Aviation Medicine
In the latest webinar we were joined by Dr Mark Sandler who has worked as an Aviation Medical Examiner (AME) for 25 years. He has had a very interesting portfolio career and has held a wide variety of roles alongside his GP work such as non-executive director at Herts Urgent Care and tribunal panel member.
Below are the questions that Dr Sandler was asked along with his responses.
My route into my portfolio career started when I was a GP trainee in Putney. My father-in-law was a pilot and asked how doctors trained to become examiners and coincidentally around the same time my GP trainer received a circular from the Ministry of Defence to organise training for RAF medical officers. From this I had the opportunity to attend the Basic Aviation Medicine course which at the time took place at Farnborough.
The Basic Aviation Medicine course is a two-week course covering areas such as aeronautical knowledge, aviation physiology, incidents and accidents, legislation and regulations and space medicine.
Overall it was a great training experience and included having to go in a centrifuge! At the end of the course there is an exam which is required for the certification to become a Class 2 AME. The exam itself is quite difficult with a lot of physiology and requires a high mark to pass.
The course is now run at KCL and more information can be found here: https://www.kcl.ac.uk/study/postgraduate/taught-courses/easa-basic-aviation-medicine
Initially, you work with private pilots and build experience before you can work with commercial pilots (Class 1 AME) which is where the majority of the work is (the ratio of commercial to private pilots is around 4:1). In order to achieve this, you also need to complete a further two-week course in Advanced Aviation Medicine https://www.kcl.ac.uk/study/postgraduate/taught-courses/easa-advanced-aviation-medicine
More detailed guidance on certification process can be found here: https://www.caa.co.uk/Aeromedical-Examiners/Certification,-training-and-policy/Guidance-on-AME-Certification
Mostly examination of the pilots including assessment of visual acuity, colour vision (lots of warning lights are red or green), urine dip, blood pressure and a general systematic review of any medical problems that they have encountered since their last review. Mental health has become more important since Germanwings Flight 9525 (co-pilot Andreas Lubitz who was suffering with depression deliberately crashed a plane into the French Alps on 24 March 2015, killing himself and 149 other people). I am also occasionally commissioned to write reports based on other specialist assessments.
An important distinction is that I act as an agent of the CAA and I am not the pilot’s doctor so I cannot give medical advice.
The role is closely aligned with occupational health and those who are interested can also consider the Diploma of Occupational Medicine (more information can be found here https://www.fom.ac.uk/education/examinations/diplomas/doccmed)
The role is very rewarding and pilots are great bunch of people to work with. I find the regulatory environment interesting and I uncover a fair amount of undiagnosed pathology.
Having a portfolio career as a GP enriches you. I feel so privileged to be a GP and my portfolio career stimulates me, keeps my interest and rejuvenated my love of general practice. It has helped develop my career and prevented burnout. I believe having a portfolio role makes you a better GP as you can bring the experience back to your GP work.
The whole process was quite lengthy and it took 3-4 years before I was appointed to examine private pilots as at that time there were very few jobs as they only recruited as someone left, it was very much “dead mans shoes”. The process is costly and you have to attract your own client base as it is an open market. There are only around 135 AMEs in the country and pilots are loyal and superstitious so will often return to who has passed them before. At the beginning it can be difficult to break into.
The last 12 months have been challenging as during the initial lockdown medicals were suspended for 3 months, leaving quite a large hole in my working week. The aviation industry has been hit hard with covid.
There have also been changes with Brexit. The UK regulator CAA (Civil Aviation Authority) is now standalone and no longer part of EASA (EU Aviation Safety Agency). This means that my European authorised stamp overnight became a UK only stamp so I have had to reapply to several European authorities which has taken a lot of time and resulted in a loss of customer base as it depends on which airline the pilots fly with as to which authorisation they require.
In the past I have worked for the CAA to undertake audit work. All AMEs require oversight visits to check their equipment is calibrated, how they document and store information and how they consult etc. In this role I was lucky to be able to travel to Hong Kong, South Africa and Dubai (business class of course!).
I have been a non-executive director at HUC for 8 years. There are also similar roles at NHS trusts. GPs are uniquely placed to know what their customers are thinking and feeling so are often welcomed. I find it very rewarding and attend 2-3 board meetings. I can sometimes be involved with interviewing and disciplinaries. It is refreshing to do something different and mix with interesting people.
Opportunities usually arise via recruitment agencies. My advice would be to reach out and let them know that you would be interested and as things come along they will send opportunities for you to apply for.
I worked in the tribunal service 25 years. The chair is a lawyer however there is also a doctor and an advocate such as an OT, benefits advisor or someone who works with the CAB. My role was to provide medical advice to the panel. It is fascinating to hear stories of people and working with other professionals is very stimulating – it is interesting how information is interpreted differently by different professionals.
The commitment is around a day a month and although it is not particularly well remunerated there is a lot of personal development as it is very useful for general practice work. It is rewarding in a non-financial way as you help some of the most disadvantaged in society so it is a way to “give something back”.
For more information on recruitment see https://judicialappointments.gov.uk/non-legal-tribunal-member-roles/
One of my philosophies is to always try and think outside the box and be imaginative. Ask the question as nothing ventured nothing gained! Know your market worth and have confidence in yourself.
Don’t just dismiss a role because you have never done it before or because you think you won’t be good enough - give everything a moments consideration. Say yes to opportunities as you never know what will happen. For example, I ended up working with a professor in London shooting a video to demonstrate how to perform a clinic test which was an experience!