Helping Keep the Public Roads Safe

This issue's interview features Dr. Michael Megehee of Pendleton, Ore. Dr. Megehee's primary work is with the Department of Transportation (DOT) and the Federal Motor Carriers Safety Administration (FMCSA), providing physical examinations, drug testing and alcohol screening for commercial motor vehicle (CMV) operators.

Briefly tell us about yourself and how you decided to become a doctor of chiropractic.

I graduated with a BS in accounting with two years of chemical engineering. I was offered a position as an inventory manager for a large corporation right out of college. After nine years of work, I was looking for something else. I was choosing between a master's degree in accounting or attending medical or chiropractic school. I decided to attend Western States Chiropractic College. I graduated in 1990 and have greatly enjoyed my practice ever since.

Describe how you became interested in occupational health and applied ergonomics.

Occupationally related health services were nearly forced upon me. During one particular week in 1996, I got a call from a local company asking if I would do their drug testing. I told them I would look into it and call them back. A day later, a second company called with the same request. When the third company called, my answer had changed to: "Yes, but let me find out the details and I will call you next week." As a result, I received Medical Review Officer training from the American Association of Medical Review Officers (AAMRO) and became a DOT-certified breath-alcohol technician and drug collector.

While I do not serve as a medical review officer for DOT-regulated companies (currently restricted to specially trained MDs and DOs), I do provide MRO services for non-DOT businesses. We provide collection and testing services not only for the companies I manage, but for companies in our area that only needed a collection site. A side benefit is that I treat a great many of their injured workers, and our office is exposed to hundreds of potential patients.

How many years have you been serving in this specialty area?

Our office started by providing DOT physical examinations for CMV operators sometime around 1992, but the real change came in 1996 when we added the alcohol and drug testing services. Having all three of these services available to the transportation industry is particularly important to companies that want the convenience of "one-stop shopping."

So, you had your introduction to working with the corporate world by performing the DOT biannual physical exams required of all CMV operators?

In 1992, the regulations changed to allow chiropractors, advanced nurse practitioners (ANPs), and physician assistants to participate in the federal medical examiner program, which was previously limited to MDs and DOs. Medical examiners provide the physical examination for CMV operators. For the most part, this includes truck drivers, bus drivers and anyone who operates a motorized vehicle that has a gross weight of 10,001 pounds, transports more than 15 passengers, or transports hazardous materials that require placarding and cross state boundaries.

The examination requirement is a federally mandated program for all CMV drivers, and must be obtained at least every two years. Of interest, however, is that nearly half of all drivers have one or more medical conditions that require a follow-up monitoring physical exam every year, or in some cases, even more often. The estimate is that at least 6 million DOT physical exams are performed annually. As you might expect, the great majority has been provided by nonchiropractic offices and clinics until recently.

You serve on the FMCSA committee charged with certifying professionals, including DCs, to perform DOT physical examinations. Tell us about this process.

The program currently being developed is called the FMCSA National Registry of Certified Medical Examiners (NRCME). In 2006, I was asked to participate in the FMCSA "brainstorming sessions" where we delineated the procedures required of the examiner to accurately and adequately perform the DOT physical. Because of my interest, experience and background, and the number of DOT physical examinations I had provided throughout the years, I was designated as a FMCSA Subject Matter Expert within these committees. I serve as a member of the team whose function is to construct a survey of those procedures that would then be used as a template for the certification program. That survey was completed at the end of 2007 and the results were recently released. At present, I am on the team to construct the core curriculum for medical examiner training. We completed that last autumn and it also is being reviewed by the FMCSA.

The FMCSA recently began an analysis to determine if the training program and the certification test evolved from our meetings are acceptable. This past March, a group of novice health care providers were selected to receive the training and will take the certification test. That portion of the process was completed by August 2008. Then, an analysis will be conducted regarding this effort's outcome and whether the test will need modification prior to the training program being released. In the future, only members from the five health care professions who attend the required training and pass the certification test (a written/computerized test) will be allowed to perform the DOT physical exams for CMV operators. Please keep in mind, however, that any of this can change depending on the needs of the program, until it's released by the FMCSA.

Do you feel your experience has been a rewarding one?

Yes, it has been highly rewarding for me personally and I feel this to be a tremendous opportunity for our profession in terms of professional expertise and acceptance.

You also provide drug testing and alcohol screening from your clinic. Tell the readers more about this service.

We perform thousands of drug tests each year. Although we specialize in DOT drug and alcohol testing, we perform far more drug tests for non-DOT businesses and firms than we provide for the transportation industry. We provide on-site collections and also utilize "quick tests," where we can provide employers a negative result within an hour. We are a registered laboratory with the state of Oregon for that purpose. We provide randomized testing programs for those companies required to do so by federal regulation and for other companies that elect to have random testing. In addition, we offer on-site hearing testing. We are listed as a collection site with many different laboratories across the U.S. that refer their clients to our office for these services.

How do you market your skills and services to companies?

I have been very fortunate to not have to market these services. Over the years, this part of my practice has gotten bigger and bigger as a result of the good will and referrals from satisfied drivers and companies we are serving. Until recently, we did not put any additional effort into building this part of my practice. However, because of the unprecedented opportunity the NRCME presents, I am now beginning to promote myself and my practice as a local expert. Providing these services always has served indirectly as my chiropractic "advertising," and I expect that to continue. How many chiropractors can say they receive hundreds of referred potential patients from satisfied drivers and their employers and get paid for it?

You make it sound easy. Have there been any major obstacles to your success?

There always are those who have difficulty accepting a chiropractor as an expert provider. However, if you have confidence in yourself, along with professional competence through adequate training and knowledge, you will have the ability to make a positive impact. This has been particularly rewarding.

What kinds of economic and bottom-line outcomes have you experienced as the result of your involvement with the business clients you serve?

Performing the DOT physical examinations helps to fill in open appointments. My staff performs the drug and alcohol testing without my help, except in a supervisory capacity. It's nice to know your office can earn income even when you're away. The downturn is you usually have to keep your office open for your drug-testing and alcohol-screening clients when you're on vacation, but only one certified staff member is required to be in the office during these times.

Performing each of these services is something I can do far into the future, even if an unforeseen health challenge prevents me from performing adjustments or providing traditional chiropractic care. I believe it's financially important for every DC to carve out a specialty. It differentiates you not only from other DCs, but from other health care providers. This is one specialty where you can readily become recognized as an expert in your community. This will be especially true after the FMCSA Certified Medical Examiner program is implemented, as it is likely that many current allopathic providers may choose not to participate. Those who become certified will then be considered the experts.

What specialized training or preparation would be required for the average DC to achieve similar results?

As described above, I enrolled in training available in my state that provided me with the expertise and certification to provide the drug testing and alcohol screening services. Basic introductory training in these two services is available online through a variety of sources. It's my understanding the nonprofit International Academy of Chiropractic Occupational Health (IACOHC) also provides this training at a very reasonable cost in cooperation with state chiropractic associations and co-sponsorship with Northwestern Health Sciences University. The Academy's Web site is www.dc-occhealth-org.com. The continuing education department of Northwestern Health Sciences University also offers a 12-hour DVD.

In addition, to expand my services potential, I also chose to become a breath analyzer technician, who provides confirmation testing for suspected alcohol use or following a positive alcohol screening test. This service, while not necessary to get started in this field, offers a service advantage to employers. However, it requires additional training, specialized equipment and a larger investment. As another training option, I recommend doctors consider becoming a certified trainer by taking a "train the trainer" course, so they will have the authority to train their staff (and potentially others) regarding the technical and legal aspects of this service.

As far as the provision of DOT physical examinations for CMV operators, at this time, all licensed DCs have the privilege of performing the examination without additional certification or training, as long as they carefully follow the federal guidelines. To monitor developments and finalization plans for the implementation of the new regulations and the FMCSA Certified Medical Examiner training and certification test, readers may visit the FMCSA Web site at www.nrcme.fmcsa.dot.gov.

Do you feel providing occupational health and wellness services has a bright future for appropriately trained doctors of chiropractic?

Yes. We have all of the advantages such as greater knowledge of common neuromusculoskeletal disorders (which is the most challenging problem facing the industry) and more flexible scheduling, and we usually have more competitive rates for our services.

What words of advice do you have for doctors interested in working within this field, particularly providing DOT services?

Start now! Trucking companies are nervous their regular provider will decide not to become certified, which will require them to find a Certified Medical Examiner. Those DCs who start now will be able to use their expertise as a FMCSA Certified Medical Examiner as a stepladder to providing other occupational services.

Do you have anything else you would like to add?

Performing drug and alcohol testing and CDL physicals can be an important and rewarding part of any chiropractic practice. However, once you have gained a reputation for competently providing these services, it naturally leads to invitations from companies asking you to do more. In addition to membership in the IACOHC, I urge readers to join the Council on Occupational Health of the American Chiropractic Association (visit www.acacoh.com for more information) to help stay in touch with happenings in this specialty.