Carriers put a lot of faith in the medical qualification of drivers. Even with all the recent technology improvements, the driver is the linchpin for safe operations on over 4 million miles of public roads in the U.S. Overall, drivers do an amazing job with hundreds of millions of safe miles driven annually; however, trucking remains one of the most dangerous professions, with around 500,000 crashes per yeari and 22 fatal injuries per 100,000 full-time workers (compared to 3.4 for all industries)ii. A 2017 study of a large trucking company showed that drivers with three or more medical conditions showed a three-fold increase in crash risk compared to healthy driversii. A missed condition on a physical exam could be the difference in a non-qualified driver vs a serious crash. Clearly, a close identification of medical issues by a qualified examiner and a thorough certification process is a key to safety.
ACCURATE PHYSICALS ARE
A DIFFICULT GOAL TO ACHIEVE
The DOT exam long form and certificate contain around 150 information boxes. The examiner’s staff usually coordinates the majority of these, leaving around five minutes for the examiner to interview the driver, perform a physical exam and make a determination. While this is hard enough, the real-world fact is that both drivers and examiners are motivated by revenue. While drivers sign a certification to be truthful, it is common for them to either omit or obfuscate their conditions so that they can work. Likewise, while examiners are expected to be objective and fair judges of driver health, no examiner wants to be known for being too cautious on relevant issues like sleep apnea or medical clearances. This tug-of-war between safety and operations is all too well-known in other areas of the trucking industry.
MOST EXAMINERS ARE NOT DOCTORS
While medical doctor (MD) licenses do top the list of certified examiners, there are as many combined physician assistants (PAs) and nurse practitioners (NPs) as MDs. Chiropractors can be certified in every state except New York, and in some states, physical therapists, naturopaths or massage therapists can be examiners. To date, dozens of examiners have had their certification revoked and dozens more have been sent through corrective retraining. Suffice it to say that while all examiners must pass the same two-hour test, their training and performance are anything but consistent.
75 PERCENT IS NOT GOOD ENOUGH
One of the services CMS and some other MRO/TPAs provide is secondary physical review. We approve roughly 75 percent of physicals and find significant issues with around 12 percent. The remainder are sent to the employer for the driver to obtain medical releases from the person who prescribed questionable medication. Our motto for this work is that “even good examiners make mistakes.” We have found that most examiners are happy to fix any errors on their exams and are grateful for a reviewer who has their back and shares a goal of completing an accurate physical.
The most common errors by examiners are omissions and subpar answers, followed closely by inattention to the risks of some medicines. It is always interesting when a driver omits a condition on the physical, but then lists a medication that they don’t realize treats the condition that they omitted. A thorough examiner will typically identify this, but when rushed or untrained, they may not connect the dots.
WHAT IS THE FMCSA doing TO IMPROVE THE STATUS QUO?
Dr. Joe Sentef, chief medical officer of the FMCSA, is committed to opening communications with examiners and carriers to answer questions and increase consistency for exams throughout the industry. A new medical examiner handbook has been completed and is in legal review, and new educational videos are under development.
HOW CAN CARRIERS HELP?
Carriers can make a significant difference by influencing the safety culture around them. Work with examiners to communicate support for their professional opinion. Understand that the cheapest examiner may not be in the carrier’s self-interest. Physicals are a vital piece of the employment and safety process and should not be treated as a regulation to fulfill as quickly and as cheaply as possible. A good TPA will help you find that balance between cost and benefit. A not-so-good TPA may press vendors to do the work even cheaper, which forces the examiner to cut corners. Communicate to drivers a zero-tolerance policy for “forgetting” to list medical conditions on physicals. Lastly, if the carrier elects not to outsource a secondary review, having someone in the office go over the physicals for completion and glaring mistakes is a value. Spending just a few minutes on each driver will keep some non-qualified drivers off the road and may save the carrier from significant losses.
Endnotes
i https://www.fmcsa.dot.gov/safety/data-and-statistics/crashes-table-8-crashes-involving-large-trucks-time-day-and-crash-4
ii https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293661/
Corporate Medical Services is a 25-year-old MRO/TPA with a full menu of services that include 24/7/365 post accident support, sleep apnea, and secondary physical review. Go to CorporateMedicalServices.com for more information.
