FMCSA Releases New Medical Examiner’s Handbook

Reaction to Shorter Guide Is Mixed
The handbook fails to offer formal medical rules or requirements, leaving the decision-making up to medical examiners. (utah778/Getty Images.)

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More than eight years in the making, federal trucking regulators have finally approved a new — albeit scaled down — version of the 2024 Medical Examiner’s Handbook, aimed at helping medical professionals assess whether a truck driver is healthy or could have a disqualifying medical condition.

Reduced from 260 to 113 pages, it may be a better read, but does it really give a medical examiner better guidance?

Many welcomed its debut late last month, but others in the medical community feel it falls short of its goals. Though it offers the guidance of best medical practices, the handbook fails to offer formal medical rules or requirements, leaving the decision-making up to medical examiners, with the assistance of drivers’ doctors.

In 2015, the Federal Motor Carrier Safety Administration pulled down the prior examiner’s handbook from the internet, leaving thousands of examiners to fend for themselves in using best medical practices when they screen drivers at least every two years.

“This is a pretty big happening, whether or not people realize it,” said Mark Schedler, senior editor for transport management at J.J. Keller and Associates. “The health of drivers is not the best. So I think a good physical examination is good for the industry and good for drivers’ long-term health.”

Schedler has conducted in-depth research on the topic.

Some of the differing views on the new handbook seem to center on the fact that none of its guidance is mandated: In an introduction to the handbook, FMCSA said that unlike regulations, recommendations and other guidance, it does not have “the force and effect of law and does not bind medical examiners in any way.”

“The whole certified medical examiner process was founded on setting up enough guidance that you could get a decent amount of consistency between examiners,” Schedler said. “The 2015 handbook was a lot more prescriptive, nearly double the [new handbook’s] length, and it gave the examiner who may not have a lot of experience at least a place to start.”

However, in fashioning the new handbook, some of the past suggestions were stripped from the publication, Schedler said.

Mark Schedler


“For example, FMCSA in the prior handbook suggested waiting periods before a driver can get back on the road with many conditions, such as heart attacks or strokes,” Schedler said. “But the new book stripped out most suggested waiting periods. I just think there’s going to be more variability, somewhat rolling back the purpose of the original certified medical examiner program.”

From all appearances, the agency is attempting to sidestep legal liability by not making the handbook suggestions formal rulemakings or policy.

“There are pros and cons to the new book,” said Dr. Brian Morris, an examiner who sits on FMCSA’s medical review board. “The old handbook was like a cookbook, and it gave very definite protocols for almost everything. FMCSA has gotten away from that by moving onto a case-by-case approach.”

In past meetings, other members of the agency’s medical review board have expressed similar concerns as Morris.

In October 2022 comments, the American College of Occupational and Environmental Medicine agreed with Morris that the draft handbook should have enough information contained within to ensure “that the same medical determination on certification is made, regardless of examiner.”

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The college said the draft handbook, similar to the new 2024 version, was “inconsistent in the extent to which it attempts to ‘teach’ what should be basic knowledge to any health care provider performing these examinations and conducting that fitness for duty/risk assessment.”

“FMCSA must also recognize that examiners will vary in their knowledge base, background, education and experience,” the college wrote. “Simply including facts about a condition will not provide sufficient information to perform the risk assessment necessary to determine whether the individual is at risk of sudden or gradual impairment or incapacitation over the duration of the medical certification.

“Of course, the ME could obtain information from the treating clinician, but the ME is ultimately responsible for making that certification determination, not just deferring to the treating clinician.”