A Year on the Ground — How Delays in Medical Reinstatement Keep Pilots from Seeking Help

For professional pilots, the decision to seek help for a mental health concern is never simple. Beyond the personal challenge of admitting something isn’t right, there’s the professional risk: grounding, loss of income, and uncertainty about when or if you’ll return to the flight deck. While regulators like Transport Canada (TC) emphasize safety above all else, the reality is that bureaucratic delays in medical reinstatement are quietly discouraging pilots from ever reaching out for care. 

When Treatment Works — But Paperwork Doesn’t 

I know this first-hand. Years ago, I went through treatment for anxiety and was prescribed an SSRI. It worked. I was functional, healthy, and capable of flying safely. But the process of regaining my medical clearance was anything but straightforward. 

Even with successful treatment and the report submitted by a psychiatrist after 5 months, it took persistence. After 10 months, I had still not heard anything from TC. I started making inquiries at that point. It took multiple phone calls and emails before I had a medical again. It seems my medical went from Prairie region in Edmonton to Ottawa and sat untouched in someone's digital inbox until I became a squeaky wheel and then my file was processed.  

Without those factors, I could easily have been left on the sidelines for months more. As it was it was just about a calendar year.  

I was lucky to have a spouse who was still earning while I was playing stay-at-home dad. In my case, I pursued this treatment during COVID, and I was laid off. The chance of getting called back to work anytime soon were slim.  

My report had been submitted for almost 7 moths before my medical was processed! 

Staffing Shortages, Long Waits 

The bottleneck lies in the system itself. Transport Canada’s Civil Aviation Medicine branch is under-resourced. Pilots and physicians submit the necessary documentation, only to face long silences. For many, the wait for reinstatement can stretch to six months, nine months, a full year or even more. 

For a working pilot, that means a year of lost wages. A year of explaining to family why bills are harder to pay. A year of wondering whether honesty about your mental health the biggest professional mistake of your life was a mistake. 

It’s no surprise then that some pilots choose to fly untreated rather than risk reporting symptoms. Ironically, the very system designed to protect public safety ends up incentivizing silence. 

A Step Back from Past Progress 

This wasn’t always the case. In the early 2000s, Transport Canada showed global leadership with their forward-thinking SSRI guidelines (2004, updated 2010). At the time, they were among the first regulators to recognize that a pilot could safely fly while on certain SSRI medications to treat depression and anxiety. 

But while the policy was progressive, today’s implementation is mired in backlog. Where once there was leadership, there is now gridlock. Compare that with recent steps in the U.S., where the FAA’s Aviation Rulemaking Committee on Mental Health and the Mental Health in Aviation Act of 2025 are actively working to streamline medical clearances and reduce stigma【FAA ARC†source】【Congress†source】. Even industry commentary notes that reducing bureaucratic delays is key to ensuring safety while supporting pilots【AvWeb†source】. 

What Needs to Change 

No one disputes the importance of thorough medical review. Safety must always come first. But safety is not served by a system so slow that it deters pilots from seeking care altogether. 

Transport Canada has to consider ways to improve processing times. Expanding medical review and psychiatric staffing in house, or delegating parts of the process to qualified psychiatrists or psychologists in a role similar to CAME’s or adopting digital review systems could all reduce turnaround times.  

Conclusion: A Call for Balance 

Pilots are human. We experience depression, anxiety, and burnout just like anyone else. When we get help, the system should support our return to health and to the cockpit — not leave us grounded in limbo. 

It’s time for regulators to strike a better balance: maintaining the highest standards of safety while making sure pilots who seek help aren’t punished by months or years of unnecessary delay. Until that happens, the quiet risk remains - pilots suffering in silence, flying untreated, because the alternative feels worse. 

References 

• Federal Aviation Administration. Mental Health and Aviation Medical Clearances Aviation Rulemaking Committee Report. (2023). 

• U.S. Congress. Mental Health in Aviation Act of 2025. 

• AvWeb. Commentary on the Mental Health in Aviation Act: Why Speed Matters in Medical Clearances.