Why Are Pilots Being Diagnosed by a Doctor Who Isn’t a Psychiatrist?

For thousands of pilots, the FAA’s HIMS Program is more than a bureaucratic hurdle—it’s a process that determines whether they will ever fly again. At the center of this system are physicians who wield sweeping authority over pilots’ careers and livelihoods. But what happens when the official in charge has no specialized training in the conditions he claims to evaluate?

The Problem of Unqualified Authority

Dr. Matthew Dumstorf, a physician employed by the FAA, has emerged as a key figure in the HIMS Program. According to publicly available information, Dr. Dumstorf did not complete a residency in psychiatry or addiction medicine. Instead, he reportedly started in radiation oncology before moving into regulatory medicine. Yet today, he is tasked with overseeing pilots’ psychiatric and substance abuse determinations—some of the most sensitive and consequential judgments in all of aviation medicine.

If this sounds concerning, it should. In most areas of medicine, patients expect that the professional rendering a mental health or addiction diagnosis is board-certified and actively practicing in that field. In the FAA’s approach to HIMS, that expectation appears optional.

The Goldwater Rule: An Ethical Standard Ignored

The Goldwater Rule, an established principle of medical ethics adopted by the American Psychiatric Association, states:

It is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

This rule arose to prevent professionals from making remote diagnoses about public figures. In other words, you cannot ethically label someone as mentally unfit or addicted without direct examination, evidence, and consent.

But in the HIMS Program, we see a troubling inversion of this standard:

• First, Dr. Dumstorf is not a psychiatrist.
• Second, he regularly issues determinations that have the practical effect of diagnosing or labeling pilots, often in contradiction to treating physicians with actual psychiatric or addiction credentials.
• Third, pilots report that these determinations are frequently based on subjective impressions, administrative interpretations, or unsupported “expert” opinions that would never pass peer review in a clinical environment.

The result is a Kafkaesque process in which pilots can be declared unfit by an official who not only lacks psychiatric training but whose opinions are often treated as unreviewable.

A Culture of Overreach

What makes this more alarming is the arrogance and opacity with which such judgments are issued. Pilots have described decisions that appear retaliatory, arbitrary, or detached from any clear standard of care. And while regulators and medical boards are quick to discipline physicians for overstepping ethical boundaries in clinical practice, FAA physicians enjoy virtual immunity from meaningful accountability.

One can only wonder: What would happen if the same standards applied to these officials as to practicing doctors? If Dr. Dumstorf were required to defend his “diagnoses” before a professional peer board of psychiatrists, would they survive scrutiny?

What Should Change?

At minimum, pilots deserve:

• Transparency about who is making medical determinations.
• Verification that those individuals are properly trained and board-certified in the relevant specialty.
• Independent oversight so that one physician’s subjective opinion cannot override a pilot’s entire treatment team.
• Adherence to basic ethical principles, including the Goldwater Rule’s core insight: you cannot ethically label someone without a direct, evidence-based clinical evaluation.

Until these standards are adopted, the FAA’s approach to HIMS will remain vulnerable to abuse—and the careers of pilots will continue to be dictated by officials who may not be qualified to judge them at all.