I’ve had a lot of physical exams in my lifetime, but never did I feel so much uncertainty about the process and outcome as with my initial flight physical for the Air Force. This is high stakes stuff, too - if something untoward is found, you may be stuck with the choice of 1) picking another job that you don’t want, or 2) not joining the Air Force after all.

As a physician, I paid close attention to the whole flight physical affair, not only out of morbid curiosity about how the organization does medicine, but also so I could help explain it to those that came later (hence this blog). It was certainly an immersive personal adventure in bureaucracy, to say the least.

Here, I attempt to distill the details I wish I had known before nervously showing up to my first flight physical.

(Towards the bottom, after the flight physical checklist is described, I included specific logistical details at Wright Patterson Air Force Base - the flight med mecca - for those who will do physicals there.)

FLYING CLASS I, II, or III?

You should arrive to your physical knowing what flying class you are shooting for. This matters because each class comes with its own standard: more or less tests, stricter criteria, variable likelihood of a waiver, 1 or 2 fingers on the rectal exam, cold or warm lube... you get the idea.

Since pilots are expensive to train, those entering Undergraduate Pilot Training (UPT) have the highest standards for entry, thus are Class I. After this initial physical, pilots then fall into Class II for the rest of their careers. Flight docs and Remotely Piloted Aircraft (RPA) pilots do an initial Class II physical. Class III is for AFSCs that fly but don’t control the aircraft (non-rated) such as loadmasters, Special Mission Aviators, CSOs, and the like. This includes Special Warfare AFSCs and others that suffer through this en route to other job-specific evaluations.

DRESS CODE

Military members wear utility uniforms (OCP, ABU). No one wore a flight suit in my group, so I’m not sure it;s authorized. Still a civilian at the time, I wore business casual. No tie. Clothes were doffed often; shoes that are easy to take on and off are advised. There was nothing like MEPS where you stood around doing weird poses in your underwear with a bunch of other people. Sensible clean undergarments are still advised.

THE FLIGHT PHYSICAL

There is a long list of tests and exams involved in the flight physical, listed below in the checklist. There is no specific order, with the following exceptions: 1) you see the dentist after the dental x-ray; 2) you see the ophthalmologist for your exam after all the eye tests; and 3) the flight surgeon is your last stop.

Your experience will vary based on the size of the group you are in, what issues they find, and sheer luck. To expedite my processing (benefit of being the only doc in a group of pilots), I was sent to the hospital for labs, urine test, chest x-ray, and EKG first thing in the morning. The rest of my group went to USAFSAM to sign in and get started, and then came over en masse later that day, when the lab was much busier with routine patients. The hospital is walking distance from lodging in the same Area. Expect to fast for 12 hours beforehand. Lucky me: they messed up my blood tests, so I had to fast again the next night too.

Flight Class I applicants have the pleasure of four hours of computer-based neuropsychological testing during the physical. My recollection is that this was divided up into 1-2 hours blocks. It is described best by the USAFSAM website details pasted here:

The primary purpose of the psychological portion of medical flight screening is to establish baseline psychological testing data for each new USAF pilot. This baseline data is used as part of a comprehensive medical examination of aviators who sustain head injury, in order to make recommendations to return to flying. With this data, psychologists can make pre- and post-injury comparisons. Each pilot candidate must take a neuropsychological screening battery and an aptitude test. No one is eliminated from training based on the results of these tests. The neuropsychological screening battery uses both visual and auditory information to evaluate brain functioning.

Below is a brief description of the items on your flight physical checklist

Medical history

Someone goes through all of your paperwork with a fine-toothed comb. You may want to refresh your memory on your answers before you leave home.

Dental

Standard dental x-rays and then quick exam by a dentist. Hot tip: if you have not been to a dentist in the last year, go to a civilian one before your flight physical. Even cavities can get you (temporarily) disqualified, so get any work you need done in advance.

Anthropometrics

Various measurements to ensure you can fit into, and function in, an aircraft appropriately. I’m told this is designed around ejection seat aircraft, but the measurement requirements do vary a little bit by your flight class. Check this USAFSAM link for more.

Vital signs

Just like MEPS. Don’t drink coffee or energy drinks that morning. Many guys had to hang out waiting on their blood pressure to come down to a passable level.

Audiogram

Hearing test in a dark booth; push the button when you hear the beep. I was sitting in there for several minutes straining to hear the beeps, thinking the test had begun. They’ll tell you when it’s about to start.

EKG

Ten stickers. Men may lose a little chest hair here. See 40 Year Old Virgin flashback.

Echocardiogram

A heart ultrasound isn’t universally required, but may be done if something comes up in your medical history, EKG, or chest x-ray.

Blood tests and urine drug screen

Be sure you are well hydrated for both of these. Seriously, suck up the bladder pain and just hold it until you get to the lab. Don’t make everyone wait on you to perform. Unlike MEPS, you get to pee in the privacy of the bathroom without an observer.

Chest x-ray

Take your shirt off and stand there. Smile for the camera.

Eye tests

Listed in the checklist in bold. Basically, you go into a series of rooms that have a series of machines - some of which you’ve never seen, even at the fanciest eye doctor office. Here’s a link to info from USAFSAM. This is the portion where some very subtle conditions you never knew you had may come and bite you. Flight medicine has a huge hard-on about eyes, and very little tolerance for eye issues.

The dilated (cyloplegic) eye exam is entertaining, because it results in a room of wide-eyed people who just sit and stare off into space for hours, since your eyes can’t focus on anything up close. It was a visible struggle for the 20-somethings who were unable to use their phones for that long. Due to quirks of my vision and glasses, I was able to read a book and my phone with glasses on, and watch the TV with them off (opposite of my everyday life). They do let you drive back to lodging like this; be smart about it – if you don’t feel safe driving with your vision wonky, get someone to give you a ride.

Flight surgeon

This is your last stop where your medical history and all of your tests will be reviewed again. The flight surgeon will work on any waivers that can be submitted, or let you know if you are shit out of luck. There can be some serious uncertainty when you leave that office.

AFTERWARDS

The physical takes 2-3 days, but will last longer if you need additional or repeat testing based on medical conditions you came with, or that were discovered there. Applicants generally come out on orders for 5-7 days to cover any contingencies. As soon as I heard my physical was over, I called and had my flights changed and started the process to amend my orders. I didn’t want to stay in freezing Ohio for any longer than I had to. Your willingness to hang out and enjoy time away from home may vary.

We were told it could take 45 days to receive the flight physical results, which is an average. If you require waivers, it may be weeks to months longer. Mine came back in less than a month.

PARTING ADVICE

There is no magic to this, no tricks. You can’t really practice any of the elements like you could in MEPS (yes, duck walk, I’m talking to you). Be honest and comprehensive when you complete the initial paperwork, and pay close to attention to all of the instructions you’re provided. Since your dream career is on the line, I know it can be tempting to fudge a little. I can tell you that these little “oversights” on the initial flight physical application come back to haunt you later in your training or career.

BONUS Material: Wright Patterson AFB Logistics

The mecca of initial flight physicals is USAFSAM - the USAF School of Aerospace Medicine – which is located at Wright-Patterson Air Force base outside of Dayton, Ohio. The base has a large footprint with all of the major things: food court, commissary, gyms, Exchange, etc. The surrounding towns are a bit run down, but have some really good food and decent amenities if you venture out.

Parenthetically, the “Wright” in Wright-Patterson refers to Orville and Wilbur, who ran their bike shop and developed their airplanes in Dayton; early flight tests happened at Huffman Prairie on base. Aerospace history is also on display locally at the wonder of all flight museums: the National Museum of the US Air Force, which is an unreal jewel. If you have any time at all before or after your physical, go there (it’s on the edge of the base, open to the public, and FREE!). The gift shop alone could occupy you for hours.

Fly into Dayton International Airport (DAY), which is nowhere near the base. Try to get your unit to rent you a car, otherwise pay out of pocket (I did and it was worth every penny), or add $50 each way to your orders for a cab/Uber.

The base is divided into different “Areas,” some of which are geographically separated from the others. Pay attention to the map and where you need to be. Only a couple of the gates are open after hours too, and Google Maps loves to lead you to dead ends in the middle of the night here; be sure to ask what gate to go through when you schedule your lodging.

LODGING

Lodging is pretty typical 80’s style base hotel dwellings, single occupancy (for the officers at least). If you are not going to arrive by 1800, you MUST call the front desk and give them a credit card number, or else they will release your room. This definitely happened to folks I know, and the alternatives aren’t awesome. Wifi is free, but not very fast. There is zero food nearby, so bring snacks, or eat before you get on base. The area is flat and tree-lined for running, and a gym is in walking distance.

USAFSAM

The USAFSAM building is in a different Area than lodging, and is a good ten minute drive away without traffic. Beware the long line at the security gate in the morning. There is limited parking if you decide to rent a car and drive yourself. Be careful of Google Maps here too – mine tried to kill me by directing me the WRONG WAY around a roundabout. Having lived in Australia for a bit, I was almost fooled.

Once you sign in, join your group in a small conference room behind the security desk. That is your hurry up and wait home base for each day. You hang out and watch VHS (I’m not kidding) movies until it’s time for the various tests. You can bring phones, tablets, and laptops, but the wifi is terrible to non-existent there in the basement.

Upstairs is a small café which has snacks, hot food, and coffee/espresso. It is a welcome sight once you are allowed to eat and drink again. There is decent wifi on this floor near the windows. A short walk away across the parking lot is a small convenience store and a Burger King.

P.S.
There’s no rectal exam involved; that was just a little doctor Joke.

Leave a comment if you have been to the flight physical recently and know about any recent changes to the process, had a different experience, or have any questions.

REFERENCES

AFI 48-123: Air Force Medical Examinations and Standards

DoDI 6130.30: Medical Standards for Appointment, Enlistment, or Induction in the Military Services

Air Force Medical Standards Directory and the Waiver Guide (.mil domain, CAC-access only)

The Air Force Initial Flight Physical Checklist