The American Transportation Research Institute has found that the Medical Examiner Registry is not fixing the problems that fleets and drivers have had with the Department of Transportation medical examination process and may be making them worse.

ATRI released the results of analysis it conducted with the Mayo Clinic looking into the Federal Motor Carrier Safety Administration’s National Registry of Certified Medical Examiners.

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

However, ATRI said the survey found that drivers and carriers were reporting insignificant improvements in some cases and increasing problems in others.

More than a quarter of drivers surveyed reported that exams were taking 20 minutes or less with 6.5% or respondents saying it took less than 10 minutes to complete. This is less than the amount of time needed to complete all required checks and drivers who had examinations. In addition, exams performed by chiropractors were more likely to have important aspects of the exam skipped.

"The data shows a polarity in the 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.”

A majority of drivers (63.3%)  reported increased exam costs while not experiencing any improvements to exam quality. Only 6.2% of drivers reported improved exam quality following implementation of the NCRME.

ATRI also said the research identified the following:

• 26.6% of drivers reported spending 20 minutes or less with their CME, with 6.5% of those drivers spending 10 minutes or less, deemed "an insufficient time to complete all required processes of a DOT physical."  

• Among the 5.9% of drivers who were not issued a medical certificate on the day of their physical exam, 22.6% 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% of motor carriers reported that they specify which CME their drivers see to ensure medical exam quality.

• The ability of drivers to find a CME close to where they live may be more challenging in the future as 15.3% of CMEs reported that they have quit performing DOT physicals or plan to quit performing DOT physicals.

Concerns expressed by motor carriers were across the board given that less than 1% of the carriers reported no major concerns with the medical certification process.

“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,” said Mayo Clinic's Cowl. “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."

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

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.