I got my FAA medical renewed today in the US, and decided for sure that no matter what FAA does with ‘reform’ I’ll be sticking with the tried and true no hassle (for me) 3rd Class medical. My AME operates half way between my home and office. I made the appointment at noon, did the MedXPress thing on my lunch hour, left work at 4:45 and was home by 5:35, $125 less in my wallet but with new medical in hand and good for another two years without further attention. Unless I develop some medical issue there is no way that going to GP etc is going to be simpler for me.
The issue is this compromise described in the AOPA FAQs that in my mind makes the ‘reform’ valueless unless the current system is causing you problems and you want to try another parallel system. The original goal was to eliminate the system, not replace it with another having less qualified doctors and less clear government guidance.
At least once every four years, you’ll need to visit a state-licensed physician. At the visit, you’ll need to provide your physician with an FAA-generated checklist, and your physician will need to certify that he or she has performed an examination and discussed all the items on the checklist, including medications, with you. Your physician will have to certify that he is unaware of any medical conditions that, as presently treated, could interfere with your ability to safely operate an aircraft. You will then need to make a note of the visit and include the completed checklist in your logbook. You do not need to report the outcome of the visit to the FAA unless you are specifically requested to do so.
I think the main opportunity this presents is the opportunity to fake the checklist (and physician sign off) for your logbook, understanding that it’s not on file with FAA and its highly unlikely anybody but you will ever look at it. Then it becomes between you and your insurance company to prove whether it’s genuine, if it comes to that. Otherwise, I think the UK experience has already proven that quasi certification by non-AME doctors does not lead to simplification, and it often leads to more complexity and the same costs. The FAA third class medical is already a fairly simple thing with no EKG etc so given that so far I have zero issues to report every two years I’ll be joining those outside the US in maintaining my FAA (third class) medical. 
I have a special issuance of a third class medical and go thru an annual medical exam regimine that takes about 30 days to get all my doctor visits in to prepare a report that is highly bureaucratic. I usually lose my flying privileges for 30 days because it takes the FAA longer than that to review my data in the que. I already know I will pass, it is merely a bureaucratic process. I have diabetes type 2 and am overweight. I must get an eye exam and letter for any diabetic eye disease. I must get a sleep doctor to prepare a report based on my compliance with my CPAP. I must get an annual cardiac stress test and exam along with a report including a CD with EKG and stress test results. I then must meet with my GP and get a general health review and blood tests for all sorts of things. He must then write a report testifying to my medications, BP history, lab results, A1C, and other stuff. My heart doctor would not do a stress test annually but would just do one every three years, based on my previous annual results. At my choice, I would visit my other doctors including the sleep doctor, and eye doctor, once per year, but they would not have to produce a report. I visit my GP usually once per quarter, but he would only need to provide a certification which is much less than he currently does every few years.
So, for me and other pilots of my vintage, this is a major deal. In effect the Sport Pilot form of medical has proven it is satisfactory over ten years. This is moderately more involved than the sport medical and requires at least a medical in the past 10 years or an SI medical which is what I get every year. I don’t fly professionally and don’t need a medical now to instruct. This change basically provides those like me with relief and certainty, saves gobs of money on doctor visits that are not medically necessary, and avoids the bureaucracy. Pilots are currently required to self ground themselves when they are sick, and this change does not affect this.
Thanks for that input, NCYankee.
I can see how this medical regime works. The biggest issue (from the authorities’ POV) with the current aviation medical system is that everybody has an incentive to not disclose stuff. And “everybody” plays this game to varying degrees, with the Germanwings suicide at the top and working down from there. By tying this to a GP (personal doctor) involvement (which ensures most conditions will be discovered, short of the pilot travelling abroad for every aspect of a treatment) and tying it to a driving license (which ensures the pilot doesn’t want to kill himself while driving, because he needs to read road signs etc to drive usefully at all, and gross inability to drive will eventually get you picked up by traffic police) this will work fine. It’s not what AMEs want the system to be, and it isn’t ICAO compliant, but it works.
Pilots are currently required to self ground themselves when they are sick, and this change does not affect this
That’s a big difference between the FAA system and EASA MED here. The FAA publishes a list of self grounding conditions. The EASA equivalent is a few hundred pages of self grounding conditions – basically anything preventing a fresh medical to be issued grounds you. That in turn ensures that pilots fail to disclose just about everything they can.
Peter wrote:
It’s not what AMEs want the system to be, and it isn’t ICAO compliant, but it works.
I think it’s what the AMEs wanted, and it was a political compromise with them to get this bill passed. It’ll be less cumbersome to those who can barely pass the exisitng medical, with a lot of supporting documentation required to do so. However I think most FAA pilots (numerically) don’t have complex medical issues, and are going to continue paying AMEs for a 3rd class medical. They’ll continue to take the path of least resistance. If you don’t have substantial medical issues the FAA 3rd class medical is trivial and involves no access to your medical records. By comparison, talking a non-aviation physician into voluntarily signing you off every four years, plus taking new online training, is going to be a pain in the rear.
The original intent was to expand existing Light Sport medical protocol, which involves zero medical exams of any kind, to GA more generally. That failed politically, not on a logical basis. What has emerged will be useless for most FAA private pilots, most of whom understand that its wiser, if possible, to avoid mixing your personal medical care with your FAA medical certification.
Peter wrote:
By tying this to a GP (personal doctor) involvement (which ensures most conditions will be discovered, short of the pilot travelling abroad for every aspect of a treatment)
There is no common database of medical records between US state licensed physicians.
Silvaire, you need to check the number of special issuances that are issued. If you include first, second and third class physicals, there are about 36,000 special issuance medicals issued per year in the US. This affects more and more pilots, particularly as they age. By the time the pilot reaches 55, about 10% of the third class medicals are via special issuance. That grows to 20+% by age 65. A special issuance still qualifies the pilot to obtain a medical, but with much more data being required. Overall. about 6.3% of medicals are obtained by special issuance. Often the pilot simply gives up or is unwilling to go thru the extra hassle and expense to maintain their medical. Many of these pilots just sell their airplane and if they remain flying, they go the sport pilot route.
Peter wrote:
In any case, this medical is sub-ICAO and thus won’t be valid outside US airspace.
That is true, but there is no medical required, only a valid US drivers licence which is not a medical certificate of any kind. Pilots who want to fly internationally can still obtain a medical and I believe the pilot must have held a valid medical within the last 10 years without any denial of the medical in order to take advantage of this.
NCYankee wrote:
Overall. about 6.3% of medicals are obtained by special issuance. Often the pilot simply gives up or is unwilling to go thru the extra hassle and expense to maintain their medical. Many of these pilots just sell their airplane and if they remain flying, they go the sport pilot route.
If and when I ever get to specially issuance and am looking at leaving the 93.7%, I’ll quit or go Sport Pilot. One of my planes now is Sport Pilot eligible so I don’t actually need a medical now. If that’s the kind of flying that’s making me happy, I’ll just stop renewing my medicals. Otherwise I’ll quit, flying isn’t important enough to me to deal with additional nonsense, it’s one of several activities I enjoy. When a medical certification becomes more than one hour every two years, I’ll be doing other things instead. There’s no way I’m going to hassle with anything other than a 3rd Class medical, including this half-assed FAA ‘reform’. The right solution is no medical certification at all.
My wife and I combined weight less than many people, so BMI is not and probably will not be a problem 
Also good for aircraft performance.
You might wanna stick with the normal 3rd class a little longer……
(source: https://www.aopa.org/news-and-media/all-news/2015/december/09/third-class-medical-faqs )
