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April 24, 2017 3:45 AM, EDT

ATRI Finds Inconsistencies With Driver Medical Exams

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This story appears in the April 24 print edition of Transport Topics.

The quality of mandatory truck and bus driver physical exams administered by certified Federal Motor Carrier Safety Administration medical examiners is inconsistent, according to new analysis by the American Transportation Research Institute.

The research project was conducted to evaluate whether a new process that requires physicians to be trained and tested before being placed on the agency’s national registry of examiners was improving the quality of exams given every two years or less to commercial motor vehicle drivers.

The analysis, done in collaboration with the Mayo Clinic, was based on a survey of 900 commercial drivers, 300 motor carriers and 1,200 certified medical examiners, ATRI President Rebecca Brewster said.

“The data show a polarity in quality of medical examiners,” said Clayton Cowl, chairman of the 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.”

Prior to May 2014, examiners issuing medical certificates to commercial motor vehicle operators were only required to be licensed by their states to conduct physical examinations, and be familiar with the demands of CMV operations and knowledgeable of the agency’s requirements.

But researchers said they were in some ways shocked to hear that 63% of drivers surveyed said the new process was not doing a better job of administering exams.

FMCSA regulations require that at a minimum an examiner must review and discuss any conditions in a driver’s health history that may impact his or her ability to safely operate a commercial motor vehicle; record the driver’s pulse rate, driver height and weight, and blood pressure; test urine for proteins, blood, and sugars; test vision and hearing; and, physically check all major body systems for abnormalities.

“One particular finding that was surprising and concerning was the amount of time that drivers reported spending with the medical examiner,” Brewster said. “We had 26% of the drivers reported spending 20 minutes or less with the medical examiner, and of that 6.5% spending less than 10 minutes. That’s clearly not enough time to do what is required of medical examiners.”

More than 34% of drivers surveyed said the quality of their exams has become worse since the new registry process went into effect in May 2014.

More than 57% of drivers said they saw no change in the quality of exams, despite the tougher requirements for medical examiners.

FMCSA spokesman Duane DeBruyne said the ATRI study is “under review” by the agency.

DeBruyne said the National Registry of Certified Medical Examiners was required by federal law and addressed four National Transportation Safety Board recommendations.

The list of certified examiners now numbers more than 52,000, said Larry Minor, FMCSA associate administrator for policy. In a presentation last month at an American Trucking Associations conference, Minor said the national registry program was working well.

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 as the reason they were not issued a medical certification.

Nearly 48% of drivers were issued certificates for less than the two-year maximum.

“The shorter-term medical certificates may reflect health and wellness issues among the driver population,” the study said.

In addition, the study showed that motor carriers still have significant concerns related to the medical exam certification process, including requests by examiners for additional medical documentation causing certification delays, driver confusion about how regulatory changes affect the ability to hold a valid medical certificate, and concerns with the competency of examiners.

Nearly 50% of motor carriers reported that they specify which examiner their drivers see to ensure medical exam quality, but less than 1% of carriers surveyed reported no major concerns with the certification process.

The analysis also concluded that the ability of drivers to find a medical examiner close to where they live may be more challenging in the future because 15.3% of the examiners reported that they have quit or plan to quit performing DOT physicals.

With an estimated 4 million driver exams conducted annually, Cowl said that some doctors say conducting exams has “become more of a bureaucratic headache than it’s worth.”

“The inconsistency in quality of exams provided our drivers creates real challenges for us as a fleet,” Victor Hart, director of safety for DOT Transportation, said in a statement. “Where, in one terminal location, a driver may be required to undergo extensive tests and provide additional documentation prior to getting a medical certificate, drivers in other locations are expedited through with cursory exams.”