A first class medical certificate is required to act as pilot in command under an airline transport pilot certificate, and it is the strictest of the three FAA medical standards. Used for ATP pilot-in-command privileges it lasts 12 calendar months if you were under 40 at the examination and 6 calendar months if you were 40 or over, and it adds an electrocardiogram at the first application after your 35th birthday and annually after your 40th.
If you are thinking about an airline career, the most important sentence on this page is the next one: take the first class medical before you spend anything substantial on training. Our guide to FAA medical certificate classes compares all three classes and BasicMed; this page is about the first class specifically and about the timing decision that sits around it.
Who Is Legally Required To Hold One
Fewer people than you would think. Under 14 CFR 61.23(a)(1) a first class medical certificate is required when you are exercising the pilot-in-command privileges of an airline transport pilot certificate, when you are second in command in a Part 121 flag or supplemental operation that requires three or more pilots, and when you are serving as a required pilot in Part 121 operations at age 60 or over.
Everything below that — commercial flying, flight instructing, charter work as second in command outside those categories — is legally satisfied by a second class. A first class is not required to hold a commercial certificate, to instruct, or to build hours. It is required to command an airliner.
Why You Should Still Take One On Day One
The regulation is about what you are doing today. The decision is about what you want to be doing in five years, and the two are not the same problem.
An airline career built on a Part 61 route runs through a private certificate, an instrument rating, a commercial certificate, a multi-engine rating and usually a flight instructor certificate before anyone hires you. Our Airline Pilot Career Program takes about nine months and costs $84,000. That is a large amount of money to commit before knowing whether the FAA will certificate you to the standard the job requires.
A first class examination costs more than a third class — a difference measured in tens of dollars, not thousands — and it answers the question definitively. If you pass a first class examination, every door is open. If something in your history is going to be a problem at the airline standard, you find out in an examiner's office in an afternoon rather than after two years and most of the tuition.
There is no downside to the choice, because of how 14 CFR 61.23(d) works. A first class certificate does not become useless when the first class window closes. The same certificate keeps authorizing commercial privileges for 12 calendar months and private privileges for 60 or 24 calendar months depending on your age at the examination. Taking a first class instead of a third costs you nothing in coverage.
The First Class Standards
The standards are in 14 CFR Part 67, Subpart B. They are the same in structure as the third class standards, with two areas tightened.
| Area | First Class | Third Class |
|---|---|---|
| Distant vision | 20/20 or better in each eye separately, with or without correction (67.103) | 20/40 or better in each eye separately (67.303) |
| Near vision at 16 inches | 20/40 or better in each eye separately | 20/40 or better in each eye separately |
| Intermediate vision at 32 inches | 20/40 or better in each eye separately, from age 50 | Not required |
| Electrocardiogram | Required at the first application after the 35th birthday and annually after the 40th (67.111) | Not routinely required |
| Hearing | Conversational voice at 6 feet or an approved audiometric test | Same |
| Mental and neurologic | Same listed diagnoses as third class, 67.107 and 67.109 | 67.307 and 67.309 |
Note what the vision standard actually says: 20/20 or better in each eye separately, with or without corrective lenses. Glasses are fine. Contact lenses are fine. Corrective surgery is fine once healed and stable. What matters is the corrected result, and an applicant who reads 20/20 through spectacles meets the first class standard with a "must wear corrective lenses" limitation on the certificate. Our page on flying with glasses goes through it in detail.
The Electrocardiogram Schedule
14 CFR 67.111(b) requires a first class applicant to demonstrate the absence of myocardial infarction and other clinically significant abnormality on electrocardiographic examination at the first application after reaching the 35th birthday, and on an annual basis after reaching the 40th birthday. Under 67.111(c) an electrocardiogram satisfies the requirement if it is dated no earlier than 60 days before the application it accompanies.
Practically: below 35, no routine ECG. At your first first-class application after turning 35, one ECG. From 40 onwards, one every year. Most examiners perform it in the office and bill it as part of the visit or as a separate line item.
The Cardiovascular History Standard
67.111(a) lists what cannot appear in the history for an unrestricted first class: myocardial infarction, angina pectoris, coronary heart disease that has required treatment or that has been symptomatic or clinically significant if untreated, cardiac valve replacement, permanent cardiac pacemaker implantation, and heart replacement. Every one of those is nonetheless certificated under special issuance every year. The list describes what blocks a routine issuance, not what ends a career.
How Long A First Class Medical Lasts
A first class certificate carries four parallel expiry dates under 14 CFR 61.23(d), all running from the same examination.
| Privileges Being Exercised | Age At Examination | Valid Through The Last Day Of |
|---|---|---|
| ATP pilot in command, and the Part 121 operations in 61.23(a)(1) | Under 40 | The 12th month after the month of the examination |
| ATP pilot in command, and those Part 121 operations | 40 or over | The 6th month after the month of the examination |
| Commercial pilot, or flight engineer | Any age | The 12th month after the month of the examination |
| Private, recreational, student, sport or flight instructor | Under 40 | The 60th month after the month of the examination |
| Private, recreational, student, sport or flight instructor | 40 or over | The 24th month after the month of the examination |
The six-month cycle from age 40 is the practical cost of an airline career, and it is the reason line pilots plan their examinations around their bid schedules. Everything runs in calendar months to the last day of the month, so an examination on 2 May and one on 29 May expire on exactly the same date. Our FAA medical expiry calculator will show every privilege level from one examination date.
What It Costs And Where To Get It
The examiner sets the fee, not the FAA. A first class examination generally costs more than the $120 to $200 typical for a third class around Los Angeles, because of the electrocardiogram and the additional vision items. Not every Aviation Medical Examiner is authorized for all three classes, so confirm when you book that the practice performs first class examinations and has an ECG on site. Our guide to choosing an aviation medical examiner in Los Angeles covers what to ask.
As with every class, you complete FAA Form 8500-8 through MedXPress before the appointment and bring the confirmation number with you. See the MedXPress guide for the fields and the disclosure rules.
If Something In Your History Worries You
Do not submit the application and hope. A denial is the one outcome that closes the alternatives: it removes BasicMed and the sport pilot driver's-license provision as fallbacks. Speak to an examiner informally first, or to an aviation medical consultant, and find out what documentation would be needed.
For conditions with an established FAA pathway, the Authorization for Special Issuance under 14 CFR 67.401 is how pilots fly with histories the standard would otherwise block. Mental health and substance histories are handled through HIMS-trained examiners, and the FAA publishes a roster of them alongside its examiner locator. Our pages on ADHD, anxiety and depression and what disqualifies you from being a pilot set out what those routes look like.
Related Reading
- FAA medical certificate classes — all three classes and BasicMed compared.
- Second class medical certificate — what commercial privileges actually require.
- Airline Pilot Career Program — the $84,000 route from zero to every rating through MEI.
- The 1,500-hour rule and R-ATP — the hour requirements behind the ATP certificate.
- FAA MedXPress guide — the application form, field by field.
- FAA medical expiry calculator.
First Class Medical Certificate FAQ
How Long Is A First Class Medical Valid?
For ATP pilot-in-command privileges, 12 calendar months if you were under 40 at the examination and 6 calendar months if you were 40 or over. The same certificate remains valid for commercial privileges for 12 calendar months and for private privileges for 60 or 24 calendar months by age, under 14 CFR 61.23(d).
What Vision Is Required For A First Class Medical?
Distant visual acuity of 20/20 or better in each eye separately, with or without corrective lenses, near vision of 20/40 or better at 16 inches, and from age 50 intermediate vision of 20/40 or better at 32 inches, under 14 CFR 67.103. Glasses and contact lenses are permitted.
When Is An ECG Required For A First Class Medical?
At the first application after reaching your 35th birthday, and annually after reaching your 40th, under 14 CFR 67.111(b). The ECG must be dated no earlier than 60 days before the application it accompanies.
Do I Need A First Class Medical To Become A Commercial Pilot?
No. Exercising commercial pilot privileges requires a second class medical certificate under 14 CFR 61.23(a)(2). A first class becomes necessary only to act as pilot in command under an airline transport pilot certificate.
Should I Get A First Class Medical Before Starting Flight Training?
If an airline career is a realistic goal, yes. It is examined against the strictest standard, so passing it confirms the professional route is open before you commit to a long and expensive training program. The same certificate still covers private and student flying for years afterwards.
Can You Get A First Class Medical With Glasses?
Yes. The standard is 20/20 corrected in each eye separately. Wearing correction results in a limitation printed on the certificate requiring you to have corrective lenses available in flight, not a refusal.
How Much Does A First Class Medical Cost?
More than a third class, which typically runs $120 to $200 around Los Angeles, because of the electrocardiogram and the additional vision items. Each Aviation Medical Examiner sets their own fee, so ask when you book.
Find Out Before You Commit
If the airlines are the plan, the order is simple: medical first, training second. Book a free consultation and we will map out the sequence, the ratings and the realistic timeline for your situation. If you have not been in a light aircraft yet, start with a discovery flight at $229 for 60 minutes, flown by you from the left seat, with no medical certificate required. Call (818) 330-1318 any day from 9 AM to 9 PM. We are at 7900 Balboa Blvd, Van Nuys, CA 91406.