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First-Class Medical Certificate: Everything Aspiring Airline Pilots Must Know

By Brock Willes on Jun 23, 2026 18:06 PM |

A career as a pilot in the United States involves meeting a variety of demands. In addition to completing flight training and passing a number of tests, you’ll need to meet strict eligibility requirements set by the Federal Aviation Administration (FAA). An important part of those requirements is earning your first-class medical certificate — which ensures that you don’t have any underlying health conditions that affect your ability to fly safely.

By understanding all requirements before you get any further into your flight training, you’ll have a better idea of what to expect and can move forward with greater confidence.

What Is a First-Class Medical Certificate?

A first-class medical certificate is the FAA’s highest level of medical certification and is required for all Airline Transport Pilots, including captains and first officers. Its purpose is to demonstrate that a pilot is both physically and mentally fit to fly a plane safely. Pilots must pass an exam conducted by an FAA-designated Medical Examiner (AME) under 14 CFR Part 67.

The FAA relies on a web-based portal called MedXPress for all pilots (or student pilots) applying for a medical certificate. Through this system, pilots complete FAA Form 8500-0 electronically ahead of their examination and receive a confirmation number that the AME will collect to begin the exam.

On the FAA website, pilots can use the Designee Management System to find an AME by clicking on the “Find Designees” button toward the top of the page.

First-Class Medical Certificate Requirements

So, what does it take to earn a first-class medical certificate through the FAA? There are four main categories of testing, each with its own specific standards.

Vision

For starters, applicants must have 20/20 vision in each eye with or without correction. This includes 20/40 near at 16 inches and 20/40 intermediate at 32 inches for all pilots age 50 and older, as well as color vision that is deemed sufficient for carrying out pilot duties.

Hearing

From a hearing standpoint, pilots are required to pass a conversational voice test at six feet or an audiometric test. Pilots who wear hearing aids may use them during the exam. In other words, pilots don’t need to have naturally perfect hearing to fly.

Cardiovascular

While there are no specific blood pressure thresholds for airline pilots, blood pressure must be controlled and considered non-risky for flying. As part of the examination/certification process, pilots must submit to an EKG at the age of 35 and then annually from age 40 onwards.

Mental/Neurological

Any history of neurological events, psychiatric diagnoses, or medication use must be carefully reviewed by the FAA with special attention to cognition, consciousness, and judgment.

In addition to the above categories, all pilots must submit to a general examination of the ears, eyes, nose, throat, heart, lungs, abdomen, and musculoskeletal system. A urinalysis must also be conducted at every exam.

How Long Are First-Class Medical Certificates Valid?

Upon passing the exam, first-class medical privileges are valid for 12 months for pilots under the age of 40. After age 40, exams must be completed every six months. When this period expires, the privileges are automatically downgraded to second- or third-class, which is why staying on top of exams is so important.

Keep in mind that expiration dates are calculated from the last day of the month the exam was conducted, not necessarily the exact date of the exam itself.

First-Class Medical Disqualifiers: What Could Ground You

The FAA maintains a list of specific conditions or diagnoses that could disqualify pilots from earning a first-class medical certificate under 14 CFR Part 67. Examples of disqualifying conditions include:

Angina pectoris
Bipolar disorder
Cardiac valve replacement
Coronary heart disease (with symptoms or treatment required)
Diabetes mellitus requiring insulin or oral hypoglycemic medication
Disturbance of consciousness without satisfactory medical explanation
Epilepsy
Myocardial infarction
Permanent cardiac pacemaker
Psychosis
Substance dependence or abuse within the previous two years
Transient loss of nervous system function without satisfactory explanation

For pilots who have been diagnosed with a disqualifying condition but can demonstrate that their condition is stable and unlikely to impair their ability to fly, the FAA has designated the Special Issuance Authorization (SI) process. Even upon obtaining an SI, however, pilots must submit to regular check-ins to prove that their condition is being managed.

For pilots with static or non-progressive medical conditions, a Statement of Demonstrated Ability (SODA) may be obtained on a one-time basis, serving as a permanent waiver under certain circumstances.

If you have any known medical conditions and plan to apply for a first-class medical certificate, it’s always best to disclose them upfront on your MedXPress application rather than to omit them and have them come up later on.

Why Aspiring Pilots Should Get Their First-Class Medical Before Starting Training

Although pilots aren’t necessarily required to obtain their first-class medical certificate before they begin flight training, doing so is generally recommended. If an issue can be identified sooner rather than later, pilots have time to pursue a Special Issuance, consult with an aviation medical specialist, or make an informed decision about how to proceed before dedicating the time and money to flight training or flight school.

As part of our admissions process at Phoenix East Aviation (PEA), our application asks for your FAA Medical Class and date. If you’re feeling overwhelmed by the process or simply don’t know where to begin, our Student Services team is always happy to assist. We can help with locating an AME, scheduling an appointment, or answering any questions you may have.

Learn More in a Professional Program at PEA

At PEA, we believe that obtaining a first-class medical certificate is the foundation on which a pilot’s career should be built, not a box to check later on. Upon earning your certificate, you can move forward in your flight training with confidence and focus on the next steps toward achieving your goals as an aviator.

Still looking for a flight training program that suits your needs? Check out PEA’s professional flight training programs, or take the next step by filling out your application today.

FAA Medical Certificate Frequently Asked Questions

Do I need perfect 20/20 natural vision to get a first-class medical certificate?

No; you don’t need 20/20 natural vision to obtain your certificate, as vision can be tested with or without correction.

Can a medical condition or past diagnosis disqualify me permanently?

Not necessarily. Even among the list of potentially disqualifying medical conditions published by the FAA, there is always the possibility of obtaining a Special Issuance if you can demonstrate that the condition is managed and poses no threat to safety.

When should I get my first-class medical: before or after starting flight training?

It’s always best to obtain your first-class medical certificate before you begin flight training. This way, you can identify any potential issues early and seek an SI if applicable.