been 12 years and maybe it's time to let me just go back to a regular authorization. Is there

[00:18:33] is a process for that? And obviously it depends on the condition. And for yours, have you had the special issuance reauthorized a couple of times? It sounds Yeah, about five or six times. I think it's usually good for a couple of years.

[00:18:44] And it's been about 12 years now. So typically a special issuance will come out and it'll authorize the AME to give a certificate as long as you meet certain criteria for the next five years, let's say. And typically, depending on the condition, if you're very stable throughout the

[00:19:00] course of that five years, just as a matter of course, they will remove the special issuance and then issue was called a large eligibility. So interesting. It's really, if your condition had like it, and I don't want to discuss that on the air obviously, but

[00:19:16] depending on if there's some aspect of your condition where it might relapse or there's reason to expect that it might not be stable over the course of your lifetime, that special issuance may be permanent.

[00:19:27] Permanent, got it. And if I wanted to sort of challenge the authorities, what is there a process for that? Is there like a FAA website thing I can go on and just submit it and see what they say or is it strictly just wait for them to decide?

[00:19:42] You can work through your AME if you have one who's willing to take up that mantle for you. Gotcha. The FAA has, they split the country into regions and within each region there is a regional fight

[00:19:56] surgeon that has some authority over that process. And there's also, they have program analysts there that can give you some background on what's going on with it. So they might not necessarily change anything for you, but they can certainly, they're a decent resource that pilots can.

[00:20:15] You just say you Google FAA regional fight surgeon and you can find the one in your area and most of them are pretty helpful when you can actually get a person on the phone or Google explain what your options are.

[00:20:27] So I'm on the MedExpress website, the FAA MedExpress website and it's obviously the form 8500-8 when you're going through your application. You ask you a bunch of questions. One of them, I believe I haven't gotten that far and I don't want to go too far deep into this

[00:20:44] and then get myself in trouble, but have you been, have you seen any healthcare professional in the last three years for anything? So let's say I went to a doctor because I,

[00:20:54] you know, I had a cough two years ago, right? And I reported it on my medical two years ago and then last year or this year, I forget to report it. And it's still within that three-year window,

[00:21:07] but it's, I don't know, was that three years ago? Was that five years ago? Was it last year? I can't remember it all blurs together. What's the risk of not keeping that box very well maintained?

[00:21:18] What the FAA is looking for is you're telling a consistent story throughout your application. And if you cross them, they send a lot of nasty letters and obviously there's a bunch of consequences that come with it. But really, they're rational people

[00:21:32] that are trying to support aviation safety and they look at this, they look at it rationally. And if you had a visit for a cold two years ago and you forget to include that on your next

[00:21:43] application, that's probably not that big a deal. If you got an accident and had a depressed skull fracture that you forget to put on there, if that comes to light, now that's probably going to be an issue. So there's a range of things. Technically, they're asking for

[00:21:59] everything. If you see in the doctor a whole bunch of times for the same thing, you can aggregate it in one line. And so tell a consistent story. If you take a medication, there should be a medical

[00:22:09] condition that goes with that medication. If you have a series of visits to a cardiologist, then there should probably be a cardiology diagnosis of your medical history too. And so they're like in first place to match up. But what I tell people is if you've been doing

[00:22:24] medical applications for 20 years, what's the likelihood that you really remember everything exactly as you reported it from year to year? So what I recommend is just when you get done filling out your MedExpress application, there's an option to download the PDF at the end of it.

[00:22:41] And so save that PDF from year to year and then when you fill out your next application six months down the road, just cut and paste everything right over and then you don't have to remember. And you just treat those, you can let the six months versus

[00:22:54] doctor visits drop off each time you do it. Yeah, keep it on a Google Drive or something that you can reference. I've got a nice folder for that stuff. I let my medical expire last year on accident. I guess it wasn't really on accident. I just couldn't,

[00:23:07] I couldn't get it scheduled. And so my entire schedule got wiped out with non-qual. So I was on the 13 month medical last year. Are there any consequences to that if you let

[00:23:18] your medical go because let's say you're on vacation and you're like, do I really need to get it before it expires? What does it matter? Because I know it drops to a class two, but is there any consequence as an airline pilot for that?

[00:23:30] Not known whatsoever. Yeah. Unless there's one three employer. If there's some consequence that you have some brief window of uncertified and uncertified time, but from an FAA perspective, they could care less. The only requirement is you must have it out of medical in order

[00:23:46] to exercise the airmen privileges that go with it. But as long as you're not flying because you're on vacation or whatever the case may be, it doesn't matter if that lapses.

[00:23:55] Tate, isn't it funny how they put the fear of God into us where we don't really know the answer to such a basic question? Yeah. Right? You started getting nasty grass from the company, right? Your medical's aspiring. Your medical's aspiring and it's

[00:24:07] I don't have a trip for the next six weeks. So does it really matter? Yeah, it's just funny. The fear of God has been put into you as an airline pilot you don't let that thing expire. And so you're like, what happens if it expires after a while?

[00:24:18] You just are like, I haven't really thought about that in like 20 years. Yeah. It is a way to get an extra month out of your medical. If it expires on June 30th, you get on July 1st, you get to the 13 month or the seven month medical, right?

[00:24:31] And is there any, is that raising your red flags if you do that more than a few times? No, no, no. Hey, think about it. Like your approach is this from an airline

[00:24:38] pilot's perspective, but there's plenty of GA pilots who just get bored and run out of money or crash or plane or just wander off. And so if your medical lapses because you're not flying, nobody cares and nobody's tracking that. Yeah, it just gets downgraded to the next level,

[00:24:54] right? Because I don't like it goes from a... Exactly. Yeah. If you're over 40, you get a class one certificate that's good as a class one certificate for six months. It remains good as a class two certificate for a year from your exam.

[00:25:06] And then it's still good as a class three for two years from the exam date. Now, after that, it expires, but as long as you're not flying, it doesn't matter. The FAA... That was a good reminder because I'm... That is, yeah. I don't think I could have

[00:25:19] pulled that out. It's been too long. It's been way too long. And under 40, it's three years. Or did they change that too? So, yeah, under 40, class one and two certificates are good for one year. And then the class three certificate is good for five years.

[00:25:33] Dan, I want to get into the HIMS program and what you guys do with that, if anything. But before we do, I wanted to talk about that bureaucratic cycle. And at the end of the show,

[00:25:43] of course, we're going to give some time to talk about MenMed and what you guys do. But how do you get out of that bureaucratic cycle if you ever get into it? And I think

[00:25:51] this is a conversation that we had at TPNX was, I think a big part of your company is you help pilots get out of that bureaucratic cycle. So can you speak to that a little bit? So I've got a great story that kind of illustrates the point.

[00:26:06] So we had, and this is a true story. So we had a client, he went to his AME and he had a new diagnosis of sleep apnea. Sleep apnea, by the way, a lot of pilots fear this diagnosis and think

[00:26:19] it's going to be the end of their career. The fact of the matter is, it doesn't matter. There is no case where a new diagnosis of sleep apnea should even delay your medical

[00:26:27] certification. It does not require FAA review. The same, he didn't know that so he deferred the exam. And so now this guy's without a certificate, gets a letter in the mail saying, Hey, do your

[00:26:38] history sleep apnea? We need more information. So he sends it in. All right. And he's thinking it's going to be good to go. But he gets another letter back and he says, Hey, thank you for

[00:26:48] submitting your information. Now please provide us a detailed clinical progress note about your migraine headaches. Migraine headaches, what? Turns out when he submitted the notes about his sleep apnea, there was mention of migraine headaches that you had five years ago. Please throw it at

[00:27:03] a time. Really weren't migraines that were probably like some head cold type of thing. So okay. So he goes back to the mineralogy who evaluated for those headaches and he responds to that letter. All right. Now it's six months or so past the exam.

[00:27:16] I'm just thinking then answered the question. Right. Then several months later he gets another letter back and says, thank you for your information about the, about your headaches. However, now we need a detailed clinical progress note about your chronic use of Percocet.

[00:27:31] What? And so he sends, so he, he's really just confused at that point. We actually, he consulted us around that period of time. It turns out he had a knee surgery several months beforehand, completely recovered from it. But his orthopedic surgeon had prescribed

[00:27:47] him some Percocet and the sort of immediate post-op phase that he took once and then, and then through the garbage. But it's still listed as an active medication and, and the records that he supplied. Right. So he goes back to the clinic, may get a,

[00:28:01] a progress note from his, from his orthopedic surgeon or tries to. The only issue is orthopedic surgeons don't care about what if you're taking Percocet or not, because it's, they're off doing more surgeries. So he gets a, he gets up with the PA

[00:28:14] and he sends that note, that note back into the, to the FAA. That's not good enough either. And several months later, he got a note from, from back from the FAA saying, Hey, thank you.

[00:28:23] But now we need a detailed clinical progress note from your treating physician about Percocet or knee surgery. And of course, like just telling the story is frustrating. You can tell what, what he was going through emotionally. And that last one, the FAA wants to see letters from

[00:28:39] physicians, not PAs and nurse practitioners, but board certified physicians. And so this is a guy, he came to us after he'd been in the cycle for about a year. And within kind of one iteration,

[00:28:51] we were able to identify all the different places that had gone wrong and help them to collect, collect an appropriate administrative package that cleared everything. But it's just a, you know, perfect example of how like everything can go wrong. His exam really,

[00:29:04] his certificate should have been issued at the initial exam, but his A and E screwed up, but should have been issued after he supplied that initial sleep apnea information, but, but there was additional medical information that came to light as part of that. And then new

[00:29:17] stuff came up and then the inappropriate person wrote the note. And at any point along that process, if he had just had somebody who was familiar with what the FAA's requirements are for documentation and helped them to submit a package that didn't raise any more red flags

[00:29:32] and answered everything, he could have initiated a certificate anyway along that, along that chain. And instead it took him a year class to get a certificate. This is just another example of your network is your net worth, right? And that's what we're

[00:29:45] trying to do on the show is democratize the network and connect pilots with professionals who know what they're doing. So this is this fantastic that you do that. And you are an AME that helps pilots with this kind of stuff, right? Correct. Yeah. So my, my founding

[00:30:04] partner Keith Roxo and I are both senior HMS AMEs. And we're very familiar with the FAA procedures. We're having quite a few people that we can call at the FAA in fact, and we really concentrate on

[00:30:16] these sort of complex medical certification issues full time to the point that I deliberately limit the number of certification exams we do mainly so we can concentrate on these more intensive administrative type issues that people run into. It's fantastic. You know,

[00:30:32] because it's really rewarding work. And I think people occasionally will describe us as pilot advocates, which is a term I don't care for particularly. I think there's probably some truth to it, but really I like to think of this as aviation safety advocates,

[00:30:45] because if a pilot who is experienced and qualified in an airplane is not flying, there's an increased burden on commercial operation that maybe needs to push somebody who doesn't have the experience or like it pushed along in there before they're necessarily

[00:31:00] ready to be in the training pipeline. Probably some 135, part 91 operators as opposed to 121, but then you have your private pilots who if they sit down and they're not flying, they're airplane, the airplane, the engines corroding, their steels are atrophoretically, by the time they actually

[00:31:15] get back on the cockpit, they're not at the same level of proficiency they once were. But it's really rewarding to see people back on the cockpit and flying again with as least a minor delay as possible. That's amazing. We did an episode with Joe Deruso,

[00:31:29] who's an aviation attorney and we briefly discussed this in person, the fact that sometimes using an attorney is who you want and sometimes it's not. So can you talk to what issues you might want to call an aviation attorney for versus what issues you want to talk

[00:31:46] to someone like yourself who has a medical background and not be going to paying attorney fees to deal with medical issues? Can you speak to that a little bit? Absolutely. We're fun to say you wouldn't hire a doctor to represent you at court. Why would you hire a

[00:32:00] lawyer to sort through your medical issues? And I think when it comes to AMCD, that's the Aeromedical Certification Division, there's no lawyers there. It's all around my doctors and really what they're looking at is making an informed, aeromedical risk decision.

[00:32:17] And so most of the time, they're not holding people's feet to the fire, even if you emit information or even outright concealed it, as long as you at some point come clean and provide a good faith description of the medical information they're looking for,

[00:32:33] that is typically good enough to get your medical certificate. If you're getting letters from AMCD and even if they're threatening that they're going to refer you to legal enforcement, if you've not actually been referred to legal enforcement and you're purely getting

[00:32:47] letters from the Aeromedical Certification Division, that I would recommend talking to us or talking to a well-informed AMB because lawyers often are not going to understand the medical nuances to allow the documentation that comes up and they're going to challenge

[00:33:01] the FAA based on procedural and legal issues. Now if you haven't been referred to enforcement because you haven't responded or you were really concealing something or your certificate has been revoked and you're trying to reverse that administrative legal stuff, well that's

[00:33:19] beyond our scope as medical providers. That's a point where a lawyer might be helpful. But we've had clients that have come to us after working with lawyers for periods of months and years and often times, you know, paying by the hour to the

[00:33:33] rate of $15,000 to $20,000 and within one case in particular that I think it up, within two, three months we were able to review everything that happened. Turned out the whole issue was that there was a misdiagnosis from way back when we were able to talk to doctors at

[00:33:50] AMCD and get that decision reversed and get that pilot a certificate within a few years. Medical issues should be handled by doctors, legal issues should be handled by pilots and until you're referred to enforcement, that's AMCD is dealing with legal issues. It makes a ton of sense.

[00:34:10] On that episode with Joe Deruso, we talked a lot about HIMS and UI cases and so can you give us your perspective on the HIMS program and maybe a little bit of what sort of work you do in that?

[00:34:22] So the HIMS program is a program that was developed on the 1970s and it was basically focused on airlines recovering high time Part 121 captains who got arrested for DUI or identified as being out of the dependent and it's evolved over time to now it expands to

[00:34:41] Part 91 pilots and even class III certificate holders as well as people who are being treated with antidepressants for PTSD anxiety and pressure. And fundamentally what it involves is a higher level of review than you typically have at just a normal FAA certification exam.

[00:35:01] And so pilots who have been diagnosed with alcohol or substance abuse or who are currently being treated with an antidepressant medication need to apply for their medical certificate with a HIMS AME. In addition to the HIMS AME, they also need to undergo some neurocognitive

[00:35:18] testing with especially trained neuropsychologists and do a psychiatric test with the board certified psychiatrist or depending on their level of certification potentially especially trained HIM psychiatrist. For people who are alcohol or are substance dependent or have been,

[00:35:35] they also need to be participating in a recovery program program AA or NAA and have some sponsors through their employer and through those recovery programs. So basically what it provides is something that didn't exist before pilots who have really significant issues with alcohol or substance

[00:35:54] use or with depression now do have a pathway back to the cockpit. It's time consuming, it's fairly expensive for the pilot but it's a great program in terms of the outcome where you know for the particular for the drug and alcohol patients the rates of relapse for people

[00:36:10] enrolled with HIMS programs extremely low which you really can't save for just about any other treatment program out there. And for those pilots who are taken being treated with antidepressants it really opens up a lot of opportunity for people who even 20 years ago

[00:36:24] would have had no chance to get the medical certification to actually have a way to get one. That's fantastic. Yeah, we talked a lot about the problems with the HIMS program on that episode

[00:36:34] and getting people out. So it's nice to hear the perspective of the people that actually need it. It's there. Ryan, I know you're dying to jump in. Yeah, I was just wondering your thoughts on the aviation rulemaking committee that's contemplating changing some of the

[00:36:47] rules around medical reporting and if you had any thoughts on that initiative that the FAA and Congress are orchestrating. It's a really tough problem set. What I would say it is I actually, I agree pretty wholeheartedly with the FAA's policies on mental health and

[00:37:07] including people who must go through the HIMS program for any of the conditions to qualify for that require it. The problem is it's taking on the order of 12 to 14 months for simple cases

[00:37:19] to make it through. That's actually less on alcohol, alcohol and DUI side than it is on the present side. If you're flying what's going to take 12 to 14 months to get through something, your incentive to report that is pretty darn small. On the flip side, the reason there's

[00:37:36] so much scrutiny is that depression and anxiety and PTSD do carry an increased risk of suicide and we don't want people completing suicide with airplanes. I don't think anybody wants that. There's a real public safety risk there. I think the actual policies and then the way the FAA

[00:37:56] is willing to consider each case on a case by case basis is very sound. My feeling is they're completely under resource and the reason it is taking that long to get through is simply because

[00:38:08] of the volume of applications they have and the lack of staffing. There's some merit to some of the rule changes and things like that. Personally, I think it introduces a lot of unnecessary risk. Really what I would like to see is an expanded psychiatric department at the AMCD

[00:38:24] and the federal air surgeons office and more funding for them to be able to process applications in a timely manner because if they had their current policies and the resources to process them and people could report a condition and make it through the process in two or three

[00:38:38] months, I think it would really be a boom to aviation safety and it would change people's perspective about reporting dramatically. Good point. Good balance opinion on that. I think we've heard both sides of it from an attorney's perspective, medical perspective,

[00:38:54] so that's really good. If you missed that episode, don't know the number off the hand, but we'll put it in the show notes to Joel LaRusso's episode. Three tips you'd give for pilots to make sure they pass their medical all the way to 65. Ambien. Ambien.

[00:39:07] So contact wingman. I think the biggest thing is... And this is more preventative, right? And I want to wrap the show up with how people get in touch with you, how to reach out if they have an issue. But I mean, I don't know.

[00:39:21] Do you see any sort of pattern in terms of obviously we know we need to exercise and be healthy, right? But is there any other tips, tricks, life hacks, whatever, read out, live that Ryan's going to send you if you email ask at passiveincomepilots.com?

[00:39:34] Anything that you'd recommend to make sure that you keep stamping those tickets? I think the biggest thing is keep track of your health. Have a good relationship with a good physician and tell everybody if you have a medical condition, go to a doctor,

[00:39:49] get treated, get better. And as long as your medical condition is well controlled, chances are you're going to be able to get your medical certificate. And I've talked to way too many pilots who have something simple and common, like high blood pressure, right? High blood pressure,

[00:40:06] if you show up to your AME and your blood pressure is anything less than 155 over 95 and you take up to three of generally acceptable classes of hypertension medications, your AME can hand you a certificate right there in the exam room, right?

[00:40:21] And by the way, 155 over 95 is horrible blood pressure. It should be down to less than 120 over 80. But I've talked to so many pilots who think that the FAA is going to come down on them for

[00:40:32] having high blood pressure, that they completely ignore it, refuse to go to their doctor to get evaluated, aren't on treatment for it and then try to cajole the situation when they show up

[00:40:42] for their exam. And so that's a really simple example where if you just take a proactive approach to maintaining your health, the FAA doesn't care about high blood pressure. They care that you're being well treated. And that's true for it's becoming true even for diabetes. We have a

[00:40:59] handful of clients who have made it through successfully with type one diabetes. We have a number of people flying with type two diabetes, hypothyroidism, history of heart attack, history of stroke. These are all conditions that we've helped people to qualify with.

[00:41:13] And some of those folks tragically had those bad health outcomes and those major events because they were somewhat concerned with how the FAA was going to regard the early warning, high cholesterol, high blood pressure type things. Eat healthy, maintain a good body weight,

[00:41:30] don't smoke, drink in moderation. But then also as you're getting older make sure that you actually have a good primary care doctor and you're screening for cancer or you're doing all the preventive health stuff that they would recommend. That's fantastic. Someone wants to

[00:41:43] reach out to you, get some advice. You said you do free consultations. I'm sure you might get a handful that reach out after hearing about this. And again, I can't stress how much

[00:41:54] of a value added is to be able to have your name in a Rolodex in case something comes up. How do people find out more about you and how do they get in touch?

[00:42:03] So it's super easy to find us if you, Google Wingman Men or just go to our website www.wingmanmed.com and the center is a big free consult button. And so you click on that,

[00:42:13] enter a few pieces of information, your name, email address, and why you're wanting to get in touch with us. And then we'll try to get you in for free consult. Those are in high demand.

[00:42:23] So we do have a little bit of screening but generally speaking if you have a new medical concern particularly if you have certificate and have some something that is going to affect you, chances are you're going to get that free consult. We also have a MedExpress simulator.

[00:42:36] So that's something that is available on our website under the resources tab. But that allows you to go through and fill out a questionnaire that is exactly the same as what you'd counter on the actual FAA medical certificate application. And if you think that

[00:42:51] we will, one of our aerospace medicine physicians will review it and provide you a summary of how things might affect your medical certification. And that is gold. That's incredible. Yeah, it's gold. That's amazing. Oh my gosh, that is so cool.

[00:43:07] It's a great resource and it's a great way to screen too because it really focuses the discussion rather than getting on the phone and trying to ease everything out. And we can tell you in

[00:43:16] five minutes, hey, like you're going to be fine. Well, yes, some real issues. Why don't you get on the phone with us and we've walked you through what you get. Is that proprietary? Are you

[00:43:23] the only one doing that? That's pretty cool. To my knowledge whether you're on doing it, but it's open source information. It's just we copied the MedExpress application which is publicly available. That's cool. That's incredible. And then we also put out a lot of free information

[00:43:35] too. We left you on podcasts, we've done a few of these just to put information out there. We try to get to a lot of the pilot hiring conferences to just explain some of the same things we talked

[00:43:45] about on the show. And we also publish blog articles about every other week. As we start seeing questions come up with frequency, we try to put those out for public consumption so that those resources are available without any charge for people in a read. That's great.

[00:43:59] That's fantastic. Dan, thank you so much for coming on, sharing this information. This will be hugely beneficial to the pilot group. We'll link to all that stuff in the show notes and we'll catch you on the next episode. Thank you. Fantastic. Thanks guys. It was great being here.