New Federal Program Establishes Requirements for Medical Examiners

Written by on July 31, 2012 in Features - No comments

Healthcare professionals must comply with new regulations to continue to provide mandatory state examinations for truck and bus drivers.

Lawrence Earl, MD

Medical Director, National Academy of DOT Medical Examiners (NADME)


Performing government mandated employee physicals has long since been a source of additional revenue for medical practices. In his article, Dr. Earls details the new regulations and recommendations recently released from the National Registry, in addition to information on the curriculum for the training required to obtain a license to continue to provide these examinations. This article is the first of a series on these new regulations; we look forward to bringing you in our upcoming issues.

The National Registry of Certified Medical Examiners (National Registry) is a Federal program that establishes requirements for healthcare professionals that perform physical qualification examinations for truck and bus drivers. To become a certified medical examiner (ME) and be listed on the National Registry, healthcare professionals must complete training and testing on the Federal Motor Carrier Safety Administration’s (FMCSA) physical qualifications standards and guidelines.

FMCSA developed the National Registry of Certified Medical Examiners final rule as part of the agency’s commitment to enhancing the medical oversight of interstate drivers, and preventing commercial vehicle-related crashes, injuries and fatalities. This rule addresses four National Transportation Safety Board (NTSB) recommendations on comprehensive training for medical examiners, and tracking of driver medical certificates.

All healthcare professionals who intend to perform physical examinations and issue medical certificates for commercial motor vehicle (CMV) drivers to meet the requirements of Section 391.41 of the Federal Motor Carrier Safety Regulations (FMCSRs) must be certified and listed on FMCSA’s National Registry by May 21, 2014.  After this date, medical certificates for CMV drivers may only be issued by certified medical examiners listed on the national registry.  In order to become certified, examiners must undergo training and pass a certification exam.

Currently, the only requirement to perform DOT exams is to be a licensed MD, DO, DC, NP or PA.  Of the potential 400,000 pool of these professionals available, the FMCSA estimates 40,000 will be needed to serve over 6M commercial drivers.

Improper medical certification of drivers has led to an increase in crashes, with documented cases of drivers with serious disqualifying conditions having caused fatal and disabling accidents.

Longstanding studies reveal inadequacy of medical examiner’s understanding of the relationship between driver health and the performance of tasks of commercial driving.

Medical examiners need to be knowledgeable of the specific physical and mental demands associated with operating a CMV.  This includes the requirements or standards of Section 391.43 as well as the medical advisory criteria and guidelines prepared by the FMCSA. The standards and guidelines aid the medical examiner in making the individual determination whether a driver should be issued a medical certificate, and to be proficient in following the medical protocols necessary to adequately perform the medical examination.

The National Registry final rule addresses four NTSB recommendations on a comprehensive medical oversight program for interstate drivers that include the following elements:

  • Individuals performing medical examinations for drivers are qualified to do so and are educated about occupational issues for drivers (H-01-017);
  • A tracking mechanism is established that ensures that every prior application by an individual for medical certification is recorded and reviewed. (H-01-018);
  • Medical certification regulations are updated periodically to permit trained examiners to clearly determine whether drivers with common medical conditions should be issued a medical certificate. (H-01-019); and
  • Individuals performing examinations have specific guidance and a readily identifiable source of information for questions on such examinations (H-01-020).

In 2005 the Safe, Accountable, Flexible, Efficient Transportation Equity (SAFETEA-LU) Act was passed. It established the Medical Review Board (MRB) that advises FMCSA on medical concerns, including physical qualifications for drivers, medical standards and guidelines, the educational curriculum for medical examiners, functional tests for drivers w/ disabilities, reviews all FMCSA medical standards and proposes new science-based standards and guidelines.


This law also directs FMCSA to remove from the registry the name of any medical examiner that fails to meet or maintain the qualifications and requirements established by the Secretary of Transportation for being listed in the registry and shall accept as valid only medical certificates issued by persons on the national registry of medical examiners.


NRCME training programs are required to cover eight core curriculum topics:


The eight topics are:

  1. Background, rationale, mission and goals of the FMCSA medical examiner’s role in reducing crashes, injuries and fatalities involving commercial motor vehicles.
  2. 2.  Familiarization with the responsibilities and work environment of commercial motor vehicle (CMV) operations.
  3. 3.  Identification of the driver and obtaining, reviewing, and documenting driver medical history, including prescription and over-the-counter medications.
  4. Performing, reviewing and documenting the driver’s medical examination.
    1. Performing, obtaining and documenting diagnostic tests and obtaining additional testing or medical opinion from a medical specialist or treating physician.


  1. Informing and educating the driver about medications and non-disqualifying medical conditions that require remedial care.


  1. Determining driver certification outcome and period for which certification should be valid.


  1. FMCSA reporting and documentation requirements.


After training, medical examiners would be required to provide FMCSA with their state medical license, business address and phone number, and medical examiner training provider. In addition, the applicant would provide several documents, including a statement that the applicant is capable and willing to comply with FMCSA requirements; that upon request he or she would provide copies of documents showing evidence of completion of training, States licenses, etc.; and an affirmation that all of the information provided is true.


The FMCSA will then issue an approval to take the certification exam. The computerized test consists of 120 multiple choice questions, will be proctored and have a 2 hr time limit. Pass/Fail results will be given immediately at the testing site, with the first tests expected to be given after August, 2012.


In addition to the initial certification test, medical examiners would be required to complete “refresher” CME training every 5 yrs, and to recertify by passing the medical examiner certification test every 10 years in order to remain listed on the registry. Classroom as well as online training will be acceptable.


Certified examiners will electronically send a monthly report of DOT exams to the FMCSA and will be required to have an electronic form of communication to receive updates to the DOT medical exam, NRCME training, and changes in FMCSA policy. Examiners will also be required to produce a copy of an exam within 48 hours upon FMCSA request, such as for investigation of improper certification of a CMV driver.


The FMCSA may remove an examiner from the NRCME if he/she certifies a driver who fails to meet applicable standards or makes a false claim to have obtained the required training.


FMCSA will also monitor medical examiner performance and investigate any patterns of errors or improper certification of CMV drivers.


Commercial drivers will access the National Registry database to select only certified examiners as of May 21, 2014.


It would wise for medical examiners to seek training and certification early, don’t wait for the May 21, 2014 deadline. Once certified, you can promote this to your motor carrier clients and prospects to become the preferred DOT examiners in your area.

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