There is a tension between federal Department of Transportation (DOT) and Federal Motor Carrier Safety Administration (FMCSA) regulations that outline who can perform CMV driver examinations and state regulations related to the performance of physical examinations for medical purposes – state regulations that govern the medical practice of physicians (both allopathic and osteopathic), physician assistants, nurse practitioners, chiropractors, and, in some cases, naturopathic and other allied professionals.
Although FMCSA guidelines explicitly indicate that physicians, physician assistants, nurse practitioners, and chiropractors may perform DOT examinations, the guidelines also indicate that deference must be given to state regulations that may specify the requirements and limitations that may apply to these professions. Put another way, FMCSA guidelines do not limit who can perform DOT examinations to these categories of providers, and indicate that examinations may be performed by providers licensed in a given state to perform physical examinations for medical purposes. FMCSA guidelines also defer to state regulations regarding the level of supervision necessary for physician assistants and nurse practitioners who perform medical examinations.
Another area of confusion relates to the performance of medical examinations on drivers who do not meet the definition of CMV drivers as outlined by the FMCSA. For example, school bus drivers are specifically exempted from FMCSA driver requirements, despite appearing to meet the definition of drivers of vehicles with 15 or more passengers. While most states have no requirements whatsoever related to performing medical examinations on school bus drivers, some states have such requirements, and those requirements may appear to conflict with FMCSA guidelines. In these cases, it needs to be understood that school bus drivers are not considered CMV drivers as defined by FMCSA regulation, and that state (or local) requirements for school bus driver examination are unrelated to FMCSA requirements. Some states may require that school bus drivers have medical examinations, and state regulations may specify that such examinations can only be performed by medical doctors and not by physician extenders or chiropractors.
Unfortunately, conflicting state and local regulations may lead to great confusion for employers, medical examiners, and drivers. Worse yet, often the application of these regulations is carried out at local Department of Motor Vehicle (DMV) offices, and many DMV employees may not have a clear understanding of these regulatory distinctions and how they apply in practice. Usually, with some homework regarding possible applicable state and local regulations coupled with education of DMV supervisory and management personnel, these conflicts can be resolved and medical examiners can then perform those examinations that they are qualified to perform by applicable federal, state, and local regulations.
Steven St. Clair, MD, MPH
Dr. St. Clair is a medical consultant to the NRCME Training Institute, LLC. The NRCME Training Institute, LLC provides an affordable 100% online DOT medical examiner training program which meets and exceeds FMCSA requirements.