Opinion: Using the Medical Examiners Registry

By Michael Megehee, D.C.

President

TeamCME

This Opinion piece appears in the May 7 print edition of Transport Topics. Click here to subscribe today.

Mandated by the legislation called SAFETEA-LU and signed by President George W. Bush in 2005, the final rule for the National Registry of Certified Medical Examiners — to be known henceforth simply as the “National Registry” — was finally released to the public April 18 and goes into effect May 21.

The new regulation will require for the first time that medical examiners (MEs) who perform commercial driver license (CDL) physicals attend an accredited training course and pass a test to become certified medical examiners (CMEs) in the National Registry.

Commercial drivers also will be required to use National Registry CMEs for obtaining a CDL medical certificate, beginning May 21, 2014.

Since the legislation was signed, motor carriers and drivers have voiced concerns ranging from having fewer physicians to choose from to increased fees for the required medical exam.

And some drivers fear tighter controls will threaten their medical qualification to drive.

Meanwhile, the MEs have worried about the costs of their own training and the time they must devote to passing the certification test.

It’s easy to understand these concerns, but in the end, my group believes the National Registry will benefit the great majority of drivers, motor carriers and medical examiners.

Yes, some drivers will lose their CDLs because of serious medical conditions, but there actually are very few of what I call “absolute” disqualifiers — that is, medical conditions or medications that are an automatic “fail” over which no ME has discretion to allow the driver to stay on the road. They are:

• Use of the drugs methadone or Chantix (varenicline) or a Schedule I drug.

• An implanted defibrillator.

• Epilepsy.

• Significantly decreased visual acuity in both eyes.

• Severe hearing loss in both ears.

For almost everything else, the key to success for drivers will be having an ME who knows how to guide them through the process required to win — or keep — that all-important medical certificate.

Sometimes it’s knowing what not to worry about. For some reason, many drivers believe insulin use, loss of a limb or blindness in one eye means irrevocable disqualification. They don’t. There are federal exemptions both for insulin use and for the loss of vision in one eye, and there is a special performance evaluation available for loss of a limb.

And while federal exemptions can take as long as six months to obtain, many states have these same exemptions — and others — that can be obtained in just a couple of weeks, allowing the driver to drive as long as he doesn’t cross state lines.

A trained ME eliminates errors that would disqualify a driver who otherwise could have continued to drive. Incorrectly disqualifying a driver is tragic and has serious consequences for the lives of those drivers and their families. As an ME, I can tell you that having to disqualify a driver is bad enough already — mistakenly disqualifying a driver would be far worse.

When MEs know the Federal Motor Carrier Safety Administration’s medical guidelines and apply them correctly, motor carriers can be certain their drivers are medically qualified and unlikely to cause an accident because of a known medical condition.

Although the desire to avoid tragedy is enough, decreased motor carrier liability is a welcome side effect. MEs unaware of the FMCSA medical standards generally are also unaware of the medical liability they face if they certify an unhealthy driver who subsequently causes an accident.

There is an art to being a ME. Besides knowing the FMCSA medical standards, the best MEs know how to preserve public safety while having a minimal effect on motor carrier and driver routines.

There are MEs, of course, who would just as soon not attend a training course or take a certification test. That’s a shame, because those who do undergo training and pass the test will become the first members of a new medical specialty — the U.S. Department of Transportation Certified Medical Examiner.

Although the total number of CDL physical exam providers will decrease, that’s not necessarily bad news because the certified MEs probably will be called upon to perform a larger number of CDL physicals. That would lead to “economy of scale,” i.e., when you increase production, you learn to make that product more efficiently, and greater efficiency leads to decreased costs. After all, in the nearly 100 years since Henry Ford added a conveyor belt to his assembly line and began rolling out more reasonably priced automobiles, we’ve all become aware that mass production equals lower prices.

To be sure, the National Registry is breaking new ground for medical examiners — but it’s not the first time the DOT has used this process.

In 2000, essentially the same thing occurred in the medical review officer (MRO) program in respect to drug testing. At that time, there was recognition that training was needed to decrease the errors made in determining CDL driver drug-test results. There were similar concerns of fewer providers, fewer choices and higher prices.

Though there are fewer MROs today, the cost for an MRO review has decreased, and there are significantly fewer MRO errors. After a period of adjustment, I think we will reap the same benefits from the National Registry.

By helping drivers to identify and manage their medical conditions, the National Registry and its certified medical examiners will make our highways safer and benefit drivers, motor carriers, medical examiners — and the public.

TeamCME, Pendleton, Ore., is a national network of medical examiners offering DOT- related services. The author was on the team that created the program for training and certifying physicians on the National Registry of Certified Medical Examiners.