The National Registry of Certified Medical Examiners (NRCME) would be a list of certified medical examiners who fully understand the medical standards in the Federal Motor Carrier Safety Administration Regulations and how they relate to the mental and physical demands of operating a commercial motor vehicle. Medical examiners would be required to successfully complete required training and pass a certification test before being listed on the NRCME.

2. Who are medical examiners?

Federal Motor Carrier Safety Regulations define a medical examiner as, a person who is licensed, certified and/or registered in accordance with applicable State laws and regulations to perform physical examinations. The term includes, but is not limited to, Advanced Practice Nurses, Doctors of Chiropractic, Doctors of Osteopathy, Medical Doctors, and Physician Assistants. (49 Code of Federal Regulations 390.5)

A recent Federal Motor Carrier Safety Administration survey found that there are approximately 400,000 potential medical practitioners who could perform physical examinations for commercial motor vehicle drivers. To perform physical examinations of the more than 6 million commercial motor vehicle drivers, there would be a need to train and certify more than 50,000 medical examiners when the National Registry of Certified Medical Examiners is established.

3. Do medical examiners differ from medical review officers?

Yes. A medical review officer is a licensed physician who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results. More information on medical review officers is available online at http://www.dot.gov/ost/dapc/mro.html.

4. Why is the National Registry of Certified Medical Examiners necessary?

Over the past 20 years (1982-2002), the Federal Motor Carrier Safety Administration (FMCSA) estimates there has been a 42% increase in registered large trucks and a 93% increase in miles traveled by large trucks. There are approximately 7 million registered large trucks, 700,000 commercial buses, 11 million commercial driver’s license holdersand over 600,000 interstate truck and bus companies in the United States. These statistics reflect a significant increase in the presence of large trucks on our Nation’s highways over the last several years.

There is also evidence that improper medical certification has contributed directly to crashes. The National Transportation Safety Board, for example, has documented cases where drivers with serious disqualifying medical conditions were involved in significant fatal and injury crashes. Reports from FMCSA field staff indicate numerous problems on our roads, where drivers who have disqualifying medical conditions are operating commercial motor vehicles. These issues indicate there is a need to improve the medical certification process, and the National Registry of Certified Medical Examiners is one strategy for addressing this problem.

Interest in certifying medical examiners to evaluate interstate commercial motor vehicle drivers dates back to at least 1978 when the National Highway Traffic Safety Administration commissioned a feasibility study on the issue. This study addressed the primary weakness in the overall system – the lack of medical examiner understanding of the relationship of driver health to the task of operating commercial motor vehicles interstate. The study concluded that there were not enough medical examiners to support a certified medical examiner system for all interstate commercial driver examinations.

The idea of having a National Registry of Certified Medical Examiners has been raised periodically by the government since that time. In August 2005, Public Law 109-59, The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) was enacted. Section 4116 requires, “The Secretary, acting through the Federal Motor Carrier Safety Administration - (1) shall establish and maintain a current national registry of medical examiners who are qualified to perform examinations and issue medical certificates; (2) shall remove from the registry the name of any medical examiner that fails to meet or maintain the qualifications established by the Secretary for being listed in the registry or otherwise does not meet the requirements of this section or regulation issued under this section; (3) shall accept as valid only medical certificates issued by persons on the national registry of medical examiners; and (4) may make participation of medical examiners in the national registry voluntary if such a change would enhance the safety of operators of commercial motor vehicles.”

5. How would the National Registry of Certified Medical Examiners work?

The names of all certified medical examiners nationwide would be listed in the National Registry of Certified Medical Examiners (NRCME) database. Medical examiners who wish to pursue certification would participate in required training and pass a test to obtain certification to conduct the physical examinations required for commercial motor vehicle drivers in interstate commerce. Information about the certified medical examiners would be available to drivers who wish to become commercial motor vehicle drivers. The NRCME Web site would be used to disseminate information to practitioners on new medical discoveries and policies or requirements relevant to the examinations. The NRCME Web site would also provide program information to the certified medical examiners, medical examiners who wish to become certified, and the interested public. The primary method of information dissemination would be through the NRCME Web site (http://www.nrcme.fmcsa.dot.gov). A resource center with a toll-free telephone number would also be available.

6. Who would be responsible for setting up and maintaining the National Registry of Certified Medical Examiners database?

The Federal Motor Carrier Safety Administration is responsible for implementing, overseeing and maintaining the National Registry of Certified Medical Examiners database and program. This may be accomplished through partnerships with public and private-sector organizations.

7. How would having a National Registry of Certified Medical Examiners impact the general public?

The Federal Motor Carrier Safety Administration is dedicated to making our highways safer. The National Registry of Certified Medical Examiners would promote confidence in the quality of the medical examinations of commercial motor vehicle drivers. Ensuring that commercial motor vehicle drivers are physically and mentally able to handle the demands of commercial driving safely would potentially decrease the number of crashes involving commercial vehicles on our Nation’s highways.

8. Will there be an opportunity to provide comments about the National Registry of Certified Medical Examiners?

There will be numerous opportunities to comment on the National Registry of Certified Medical Examiners (NRCME) during its developmental phases. Public forums are planned during critical developmental stages of the NRCME program. The first public meeting was held on June 22, 2005 at the Crystal City Marriott in Arlington, Virginia and provided all attendees an opportunity to discuss the NRCME program with subject matter experts. Two Public Listening Sessions are planned for 2006: San Diego, CA on June 29 and St. Louis, MO on July 26. Additional information about public meetings can be found online at http://www.nrcme.fmcsa.dot.gov. There will also be opportunity to comment during the rulemaking process.

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Commercial Motor Vehicle Driver Questions

9. What impact would the National Registry of Certified Medical Examiners have on commercial motor vehicle drivers and the motor carrier industry?

When the National Registry of Certified Medical Examiners (NRCME) is established, interstate commercial motor vehicle drivers would be required to be medically examined and certified by a certified medical examiner listed on the NRCME. Information regarding certified medical examiners listed in the NRCME database would be readily available to motor carriers and commercial motor vehicle drivers through the NRCME Web site, http://www.nrcme.fmcsa.dot.gov, and the toll-free telephone line.

10. How would the National Registry of Certified Medical Examiners help me if I live in a rural State?

When established, the National Registry of Certified Medical Examiners (NRCME) would provide a readily accessible list of medical examiners who are certified to perform examinations and issue medical certificates according to the requirements of Section 391.43 of the Federal Motor Carrier Safety Regulations. The NRCME would make it easier to find a certified medical examiner in your area. When the NRCME is established, this list would be available online at http://www.nrcme.fmcsa.dot.gov.

11. How would the medical certificate issued under the National Registry of Certified Medical Examiners be different from the medical certificate commercial motor vehicle drivers are required to have now?

The medical certificate would continue to be used, but would be revised to include additional information. The difference would be that when the National Registry of Certified Medical Examiners (NRCME) is established, the medical certificate would have to be issued by a medical examiner who has successfully completed the Federal Motor Carrier Safety Administration’s (FMCSA) required training, has passed a certification test, and is listed on the NRCME. This would ensure that all medical certificates are issued by medical examiners who demonstrate comprehensive understanding of the medical standards in the Federal Motor Carrier Safety Regulations, and how they apply to the mental and physical demands of operating a commercial motor vehicle.

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Medical Examiner Questions

12. How would the National Registry of Certified Medical Examiners impact medical examiners?

When the National Registry of Medical Examiners (NRCME) is established, medical examiners who wish to conduct Federal Motor Carrier Safety Administration (FMCSA) physical examinations for commercial motor vehicle drivers would be required to complete required training and pass a certification test in order to be listed in the NRCME database. The training would enhance the medical examiner’s knowledge of FMCSA’s physical qualification regulations and standards, understanding of the mental and physical demands of operating a commercial motor vehicle, and ability to determine if a driver can handle these demands safely. Medical examiners would maintain competency through ongoing training, certification, and recertification.

13. Do all medical examiners have to be certified?

When the National Registry of Certified Medical Examiners (NRCME) is implemented, all medical examiners who intend to perform examinations and issue medical certificates for drivers to meet the requirements of Section 391.41 of the Federal Motor Carrier Safety Regulations (FMCSRs) would have to be certified and listed on the Federal Motor Carrier Safety Administration’s NRCME. In order to be certified, medical examiners must pass a test demonstrating comprehensive understanding of the medical standards in Section 391.41 of the FMCSRs, and how they relate to the mental and physical demands of driving a commercial motor vehicle. When the NRCME is established, information on training and certification would be available on the NRCME Web site at http://www.nrcme.fmcsa.dot.gov.

14. How do I become a certified medical examiner?

When the NRMCE program is implemented, you would be required to complete the training and pass the certification test required by the Federal Motor Carrier Safety Administration (FMCSA) to become a certified medical examiner. Training would be offered in selected locations and online.

The NRCME program is in the process of being developed and is currently in the rulemaking phase. Rulemaking allows for the public to comment on the proposed program model. Therefore, a definitive date when the program will be in place is not yet available. When the NRCME is established, information on the training and certification test would be available on the NRCME Web site at http://www.nrcme.fmcsa.dot.gov.

Information on how to begin performing the commercial motor vehicle driver physical examination in the meantime is available on the FMCSA Web site at http://www.fmcsa.dot.gov, Medical Program link.

15. How much will it cost to become a certified medical examiner?

When the National Registry of Certified Medical Examiners (NRCME) is established, there would be a cost for the training, certification, and recertification required for medical examiners. There is a rulemaking in process for the NRCME program. As a part of that process, FMCSA will conduct a regulatory analysis that will include cost/benefit analyses.

16. Where is certified medical examiner training being offered in my area?

When the National Registry of Certified Medical Examiners (NRCME) is established, information about training would be found on the NRCME website at http://www.nrcme.fmcsa.dot.gov.

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