When Evidence Is Overruled: Growing Concerns About Decision-Making at the Top of the FAA Aeromedical Office

In recent years, pilots and other aviation professionals participating in the FAA’s aeromedical certification process have reported a troubling and increasingly consistent pattern: clinical recommendations and evidence-based decisions appear to be overridden at higher levels of the FAA hierarchy.

While individual cases vary, the pattern emerging across multiple aviation professionals suggests a deeper institutional problem within the FAA’s Office of Aerospace Medicine.

At the center of this issue are two key figures:

• Dr. Brett Wyrick, Deputy Federal Air Surgeon
• Dr. Susan Northrup, Federal Air Surgeon

Both play important roles in aeromedical decision-making, yet their actions appear to reflect very different approaches to the evaluation of pilots, air traffic controllers, and medical evidence.

A Pattern Pilots Are Beginning to Notice

Across several cases reviewed by members of the Pilots for HIMS Reform coalition, the same sequence appears repeatedly:

• A pilot or air traffic controller completes years of monitoring, testing, and compliance requirements.
• Clinical professionals—including HIMS psychiatrists, neuropsychologists, and HIMS AMEs—provide favorable evaluations.
• FAA officials indicate that advancement or relief from monitoring is appropriate.
• The expected decision is delayed, modified, or reversed.

In many of these cases, aviation professionals report receiving direct indications from FAA officials that progress was forthcoming—only to later encounter new restrictions, delays, or unexplained reversals.

The result is a growing perception that the aeromedical process is not governed solely by clinical evidence, but by internal decision-making dynamics that are not transparent to those affected.

Evidence-Based Medicine vs. Institutional Control

Those who have interacted with senior FAA medical officials often describe Dr. Brett Wyrick as someone who evaluates cases through a clinical lens—reviewing testing results, psychiatric evaluations, neuropsychological findings, and long-term monitoring data.

However, in a number of cases the expected outcomes have not materialized.

Instead, decisions appear to be revised or halted at higher levels of the FAA aeromedical hierarchy, creating confusion among both aviation professionals and the physicians responsible for evaluating them.

When evidence-based recommendations are overridden without clear explanation, the process begins to resemble administrative control rather than medical judgment.

A Key Question: Who Has Final Authority?

In multiple cases reviewed by Pilots for HIMS Reform, individuals report that Dr. Brett Wyrick indicated that advancement or relief from monitoring was medically appropriate based on the available clinical evidence.

However, in several of those same cases, the expected outcome did not occur.

Instead, the final decision was reportedly made at the level of the Federal Air Surgeon, Dr. Susan Northrup, resulting in continued monitoring or additional requirements.

Without clear explanations for these decisions, affected aviation professionals may perceive the process as subjective or administratively driven rather than medically determined.

The Human Cost of Uncertainty

For pilots and air traffic controllers, the consequences of these reversals can be profound.

• Frequent drug and alcohol testing
• Psychiatric evaluations
• Neuropsychological testing
• Peer monitoring
• Ongoing reporting obligations

When aviation professionals meet every requirement and receive favorable clinical evaluations, they reasonably expect the process to move forward.

Instead, unexplained delays or reversals create a sense that the system has no predictable endpoint.

This Issue Affects More Than Pilots

The FAA’s aeromedical system governs all aviation professionals who require medical certification, including:

• Airline pilots
• Corporate and charter pilots
• Flight instructors
• Air traffic controllers

Concerns about transparency and evidence-based decision-making therefore affect the broader aviation workforce responsible for maintaining the safety of the national airspace system.

Why Transparency Matters

The FAA’s aeromedical certification system plays a critical role in aviation safety.

However, oversight must also be predictable, evidence-based, and transparent.

When decisions appear to shift behind closed doors, the credibility of the system itself is put at risk.

Why These Patterns Are Now Coming to Light

For many years, aviation professionals navigating the FAA’s aeromedical certification process often felt isolated in their experiences.

Through organizations such as Pilots for HIMS Reform and a growing network of aviation professionals sharing their experiences, patterns that once appeared isolated are now becoming visible across multiple cases.

As more individuals speak openly about their interactions with the aeromedical system, a clearer picture is emerging—one that raises important questions about consistency, transparency, and how medical decisions affecting aviation careers are ultimately made.

A Growing Call for Accountability

• What criteria determine when monitoring ends?
• Who has authority to override clinical determinations?
• Are aviation professionals held in monitoring longer than medically necessary?
• What oversight ensures decisions remain evidence-based?

The Need for Independent Oversight

As these concerns continue to surface across multiple cases, they highlight a broader issue within the FAA’s aeromedical certification system: the absence of independent oversight over high-level medical determinations.

Pilots for HIMS Reform supports greater transparency, clearer medical standards, and independent review mechanisms to ensure aeromedical decisions remain grounded in evidence and consistent practice.