In 2005, I recognized the opportunity performing commercial driver's license (CDL) exams represented to the chiropractic profession. I even thought I was overly optimistic by referring to it as the "greatest opportunity ever" for DCs; the "brass ring" within our reach.
My error was that I was not optimistic enough. I drastically undervalued the impact performing CDL physical exams would have. And that impact is more than just financial: As we speak, it is advancing acceptance of the chiropractic profession into other federal, state and private-sector programs.
With 23.5 million total driver exams performed over the same time, we can estimate the average number of driver physicals being performed every year as more than a million exams, representing annual payouts of over $600 million.
There is only one bit of news that is puzzling. The chiropractic profession is measurably the smallest group of CMEs. There are only about 3,500 DC CMEs compared to the largest group (MDs), with more than 19,000 providers. However, although outnumbering DCs by more than a five-to-one margin, MD CMEs performed only just over twice as many total exams compared to DC CMEs.
The Financial Advantages
Chiropractors have insurmountable advantages in performing driver exams. They operate at a lower overhead cost, giving them a significant advantage in pricing. The average reimbursement for DCs is above $80, making it a better reimbursement than many chiropractic services. And there is no insurance involvement. Perform the exam and get paid. DCs also generally have more open appointments, giving drivers the opportunity to obtain same-day appointment.
The Veterans Administration now is required to provide or pay for driver physicals for veterans. That program is still being initiated, but an effort was thwarted to eliminate DCs from providing VA driver exams, even if certified medical examiners in the National Registry.
The Non-Financial Advantages
As you might imagine, drivers are generally not a healthy group. A medical condition can end their driving earlier than in other professions. Fortunately, the well-trained and concerned CME is a significant resource to drivers. Those CMEs who will go the extra mile to guide the driver through the medical requirements to allow the driver to "keep on truckin'" provide a rare and valuable service.
What's more, consider how DCs performing driver exams have affected other programs. DCs in up to 30 states are or will soon be allowed to perform FAA BasicMed medical exams on general aviation pilots.
When I graduated from chiropractic school, I bothered the FAA Surgeon so much that I had to back off, leaving me with the opinion that performing pilot physicals would not occur during my time as a DC. I was wrong about that, happily so.
Although there are not the number of FAA BasicMed exams being perform as compared to driver exams, the FAA medical program is generally considered the "gold standard" of medical programs by government agencies and the private sector alike. Some states have required that to perform the FAA BasicMed exam, you have to first be a CME in the National Registry.
But that's not all. Hopefully later this year, DCs will also be included in the U.S. Coast Guard Merchant Mariner medical exam program, plus an opened door for DCs to perform the medical exam for scuba divers. Others potential opportunities include medical evaluation for respirator use, respirator fit testing and more.
I have just touched on the tip of the iceberg with this article. I haven't even touched on the other services to the transportation industry that DCs can provide – far bigger than I ever imagined.
Well-Worth the Investment
I projected that DCs would the major presence in performing driver exams. The profession needs more certified medical examiners. It requires taking a FMCSA-accredited training program (most are less than 12 hours) and a few weeks of study to pass the NRCME certification test. (If you don't pass it the first time, you have to wait 30 days to take it again.)
Becoming certified in the National Registry is well-worth this small investment of your time. Isn't getting a piece of $600 million a year while contributing to a worthwhile effort to benefit drivers and help ensure safe roads enough?
Dr. Michael Megehee was appointed by the FMCSA in 2005 as a member of the National Registry Brainstorming Sessions. He served on the NRCME Survey Team that established the basis for NRCME certification, and was a member of the NRCME Education Team that developed the core curriculum for the accredited physician training. Dr. Megehee is president of TeamCME, a nationwide network of DOT medical examiners.