The Civil Aerospace Medical Institute (CAMI), as a component of the Office of Aerospace Medicine (OAM), surveyed the population of aviation medical examiners (AMEs), as federal designees, in 2012 to assess their satisfaction with Federal Aviation Administration (FAA) airman medical certification services and to gather their feedback on how to improve those services. Reported here are results from an indepth content analysis of AME recommendations for improving medical certification services, systems/tools, processes, and policies.