How many chiropractors have truck drivers as patients? Ahh, I see a lot of hands. If you have never performed a U.S. Department of Transportation (DOT) physical or feel a little intimidated by them, the time is ripe for this profession to get involved in a federally mandated program.
As you know, the practice of chiropractic is ever-evolving. One large and mostly unnoticed evolution began in 1992, when the DOT added doctors of chiropractic, advanced practice nurses and physician assistants to the list of medical examiners authorized to perform commercial motor vehicle (CMV) driver physical examinations. The vast majority of DCs practicing today do not perform these exams, simply because they are unaware they can do so. If your state allows chiropractors to perform physical examinations and has CMV drivers who cross state lines, you are allowed to perform these essential and practical examinations.
First a bit of history: In 2000, the DOT decided there were simply too many commercial motor vehicle accidents on our highway systems in the United States, so the Federal Motor Carrier Safety Administration (FMCSA) was established. In August 2005, President George W. Bush signed the "Safe, Accountable, Flexible, and Efficient Transportation Equity Act: A Legacy for Users," otherwise known as "SAFETEA-LU." This act mandated that FMCSA establish and maintain a current national registry of medical examiners qualified to perform examinations and issue medical certificates for CMV drivers.
In November 2005, the first meeting of a working group was held in Washington to begin the process of delineating a task list to be sent to some 5,000 DCs, APNs, DOs, MDs and PAs in the form of a survey. From that survey, medical examiners across the country decided the critical tasks necessary in performing a CMV driver physical examination. In early April of this year, the task group met again and began the painstaking process of deciphering the survey - which, by the way, had a response rate of greater than 50 percent (which is very good). The best news is your profession is represented in the working group!
When the National Registry of Certified Medical Examiners, (NRCME) program is implemented, practitioners who perform these exams must complete required training, pass a certification test and be listed in the NRCME in order to continue performing them. It is estimated that within the next two years, the mandatory training will be implemented.
Whether you have never performed one of these exams or do them now, you should seriously consider getting trained and taking the certification test when it is mandated and offered. What about right now? Get going. Start doing them. You are already qualified by virtue of your CCE and state license status. At this time, there is no certification requirement and there are no FMCSA-certified trainers. If your state allows DCs to perform physical examinations, you meet the FMCSA criteria to perform CMV driver physical examinations. If you graduated from a CCE-accredited chiropractic college, you have the training and background knowledge to perform these exams.
There are currently more than 6 million commercial drivers on the road. The FMCSA estimates there are approximately 400,000 potential medical examiners in the United States. It also estimates that at least 50,000 medical examiners are needed initially to perform these essential examinations. Depending on where you are located, you could perform as few as 10 or as many as 500 physicals per year. These physicals, although thorough and complete, usually are performed on healthy individuals and are not complicated. Generally, they are compensated on a cash basis. That means no insurance hassles.
Remember, not every doctor will go through the trouble of certifying and testing when the NRCME is mandated - so the initial driver-doctor ratio will be huge. As time goes by, more medical examiners will be certified, but if you are one of the first, your niche will be more easily carved. The potential is limitless. You don't need practice management to tell you that! Once you've established a niche, CMV physicals will come rolling in. They will have to - it's the law.
The training guidelines and certification test blueprint will be developed over the next year for the NRCME. If you have never performed an FMCSA examination for a driver and do not want to wait a year or so, log on to www.fmcsa.dot.gov to download an FMCSA, CMV driver physical form. Get a copy of the regulations, study them and start performing physicals now, or get current training. Familiarity with procedures will assist in the NRCME training and certification test at a later date.
Let those trucking and bus companies know you have an open door. Once you have the physical down pat, you might think about adding chain-of-custody drug testing and breath alcohol testing to the mix. These companies must have all of their drivers in a program. Offering all three DOT requirements is very enticing to trucking companies. Specific additional training is required for drug and alcohol testing, per FMCSA guidelines.
If you are looking to gain power and growth potential, consider building the DOT portion of your practice. If you are a little rusty or just confused, don't wait for the official training; start now. Get some training. The sooner you get going, the better position you will be in when the NRCME takes effect.
Dr. Clinton Smith, a 1988 graduate of National College of Chiropractic, is a practicing chiropractic physician in the Metro East area of St. Louis. He was one of the initial members of the Working Integrated Product Team of the NRCME program in Washington, D.C., and has been performing DOT examinations, drug collections and breath alcohol testing for 15 years. Contact Dr. Smith with questions or comments at
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