DOT Final Rule to Be Released

With help from members of the chiropractic profession, six years of development and unexpected delays, the Federal Motor Carrier Safety Administration (FMCSA) has completed work on the final rule for the National Registry of Certified Medical Examiners. The Office of the Secretary of the Department of Transportation has confirmed that the final rule was received Aug. 1. This marks the official "beginning of the end" of this lengthy process, as the last phase of a final rule generally follows a strict four-month timetable.

The final rule is already being evaluated by the Office of General Counsel within the DOT Secretary's office, where it is assigned to a specific attorney. The General Counsel has one month to perform a legal review of the final rule. It almost always uses the entire month before returning a final rule to FMCSA. Usually within a week, FMCSA will then submit the final rule to the last step prior to being published.

The final rule is sent to the Office of Management and Budget (OMB), which is part of the Office of the President, for "monetary" review. The OMB has 90 days to finish its review, which it rarely accomplishes before that time. OMB returns the final rule to FMCSA, which publishes it in the Federal Register for all parties outside of the Department of Transportation to view for the first time.

In this case, that should occur around the middle of December 2011. FMCSA rules have a minimum 30-day waiting period prior to going into effect, and few come with waiting periods in excess of the minimum. If all goes as expected, the national registry should become effective mid-January 2012.

For those DCs eagerly awaiting the opportunity to become a certified medical examiner (CME) in the national registry, this represents the end of a long wait. The registry will require all physicians to attend an "accredited" training course on FMCSA medical standards and guidelines used to determine the driving status for commercial drivers. Within the next 2-3 years, only CMEs in the national registry will be authorized to perform driver medical exams. After attending the training course, physicians must pass a 120-question multiple-choice certification test to be listed in the registry as a certified medical examiner. A similar change occurred in the federal drug-testing program involving medical review officers in 2000. The result was that a new medical "specialty" was created. Those familiar with the national registry expect the same thing to occur with certified medical examiners.

There have been a number of developments over the past six years that make the national registry even more significant. Earlier estimates put the number of commercial drivers at around 4 million. Based on that data, FMCSA estimated that 40,000 CMEs would be needed. However, recent data indicates that there are 14 million drivers with commercial driver's licenses. Of these, 7 million are inactive; however, new federal regulations will require all commercial drivers to have a current medical certificate regardless of whether they are actively driving. And with commercial driving considered a growth industry over the next 10 years, the number of drivers is expected to increase significantly.

No one knows for certain how many medical exams for drivers are performed each year. That said, nearly half of drivers have a medical condition that requires them to receive a new medical exam each year, and most motor carriers require a new driver to have a fresh medical exam when they are hired, regardless of whether their medical certificate is still valid. High turnover and the hiring of new drivers is an ongoing process with many motor carriers. Some drivers who are not required to have a commercial driver's license are nonetheless required to have a medical certificate, and two years ago, firefighters who work fighting forest fires were required to have a current medical certificate. Although school-bus operations are exempt from the federal regulation, states generally require school-bus drivers to have a medical certificate. The only thing for sure is that more exams are probably being performed than anyone would have ever guessed. It's no wonder the national registry deserves careful consideration.

Only five major professions are specifically authorized to become a certified medical examiner: MDs, DOs, ANPs, PAs, and DCs. Recognizing the importance of the national registry, the ACA has supported the inclusion of the chiropractic profession as CMEs. Performing physical exams is typically viewed as a primary care service that can propel the chiropractic profession into greater acceptance in other health care programs and improve our collaboration with our medical counterparts. Many of the common medical conditions afflicting commercial drivers require communication with the driver's primary care physician to maintain their driving privilege. Those medical providers who do not become CMEs themselves will depend on the specialized knowledge and expertise of the CME to determine correct driving status of their patients during the DOT medical exam process.

Six years ago, I described the upcoming National Registry of Certified Medical Examiners as the greatest opportunity available to the chiropractic profession. With the incredible work being done to include chiropractic services in the military, that was really going out on a limb. Now, the national registry is poised to exceed even my expectations. Performing DOT medical exams will not be right for all DCs, but all DCs should consider what the national registry could mean to them and to the chiropractic profession.

To learn more about the FMCSA's National Registry of Certified Medical Examiners, read Dr. Megehee's 2010 article, "A Billion-Dollar Opportunity for Chiropractors" (March 12, 2010 issue).