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Survey cites increased medical exam costs after NRCME implemented

By The Trucker Staff
Posted Apr 20th 2017 2:13PM

ARLINGTON, Va. — A majority of professional truck drivers are reporting increased exam costs following the implementation of the National Registry of Certified Medical Examiners (NRCME) rulemaking.

So say the results of a survey conducted by the American Transportation Research Institute in collaboration with the Mayo Clinic.

ATRI is the research arm of the American Trucking Associations.

ATRI and Mayo Clinic jointly surveyed over 900 commercial drivers, 300 motor carriers and 1,200 certified medical examiners (CMEs) to better understand the impacts that the NRCME has had on the trucking industry since its implementation in 2014.

The NRCME was designed to improve the DOT physical exam process and ensure that medical examiners understand FMCSA regulations and guidance for issuing medical certificates.

The survey showed 63 percent of the drivers surveyed said they were experiencing increased costs of the medical examination, a result of new guidelines imposed in the rulemaking.

ATRI's research focused on commercial driver and motor carrier impacts and also identified the following:

  • 6.2 percent of drivers reported improved exam quality post-NRCME implementation.
  • 26.6 percent of drivers reported spending 20 minutes or less with their CME, with 6.5 percent of those drivers spending 10 minutes or less, an insufficient time to complete all required processes of a DOT physical. Drivers certified by chiropractors were more likely to have important medical checks omitted.
  • Among the 5.9 percent of drivers who were not issued a medical certificate on the day of their physical exam, 22.6 percent cited having a medical condition that required treatment before certificate issuance as the reason.
  • Motor carriers still have significant concerns related to the medical certification process, including requests by CMEs for additional medical documentation causing certification delays, driver confusion of how regulatory changes impact the ability to hold a valid medical certificate, and concerns with the competency of CMEs. Nearly 50 percent of motor carriers reported that they specify which CME their drivers see to ensure medical exam quality.
  • Less than 1 percent of carriers reported no major concerns with the medical certification process.
  • The ability of drivers to find a CME close to where they live may be more challenging in the future as 15.3 percent of CMEs reported that they have quit performing DOT physicals or plan to quit performing DOT physicals.

"The data show a polarity in quality of medical examiners," said Clayton T. Cowl, MD, MS, Chair of Mayo Clinic's Division of Preventive, Occupational and Aerospace Medicine. "Those examiners who are performing only minimal examinations may have received substandard training or are not taking their role seriously. The key seems to strike a balance between meeting the regulatory intent of the examinations and communicating with drivers ahead of time to minimize confusion regarding the need to document clinical stability. This is particularly true for drivers with multiple or complex medical conditions from whom medical examiners do need more documentation in order to make a certification decision."

"The inconsistency in quality of exams provided our drivers creates real challenges for us as a fleet. Where in one terminal location a driver may be required to undergo extensive tests and provide additional documentation prior to getting a medical certificate, drivers in other locations are expedited through with cursory exams," said Victor Hart, Director of Safety for DOT Transportation.

A copy of the report, as well as a white paper detailing the findings of Mayo Clinic's survey of medical examiners, is available on ATRI's website at


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