The Female Flight Physical

I wasn’t sure whether to dive right into a topic or introduce myself first. I love covering a lot of ground, but why trust my opinion until you know who I am, right? So here goes. I’m a new Senior Aviation Medical examiner (AME) based in Coeur d’Alene, Idaho. I moved here six years ago and have been practicing internal Medicine for almost 20 years. Over the years, I’ve often listened to my husband talk about the FAA and the flight physicals pilots undergo. He always seemed stressed out by them, which fascinated me. Why are pilots so anxious about a physical? 

As the years went by, I noticed the same pattern among our pilot friends. They would stress over any ailment or, worse, ignore symptoms of illness out of fear of losing their medical certification. This pattern hit home when we nearly lost a friend to stage 4 colon cancer in their 50s because they chose to ignore the signs rather than risk their medical certification. I knew this had to change. 

Earlier this year, I decided to become an AME. I’m 15 years younger than the average AME and part of a small percentage of male AMEs. So, what else sets me apart? My journey began with the perspective of a commercial pilot. 

I spent months researching what makes this exam so intimidating. What information could I share to help ease pilots’ tension? How could I empower them to live healthy lives? How could I help pilots navigate the process when medical conditions arose? 

I started by asking the pilots themselves. My husband was first, followed by numerous pilot friends of all ages and medical classes. I compiled a list of trusted local specialists I’ve worked with over the years to ensure pilots had access to care when needed. I also created a schedule to address pilots’ concerns whenever they need me. 

In October, I traveled to Oklahoma to complete my training, filled with excitement. Believe it or not, the FAA offers many avenues for pilots to continue flying safely, even when medical conditions arise. I returned ready to take the next steps. I made time to visit flight schools and give talks. I attended pilot association meetings, answering questions from those who might otherwise have been afraid to ask their own AME. 

I also quickly found The Ninety-Nines and am so glad I did. I felt welcomed into this elite group of women and can’t wait to contribute! 

I plan to continue writing articles that touch on the examination process, disease management, FAA procedures, and anything else this amazing community needs. I want to make it my mission to guide you through the process and get you back to doing what you love. My ultimate goal is to empower healthy living for a lifetime of flying. 

Thank you for having me and join me next time for a deep dive into the examination process.

Let’s talk about the flight physical, specifically as a female pilot. 

When I first thought about writing this, I spent some time narrowing down the topic and figuring out the best approach. I realized it might be helpful to focus on how to best prepare for the elements of the exam that might feel, well, a bit awkward. 

First, let’s clear up some confusion. According to the AME guide published by the FAA, breast exams are not required unless indicated by your past medical history or current symptoms. The same goes for pelvic and rectal exams. Yes, those exams are listed on the form, but unless there’s a reason to perform them, the guide tells us to mark “normal” without conducting the exam. 

Let’s discuss chaperones. Not all offices have the staffing for one, and my office happens to have a male medical assistant. If you feel more comfortable, bring a friend to the appointment as your chaperone, or ask the office ahead of time if they provide one. 

Now, let’s tackle a common concern: the EKG. I know how awkward it can feel as a woman because those leads are placed in some pretty sensitive spots. So, how can you make this process more comfortable? 

I’ve found that wearing a wireless sports bra makes a big difference. Not the super-tight, high-impact kind that’s hard to get on and off – I’m talking about one with moderate support that can be easily adjusted for lead placement without exposing you too much. Six of the 10 leads are placed around your chest, with two centered between your breasts and four just under your left breast. The sports bra can even help hold the leads in place and doesn’t interfere with the reading. 

If you’re still not comfortable with that, consider wearing a loose-fitting, open-front button-down shirt. I offer disposable capes to my female pilots, but not all AMEs do, so it’s worth planning ahead. Prefer to get your EKG elsewhere? That’s an option! You can have the test done by your primary care provider or another clinician if it’s performed no earlier than 60 days before your flight physical. Just make sure it’s a 12-lead EKG. It must have your identifying information on it including your full name and date of birth. 

Another question I’m asked is whether your shirt needs to come off for the heart and lung exam. The short answer? No. While it’s best to listen to these sounds through bare skin, that doesn’t mean you have to be topless. Lifting the bottom of the shirt or sliding the stethoscope under a shirt collar works well. I offer a disposable open front cape in my clinic, and it doesn’t hurt to ask your AME if they do as well. 

Now, let’s talk about the urinalysis. For this, the FAA is looking for the presence of protein and glucose. This helps detect conditions such as uncontrolled diabetes, hypertension or kidney disease. A standard urine test is not an observed urinalysis and should be done privately in the restroom. To make this as smooth as possible, stay hydrated and, if you can, avoid scheduling the test while menstruating. I get that it’s not always avoidable, but minimizing the chance of contamination can save you some stress. 

Lastly, scars or tattoos. We’re trained to ask about these, even in hidden places. If you’d rather not show a specific area, just let your AME or medical provider know. Depending on the location, a description or even a photo might suffice. 

I hope this helps you feel more prepared and confident for your next flight physical. If you have questions or want to share ideas for upcoming articles, I’d love to hear from you. After all, this column is for you. 

Send your questions or suggestions for upcoming articles to info@aviatemedical.com. 

(Disclaimer: This is general information and not medical advice. Always consult your AME or medical provider for personalized guidance.)

‍