Aviator Healthcare Hesitance: An Examination of Healthcare Avoidance, Pilot Mistrust, Presenteeism, & Risk

Main Article Content

Aric J. Raus


Safe aviation operations require pilots to maintain constant physical and psychological well-being.  While the FAA and pilot advocacy organizations encourage aviators to discuss health concerns with their medical providers, studies demonstrate continued healthcare hesitance behaviors.  This article explores possible factors impacting aviator healthcare hesitancy, including pilot personalities, financial considerations, and pilot mistrust. After providing a background of these areas, the article turns to research into the impact of presenteeism within the community, along with its associated personal and operational safety risks.  Ultimately, this article seeks to prompt and aid future research by providing an overview of the current literature on the prevalence and implications of healthcare hesitance in the aviation community. 

Article Details



Airplane Owners and Pilots Association. (2007). Regulatory Brief: Pilot Medical Applications Center of Congressional Investigation. https://www.aopa.org/advocacy/advocacy-briefs/regulatory-brief-pilot-medical-applications-center-of-congressional-investigation

Albright, J. (2017). 'Fixing' problem pilots: Find the solution from within (if possible). Business and Commercial Aviation, pp. 22-26. https://aviationweek.com/business-aviation/fixing-problem-pilots

American Airlines. (2012). 2012 Pilot Long-Term Disability Plan. Retrieved August 23, 2023, from https://my.aa.com/wp-content/uploads/2017/08/2012_LAA_Pilot-LTD-Plan-1.pdf.

Bostock, S., Crosswell, A. D., Prather, A. A., & Steptoe, A. (2019). Mindfulness On-The-Go: Effects of a Mindfulness Meditation App on Work Stress and Well-Being. Journal of Occupational Health Psychology, 24(1), 127-138. http://doi.org/10.1037/ocp0000118.

Britt, T. W., & Long, C. P. (2016). Waivers for mental health disorders in the aviation components of the armed forces: Recommendations for improving evidence-based decisions and aviator return to duty (USAARL Report No. 2016-11). United States Army Aeromedical Research Laboratory. https://apps.dtic.mil/sti/pdfs/AD1007460.pdf

Britt, T. W., McGhee, J. S., & Quattlebaum, M. D. (2018). Common mental disorders among US Army aviation personnel: Prevalence and return to duty. Journal of Clinical Psychology, 74(12), 2173–2186. https://doi.org/10.1002/jclp.22688.

Daku, S. (2021). Mental Health Survey of UND Students. UND Aviation Mental Health Summit. Chicago: https://www.youtube.com/watch?v=zNUA7dL_mgo&list=PLwxMPKSgEvgzXjHmB85x86Ts_IICdbhVK&index=4.

Federal Aviation Administration. (2023a). Application for Medical Certification (FAA Form 8500-8). https://medxpress.faa.gov/MedXPress/Help/Instructions.htm.

Federal Aviation Administration. (2023b). Guide for Medical Examiners: Decision Considerations. https://www.faa.gov/ame_guide/app_process/exam_tech/item47/amd.

Federal Aviation Administration. (2023c, October). Pilot Mental Fitness. https://www.faa.gov/pilot-mental-fitness

Fraher, A. L., & Gabriel, Y. (2014). Dreaming of flying when grounded: Occupational identity and occupational fantasies of furloughed airline pilots. Journal of Management Studies, https://doi.org/10.1111/joms.12081.

Frantell, K. (2021, December 15). Mental Health Help-Seeking [Conference Session]. University of North Dakota Aviation Mental Health Summit. Chicago, IL, United States. https://www.youtube.com/ watch?v=zNUA7dL_mgo&list=PLwxMPKSgEvgzXjHmB85x86Ts_IICdbhVK&index=4.

Geil, L. (2023). FAA easing mental health barriers for pilots. Airline Owners and Pilots Association. https://www.aopa.org/news-and-media/all-news/2023/may/18/faa-easing-mental-health-barriers-for-pilots

Hadjistavropoulos, H. D., McCall, H. C., Thiessen, D. L., Huang, Z., Carleton, R. N., Dear, B. F., & Titov, N. (2021). Initial outcomes of transdiagnostic internet-delivered cognitive behavioral therapy tailored to public safety personnel: Longitudinal observational study. Journal of Medical Internet Research, 23(5), https://doi.org/10.2196%2F27610.

Hoffman, W.R. (2021). Hiding in plain sight: U.S. aviation healthcare anxiety, aversion and delay. UND Mental Health Summit. Chicago, IL, United States. https://www.youtube.com/watch?v=zNUA7dL_mgo&list= PLwxMPKSgEvgzXjHmB85x86Ts_IICdbhVK&index=4.

Hoffman, W. R., Aden, J. K., Barbera, D., & Tvaryanas, A. (2023). Self-reported health care avoidance behavior in U.S. military pilots related to fear for loss of flying status. Military Medicine, 188, e446-e450. https://doi.org/10.1093/milmed/usac311.

Hoffman, W. R., Aden, J., Barbera, R. D., Mayes, R., Willis, A., Patel, P., & Tvaryanas, A. (2022). Healthcare avoidance in aircraft pilots due to concern for aeromedical certificate loss. Journal of Occupational and Environmental Medicine, e245-e248. https://doi.org/10.1097/JOM.0000000000002519.

Hoffman, W. R., Barbera, R. D., Aden, J., Bezzant, M., & Uren, A. (2021). Healthcare related aversion and care seeking patterns of female aviators in the United States. Archives of Environmental & Occupational Health, 77(3), 234-242. https://doi.org/10.1080/19338244.2021.1873093.

Hoffman, W., Chervu, N., Geng, X., & Üren, A. (2019). Pilots' healthcare seeking anxiety when experiencing chest pain. Journal of Occupational and Environmental Medicine, 61(9), e401-e405. https://doi.org/10.1097/jom.0000000000001662.

Johansson, F., & Melin, M. (2018). Fit for flight? Inappropriate presenteeism among Swedish commercial airline pilots and its threats to flight safety. The International Journal of Aerospace Psychology, 84-97. https://doi.org/10.1080/24721840.2018.1553567

Kurukulaadithya, T., Nair, R., Tariq, W., Wall, J., & Rodwell, J. (2023). The career adaptability and support structures of pilots losing medical certification. Social Sciences, 4, https://doi.org/10.3390/socsci12040237.

Medical certificates: Requirement and duration, 14 C.F.R. § 61.23 (2022). https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-61#61.23.

National Business Aviation Association. (2023, July 19). FAA Effort Underway to 'Reconcile' Pilot Medical Records Among VA Disabilities Recipients. https://nbaa.org/flight-department-administration/personnel/medical/faa-effort-underway-to-reconcile-pilot-medical-records-among-va-disabilities-recipients/

Nestor, M. S., Lawson, A., & Fischer, D. (2023). Improving the mental health and well-being of healthcare providers using the transcendental meditation technique during the COVID-19 pandemic: A parallel population study. PLoS One, 18(3), https://doi.org/10.1371/journal.

Nowadly, C. D., Blue, R. S., Albaugh, H. M., Mayes, R. S., & Robb, D. J. (2019). A preliminary study of U.S. Air Force pilot perceptions of the pilot-flight surgeon relationship. Military Medicine, 184(11-12), 765–772. https://doi.org/10.1093/milmed/usz088.

Pacific Neurobehavioral Clinic. (2023, June 15). FAA Neuropsychological and Psychological Evaluations. https://www.neuropacific.com/evaluations/faa-hims-neuropsychological-and-psychological-evaluations/

Patel, P. K., Hoffman, W. R., Aden, J., & Acker, J. P. (2023). Healthcare avoidance amongst Canadian pilots due to fear of medical certificate loss: A national cross-sectional survey study. Journal of Occupational and Environmental Medicine, http://doi.org/10.1097/JOM.0000000000002838.

Snyder, Q. (2021, December 15). Aviation Mental Health Summit Overview [Conference session]. University of North Dakota Aviation Mental Health Summit. Chicago, IL, United States. https://www.youtube.com/watch?v=NK0Onz22XGk&list= PLwxMPKSgEvgzXjHmB85x86Ts_IICdbhVK&index=3.

Southwest Airlines Pilot Association. (2016). What if you get sick and injured and can't fly? https://swaparesources.s3-us-west-2.amazonaws.com/assets/pdf/Benefits/What_If_ Benefits_Booklet.pdf?mtime=1442434641.

Weis, K. (2023, August 25). "Pilots are crying out for help": Pilots criticize FAA for outdated, prohibitive mental health policies. https://www.cbsnews.com/colorado/news/pilots-crying-out-help-pilots-criticize-faa-outdated-prohibitive-mental-health-policies/

Wu, A. C., Donnelly-McLay, D., Weisskopf, M. G., McNeely, E., & Betancourt, T. S. (2016). Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey. Environmental Health, 15(121), https://doi.org/10.1186/s12940-016-0200-6.