Choosing a Medical Examiner: How To Make Sure They Are Certified

With the recent implementation of the National Registry of Certified Medical Examiners (NRCME), motor carriers are discovering that many of the medical examiners that were performing physicals on their drivers have decided not to continue providing that service. As a result, trucking companies and their drivers are forging new relationships with the medical community to ensure compliance.
As motor carriers and drivers begin searching for new medical examiners, understanding the medical examiner training process is key to building productive and mutually beneficial relationships.
The process: Medical examiners wishing to be listed on the NRCME must now undergo extensive training and testing before being registered and every five years thereafter. The training ensures doctors have a thorough understanding of the life of a truck driver and the unique operating environment associated with it. Medical examiners are also given detailed explanations of twelve physical qualification categories listed in the federal regulations (49 CFR 391.41(b)). They are also provided with FMCSA approved medical guidance and medical advisories they are encouraged to follow.
The result: With this additional training comes heightened awareness of potential liability concerns medical examiners face when determining if a driver is qualified. As a result, many drivers are facing more scrutiny during examination than they have in the past. Particular attention has been paid to obstructive sleep apnea, a result of misinterpretation of the medical requirements. ATA has developed a white paper that outlines these misconceptions and contrasts them with current regulatory requirements. It is available here.
Also, because the pool of available medical examiners has contracted and doctors are forced to bear the additional cost in terms of training and administrative overhead, many motor carriers and drivers are reported significant increases in the cost of a medical qualification physical.
Discussion Points for Certified Medical Examiners: When forging new relationships with medical examiners, it is increasingly important to engage potential medical examiners in thoughtful conversation before committing to their services. Below are some suggested questions, developed by the Colorado Motor Carriers Association, and shared with ATA, that trucking companies and driver can ask when seeking out a new medical examiner.
1. Do you screen for Obstructive Sleep Apnea? What are your screening criteria?
Note: Risk factors for obstructive sleep apnea must be taken in aggregate. Any single factor (e.g. neck circumference, Body Mass Index (BMI), admitted snoring, etc) alone is not an indicator of OSA. Medical examiners should use more encompassing criteria – i.e. discuss issue in-depth with the driver.
2. If you determine a driver may have Obstructive Sleep Apnea, what is your next step?
Note: Typically, if a medical examiner suspects obstructive sleep apnea, he or she will either: 1) disqualify the driver pending sleep study; 2) provide a 30 day certificate pending a sleep study (often too short to complete the study and begin treatment; 3) provide a 90 day certificate pending sleep study. There is no standard resulting in uneven application.
3. If you determine a driver needs a sleep study, will you require a specific test / specific lab?
Note: Some medical provides will require drivers to use a specific clinic. Medical providers should accept results from any qualified lab/program. To the extent possible, you want to control where your driver goes for a sleep study. This will help control costs.
4. If a driver is diagnosed with moderate to severe Obstructive Sleep Apnea after a sleep study, when will you release the driver back to being qualified to drive?
Note: You want to find out how long the medical provider will require a driver to be “in treatment” prior to going back to work – some medical providers are requiring 6 months of verified treatment, some shorter, some longer.
5. What type of monitoring / reporting will you require if a driver tests positive for OSA and is put on a CPAP or other type device?
Note: Some treatment equipment can provide Bluetooth downloads, some require downloading at an office, while others only print out results. Find out what type of reporting your medical provider can / will accept, and how it will work with your driver.
These are only suggested conversation topics. The key to this issue is to make sure you have an agreement in place with your medical provider on how your drivers will be treated. You want to make sure you get most of the unknown elements discussed so you can plan your costs in terms of time, number of drivers off-duty, insurance plan coverage, and so forth.
Contact: P. Sean Garney sgarney@trucking.org.