The Federal Aviation Administration published a report on pilot and air traffic controller mental health this Monday, which resulted from a study by a Mental Health and Aviation Medical Clearances Rulemaking Committee the FAA established in December.
Their work responded to rising concern over the FAA’s process for managing the certification of pilots and air traffic controllers who may be experiencing mental health issues. The Committee’s report suggests that certain marginalized groups, including women pilots, are more averse to seeking healthcare than their male counterparts.
However, the basis for this claim is a limited study of 154 female pilots.
Marginalized Groups More Averse To Healthcare
As the Mental Health and Aviation Medical Clearances Committee writes in its report, “The data suggest unique subpopulations within these groups face uniquely high rates of healthcare anxiety and avoidance, including young, female, and student pilots, when compared to other populations. These data suggest subpopulations may face unique barriers, which may become more pressing as the aviation workforce becomes increasingly diverse.”
However, looking more closely at the supporting data on which the committee based this conclusion, it refers expressly to the study ‘Healthcare related aversion and care seeking patterns of female aviators in the United States.’ This study is based on a small sample of the population, is not specific to mental health, and recommends further research.
As the study’s excerpt states:
“Females represent a growing proportion of pilots in the United States and data on healthcare seeking behavior in this cohort is sparse. We conducted an anonymous online survey of 154 female pilots and 131 female non-pilots in the United States. 83.7% of female pilots have experienced healthcare related aversion compared to 27.5% of non-pilots. 66.7% of female pilots had withheld information from a physician while 46.0% had delayed or forwent medical care due to concern for their medical status. Further studies should be conducted to inform policy change to address pilot healthcare barriers.”
Though the Committee expressly writes that the “subpopulations” experience “uniquely high rates” of aversion to healthcare “compared to other populations,” it supplies no like-to-like data on male pilots.
For comparison, a 2023 study by the Cleveland Clinic, based on 1,000 online survey participants, found that “83% of men have experienced stress in the last 6 months, but most are hesitant to seek professional help.”
If so, then the few women pilots engaged in the study are, for whatever reason, more aligned with the male population in their aversion to seeking medical care. This could suggest that the profession itself discourages seeking care.
Non-FAA Medical Care Can Be Detrimental To Pilot Careers
The FAA’s Mental Health ARC report details how diagnosis and medication prescribed by psychiatrists and other medical providers who are not trained in FAA requirements could negatively impact pilots’ careers and how the process of gaining medical clearances to fly should be improved.
One of the challenges for all pilots, according to the report, is covering healthcare costs. To get insurance to cover mental health treatment, some medical professionals may diagnose a different condition.
As they write:
“The US health insurance system typically only pays for ‘illness’ if it pays at all. Parity for mental health care is still an issue, as outlined by the National Alliance on Mental Illness (NAMI). Most typically, if someone seeks care for something that is not an ‘illness’ (e.g., dealing with the death of a child, marriage counseling, or work stress), it is not covered by insurance. Consequently, individuals either need to pay out of pocket, or the provider ends up attaching a diagnosis code to an individual’s bill so that the insurer will pay, resulting in the individual being labeled with an illness they may not actually have. This ‘upcoding’ can be especially problematic for pilots/controllers with respect to recertification because they may have been ‘diagnosed’ with a mental illness far more severe than what they were experiencing.”
In this sense, women pilots could be adversely affected. The American Psychiatric Association reported in 2017 that, “Physicians are more likely to diagnose depression in women compared with men, even when both genders have identical symptoms or similar scores on standardized measures of depression.” Additionally, the Association found, “Women are more likely to be prescribed psychotropic medications than men.”
The FAA’s guidelines have strict limitations on the types of medications pilots can take while still being allowed to fly. The Mental Health ARC’s review includes a comparative study of what prescriptions are permitted by the FAA and other civil aviation regulators and found a lack of agreement between them.
Is There A Growing Population Of Diverse Pilots In The U.S.?
I asked the FAA for data substantiating the Mental health ARC’s statement that aviation has become “increasingly more diverse” or that there is a “growing proportion” of women pilots, as the study the ARC cited suggests. The validity of those claims is relative to expectations.
The FAA shared pilot demographic data with me for this report.
- Over the last decade, from 2014 through the end of 2023, the total number of pilots in the U.S. in all categories, including students, recreational pilots, sports pilots, private, commercial, and airline pilots, as well as rotorcraft and glider pilots, increased by 26% from 593,499 to 806,940.
- The number of women pilots licensed in all categories more than doubled from 39,322 in 2014 to 82,817 in 2023. Still, women only represent 10.2% of the total licensed pilot population.
- Women make up only 5% of the U.S. airline pilot population, though their numbers increased by 49.9% from 6,408 in 2014 to 9,071 by 2023. The total number of airline pilots grew by 14% during that time, from 152,933 to 174,113.
- The average age of airline pilots in 2023 was 50.4, and the largest cohort (24.784) is between 55 and 59 years old.
- The average age of women airline pilots in 2023 was 44.8 years, with the largest cohort (1.170) of women airline pilots between 40-44 years old.
- The number of student pilot certificates the FAA issued monthly increased from 47,407 in 2014 to 69,503 in 2023.
Representation In Mental Health ARC Committee
The Mental Health and Aviation Medical Clearances Rulemaking Committee members include U.S. aviation industry trade associations, pilot and air traffic controller representative organizations, academia, and medical professionals.
The FAA would not confirm the demographics of the current group when I asked. However, a 2015 report on pilot mental fitness by the ARC showed a total of 42 ARC, observers, and medical working group members. Of these, six were women including one FAA Physician, Aerospace Medicine, who chaired the Medical Working Group.
In reply to my questions on the ARC’s claims on women pilots, the FAA referred me to their statement of April 1 in which they say they will review the recommendations from the Committee.
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