Aviation Safety:

FAA Should Improve Usability of its Online Application System and Clarity of the Pilot's Medical Form

GAO-14-330: Published: Apr 8, 2014. Publicly Released: Apr 8, 2014.

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Gerald Dillingham, Ph.D.
(202) 512-2834
dillinghamg@gao.gov

 

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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. 

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 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.

For more information, contact Gerald L. Dillingham, Ph.D., at (202) 512-2834 or dillinghamg@gao.gov.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The Federal Aviation Administration (FAA) is responsible for overseeing the medical certification of more than 400,000 pilot candidates annually, certifying that they meet FAA's medical standards and are physically and mentally fit to fly. FAA's medical certification requirement was established to prevent or mitigate the effect of various medical conditions that present an undue risk to the safety of pilots, passengers, or others. In 2014, GAO reported that although most medical certification determinations are made by FAA-designated Aviation Medical Examiners at the time of an applicant's medical exam, approximately 10 percent of applications--or nearly 40,000 annually--were deferred to FAA for further medical evaluation where the vast majority received a special issuance medical certificate (special issuance). According to FAA officials, reviewing the special issuance applicant's paperwork takes significant time and resources to complete. Further, in recent years, FAA's medical certification division had experienced a backlog of special issuance applications in need of review. Officials from FAA's medical certification division have attributed delays in the medical certification process to technological problems with the aging computer systems that support the process. To help mitigate these challenges, FAA's medical certification division identified 50 technological enhancements to its internal computer systems that support the medical certification process, of which about 20 have been identified as high priority. However, at the time of GAO's review, FAA officials had not yet implemented any of the enhancements or developed a timeline to do so. Without a timeline to prioritize the highest-priority enhancements, FAA might have been missing an opportunity to expedite the certification process for many applicants hoping to obtain a special issuance certificate. Consequently, GAO recommended that FAA develop a timeline for implementing the highest-priority technological improvements that support the medical-certification process. In 2017, GAO confirmed that FAA had developed a timeline for its 23 highest priority technological improvements. Further, FAA had implemented 16 of the 23 high priority items. For example, FAA now scans medical images in color to reduce diagnostic review times and the online form is now compatible with popular web browsers and includes an automatic save feature reducing challenges users previously encountered. With the timeline in place, FAA is in a better position to implement its highest-priority enhancements and take another step toward reducing the delays related to FAA's technology limitations all while maintaining the safety of the national airspace system.

    Recommendation: 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 develop a timeline for implementing the highest-priority technological improvements to the internal-computer systems that support the medical-certification process.

    Agency Affected: Department of Transportation

  2. Status: Open

    Comments: When we confirm what actions FAA has taken in response to this recommendation, we will provide updated information.

    Recommendation: 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 enhance the online medical-application system by clarifying instructions and questions on the medical application form and providing useful information to applicants.

    Agency Affected: Department of Transportation

 

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