F or the first time in our profession’s history, we are soon to be placed on a level playing field with our M.D., D.O., Nurse Practitioner and Physician Assistant peers. Soon, the National Registry of Certified Medical Examiners will become final rule for the Federal Motor Carrier Safety Administration. What this means is that Chiropractic Physicians will be on the front lines, keeping our roads safe for truck and school bus drivers. But what does all this really mean for each of us?
FMCSA estimates there are 200,000 examiners in the United States performing CMV exams. When the NRCME is implemented, each examiner will be required to complete certification training and successfully pass a Federal written examination. FMCSA estimates the numbers of examiners will drop to 40,000 examiners. This is for nearly 12 million drivers in the United States. These numbers reveal that opportunity abounds for examiners obtaining the training and certification.
FMCSA is concerned that the numbers of examiners will be too low. So what can you do now? Get trained. Though there is no certification training out there yet, there are companies developing these programs in anticipation of the final rule. These drivers are forced to come to your office for these exams. No other program in your practice mandates anyone to come to your office. When these drivers see your pleasant surroundings, meet your staff and see you are very professional, the possibilities are limitless.
All of this requires minimal investment on the D.C.’s part. Basic exam equipment to include would be a stethescope, otoscope, opthalmoscope, urine dip sticks, a Snellen chart and a broad base of knowledge of DOT rules, regulations and recommendations, along with some core pharmacology knowledge requirements—this will put you in the forefront of performing these examinations.
Once you have the basics and are able to apply DOT rules and regulations to your clinical findings, you will be in the top tier of CMV driver examiners in the country.
Typical reimbursement is not insurance driven. No doctor-patient relationship is created and does not require managed care inclusion or intervention. These are cash exams either paid for by the drivers themselves or the company for which they work. Most exams are between $50 and $75 per evaluation. However, once NRCME is implemented, most exams will increase to around $100 until the service pool of NRCME examiners increases to force competition, and this will take some time. An average exam takes around 20 minutes, but staff handling paperwork, blood pressure, and urine sampling can reduce the doctor’s contact to around 8 minutes for a normal, healthy driver. Of course, complicating factors such as co-morbiditities (diabetes, hypertension, smoking, seizures, etc.) will require more investigation, thus taking more time. However, the majority of CMV driver exams are straightforward and drivers are usually easily certifiable for the two year DOT maximum certification period.
So how do you begin performing these exams? Again, get trained. Once you have the basics and are able to apply DOT rules and regulations to your clinical findings, and do it consistently without wavering, you will be in the top tier of CMV driver examiners in the country. When the official training comes out, take that in a didactic lecture format or online (both will be allowed by the FMCSA) and then take the examination. There are pre-release training programs active at this time. Proposed rules state that a potential examiner should not have to drive a long distance to take the examination. Beta testing that was administered in July of 2009 was proctored at H&R Block businesses around the country. We estimate this will be the contractor of choice for examiner candidates in this program.
Many have asked about the other required testing for CMV drivers, which include breath alcohol and urine drug testing. These two will enhance your practice and make it attractive to local companies that would like it all in one place. Now, many companies have to go to three different clinics to get physicals, drug screens and breath alcohol testing performed.
Training consists of numerous modules presented in a slide show format. You will need to take notes and study for this exam. No examiners will be grandfathered into the program. All examiner types will be on the same playing field and equal. Now is the time to begin your training and get proficient in these examinations.
As insurance companies erode your bottom line, DOT work can increase it. With a little elbow grease, equipment you already have and the desire to be investigative, your office can become a highly respected DOT clinic in your area.
Plan, in the next four months, your training path. Get going and, when the NRCME switch is flipped, be the first in your area to be an NRCME examiner, then get your drug and alcohol training to complete the “trio” of DOT services. Our profession stands to be the leader in DOT work for the future. We should all explore this opportunity.
Clinton M. Smith, D.C., is President of NRCME Training Systems, LLC, located near St. Louis, MO. He is a practicing chiropractic physician specializing in DOT/FMCSA physical examinations, drug screening and breath alcohol testing. He is a past member of the Role Delineation Study for the Federal Department of Transportation/Federal Motor Carrier Safety Administration. His company instructs physicians in examination protocols and certification requirements for the soon to be implemented National Registry of Certified Medical Examiners. He has instructed for Logan College and Western States and now lectures for NRCME Training Systems throughout the country.