Becoming FMCSA - Certified Medical Examiners
OCCUPATIONAL MEDICINE
Edmund D. Brundell
DC
Over the past decade, many chiropractors have extended their range of practice into the field of occupational medicine. Many who have entered the field have found occupational medicine to be richly rewarding both intellectually and financially. If you are interested in exploring this area of practice, an initial building block for achieving that goal is becoming a certified medical examiner.
A certified medical examiner (ME) is the only healthcare professional allowed to perform the Department of Transportation (DOT) physical examinations required for drivers to maintain their commercial driver's licenses (CDL). At the time of this writing, only three states prohibit chiropractors from performing DOT physicals—New York, Michigan, and Washington.
Most medical examiners are licensed MDs, DOs, DCs, PAs, or ANPs. To become a ME, you must be a licensed professional allowed by state law to perform physical exams, and you must pass an exam.
The DOT, through the Federal Motor Carrier Safety Administration (FMCSA) has established training and examination requirements for prospective medical examiners. The first of these requirements is completion of a 12-hour training course, offered by an FMCSA-approved organization. Several companies offer this training, usually as an online course or webinar. National Wellness Courses (nationalwellnesscourses.com) also offers on-site training by arranging for several doctors to meet at a common location with an on-site instructor who is a certified medical examiner.
The course consists of regulations pertaining to the role of an examiner. There is an in-depth study of all major organ systems as well as special senses and their various disease states as they affect the safe operation of a motor vehicle. Pharmacology, both prescription and over the counter, is taught as well because it may affect the ability to drive safely.
Once this course is completed and the teaching organization has notified FMCSA, the prospective ME contacts FMCSA. They will then contact your board to confirm you are actively licensed and can perform physical examinations. Then FMCSA will email you a national registry number, and you may now contact one of three testing organizations to schedule the exam.
The exam consists of 120 questions in a multiple-choice fonnat. Twenty of the questions are research in nature and not graded. The exam has a two-hour time limit, and the grade is posted immediately after the completion of the examination. A score of 71 is required to pass the exam.
After passing the exam, FMCSA will conduct a final review of your qualifications and then email your certificate. You are now a certified medical examiner and can perform CDL physicals. The ME certificate is good for 10 years with a refresher course required at the fifth year and a repeat of the exam every 10 years.
At first glance, it might seem to be quite the involved process, both in financial commitment and time, to be allowed to perform a physical exam. However, this is not the case. First, the ME is saving lives. The DOT estimates that 40% of CDL drivers have a medical condition or conditions that either preclude them from holding a CDL certificate or require monitoring for them to retain their license. Next time you are in your automobile, consider that for every 10 semis you see, four of their drivers may not be healthy enough to operate their vehicles safely.
Unfortunately, most of these drivers are unaware of their physical status and how it may affect their driving. Conditions such as hypertension and diabetes are insidious in nature, leaving drivers with a collection of vague symptoms or the belief that they are just tired and stressed. It falls upon the ME to detect conditions that may impair driver safety and intervene as necessary.
The ME not only protects the public but the drivers as well. Today, conditions that would have cost a driver not only a CDL license but his or her life as well, such as diabetes, can be successfully managed and drivers can continue to work. Early detection and intervention by the ME can effectively add years of life to the drivers they serve.
I often remind doctors to remember that they are a certified medical examiner, performing a DOT physical on a CDL driver, not a chiropractor looking for new patients. However, being a ME does provide for new patient interactions. For drivers who may have never been in a chiropractor's office, it provides them the opportunity to see what goes on in a chiropractic office, and this often encourages them to ask questions pertaining to the benefits of chiropractic care.
Just remember that while you are performing the evaluation and examination, you are not a chiropractor; you are a medical examiner. Simply inform the driver that questions pertaining to chiropractic are best left until after the DOT examination is completed. You'll discover that most drivers appreciate not being "marketed to" and are encouraged by your focus on the exam and their needs as a CDL holder.
This approach, coupled with a professional and thorough CDL examination, helps build trust with the driver. I've had many drivers decide to pursue chiropractic care, and even those who didn't seek care often referred people to my office because they knew they would be treated in a competent manner.
The certified ME also has a unique position in interactions with other healthcare providers. In matters pertaining to the issuance of a CDL medical certificate, the ME has absolute override for all other disciplines. For example, while a driver's cardiologist may clear him or her to drive, if that driver fails to meet DOT requirements, then you, as a certified ME, can refuse to grant the medical certificate to that driver.
The ME often works in consultation with other providers. If the urinalysis of a driver indicates elevated glucose levels, a call to the driver's primary provider explaining the situation and requesting they perform a fasting blood draw often establishes a rapport between them. The provider receives a heads-up that there may be a health issue with his or her patient, the ME gets the information needed to reach a decision, and, most importantly, the driver can receive necessary care.
As richly rewarding as it can be, the role of certified medical examiner is only the beginning of what is possible for chiropractors in the field of occupational medicine. If curious, I recommend contacting organizations specializing in the field. Occmed for DC's (occmedfordcs.com) is one I have found to be extremely helpful for chiropractors to help determine if this direction is for them.
Dr. Brundell is a licensed chiropractic physician in the state of Florida. He is a certified medical examiner and certified breath alcohol technician. Anyone interested may contact Dr. Brundell at [email protected].
