Industry Unfriendly CME Issues

Here's the scoop. My class is getting ready to take our written exams for our permit. Our school sent us all to a location that they had never used before.

Out of 12 of us only 2 got an unrestricted 2 year card. Many of us got nailed with a required sleep study and a 60 day card which won't even allow us time to test out of school, while 1 person with a bmi of around 45 and a bp of 143/94 was given a 1 year card due to the bp, but no sleep study required? ??

The school was extremely unhappy and said they are sending us for a new DOT physical at another provider. Can we actually do this?

BTW I got stuck with the 60 day card and although I was ****ed because my bmi is barely 30 due to a recent weight gain with no neck size issues, signs, symptoms, etc. I immediately called and got an appointment. Incidentally, I'm qualified to give sleep studies lol and know I'll pass with flying colors.

My biggest concern is that my insurance company will pay for this one and want assurance that this is a 1 and done thing as I guarantee that they won't pay for a 2nd study in 2 months when it's not warranted in the first place. Just concerned because most employers have you redo your DOT physical and don't want to get needlessly nailed a 2nd time.

Incidentally, the DID NOT drug test us at all. They only tested us for medical things (like protein and sugar, etc.)

The school was extremely unhappy and said they are sending us for a new DOT physical at another provider. Can we actually do this?

Yes, you can.

Unfortunately you're seeing the same thing with sleep studies now that you saw with drug testing years ago. As drug testing became more common and entire industry was built around it. Now you're seeing everyone go crazy with sleep studies. In fact, the owner of a truck driving school wrote an article for us called The Sleep Apnea Witch Hunt which outlines this very thing.

Let the school send you to a different doctor for the physical and see what happens. You may not need a sleep study.

When is it OK for a trucker to get a second opinion on a DOT physical?

The FMCSA has made an important clarification for truckers concerning medical and physical qualifications to drive. Specifically, the clarification has to do with whether a trucker can seek a second opinion when obtaining a physical from a DOT-certified medical examiner.

The short answer is yes, but there’s more to it.

Chuck Horan, who oversees the National Registry of Certified Medical Examiners administered by the Federal Motor Carrier Safety Administration, says he’s received questions and concerns from drivers who are told by a medical examiner or someone else in the chain that getting a second opinion is not allowed on a Department of Transportation physical.

Horan says yes, drivers can get a second opinion, as long as they provide a full and honest history to their medical examiners and do not cross the line into illegal “doctor shopping.”

“It’s important that any time you’re dealing with the medical profession and medical judgment that you should be allowed the opportunity to go get a second opinion – to find out if the (doctor) is being extremely conservative with his call,” Horan told Land Line.

“Some are very conservative and others are not so conservative, so you may get two different answers from two different doctors using the exact same information. … In those cases, we don’t see that as doctor shopping, as long as you provide the doctor with the same information to make the call.”

Horan says medical examiners and the FMCSA are concerned about drivers who do not divulge their full medical histories to a second – or sometimes third – medical examiner after an initial examiner restricts or disqualifies the driver.

“If you go down the street and leave part of that history out, and obviously the new doctor that you’re at doesn’t have the information to make a full assessment and ends up giving you a card, that is doctor shopping,” Horan said.

The National Registry of Certified Medical Examiners went live on May 21, requiring all commercial drivers to get their next physical from a FMCSA-certified examiner.

The first few months of the registry being active have revealed some flaws and complaints.

Most of the concerns and complaints received by FMCSA – and by OOIDA’s regulatory and business services staffs – are about the inconsistency in how the certified medical examiners interpret DOT regs and guidance when conducting driver physicals.

Some examiners have run roughshod over drivers on the issue of sleep apnea , insisting that apnea testing is a regulation even though it is not.

OOIDA Member Jeffrey Spear, aka “Cowboy,” had a negative experience a few months ago when he went for a driver physical at Agnesian HealthCare in his hometown of Fond du Lac, Wis.

“They were looking to fail me and do anything they could to get me to take a sleep test,” Spear told Land Line.

Spear says the examiner measured him an inch shorter than he is, said he was heavier than he is, and measured his neck size an inch larger than it is. The examiner insisted Spear be tested for sleep apnea even though Spear had a note from his family doctor saying he did not have sleep apnea.

“(The doctor) had me down for a three-month card and I was to have a sleep study done at that time,” Spear said.

OOIDA Director of Regulatory Affairs Scott Grenerth said what Spear did next was within his rights based on the clarified FMCSA position on second opinion.

Spear sought his second opinion from Lynn Biese-Carroll, a certified examiner who is part of a medical team working out of the Highlands Petro in Racine.

According to Spear, Biese-Carroll did not think he was at risk for sleep apnea. She issued him a one-year medical card and did not order a sleep test, although Spear is to return to discuss his progress in being treated for blood pressure.

“It’s up to the doctor to do a thorough exam to see if drivers are at risk of a sudden, incapacitating event,” Biese-Carroll told Land Line in October.

“Because there is gray area (in DOT guidance), it’s up to the doctor’s medical opinion what the recommendation for follow up should be,” she said.

“We see a wide gap in practical application of the DOT’s regulations and recommendations – with some clinics being very lax, and some people being too rigid in the application of the DOT’s intended rules and regulations. We think that somewhere in the middle is probably where most of the doctors hopefully exist, with an interest in helping the drivers become healthier while still applying the rules that keep the driver road safe.”

Horan explained what the FMCSA does when two medical opinions exist for a driver.

“When we get two records on one particular driver, we have the capability of pulling the long form from both medical examiners and look at the long forms back-to-back. If they’re identical, if you have a doctor that lets you have a six-month, one-year, or two-year card, that card is good,” he said. “That card would be the card of record.”

According to a bill passed by Congress and signed into law in October 2013, the Federal Motor Carrier Safety Administration shall not issue guidance to medical examiners on sleep apnea or advance an apnea restriction without first going through a full rulemaking process that includes a public comment period.

This news release made me realize that in a framework where doctors and medical offices are paid on a "fee for service" model, more services mean more bucks. Short-time physical dates means more office visits. Sleep apnea is another gold mine here.

Just like lawyers who will take their fee and get you your disability, DOT physicals can become a racket.

A few rotten apples spoil the whole barrel here. Most medical offices are legit, providing quality service. I suggest one way to separate the goats from the sheep might be to ask up front how many sleep apnea studies they do. My regular medical office is DOT certified, so my own doctor does the exam. Can't beat that!

Thanks so much for your input guys! I think we found a bad apple for sure. There were 2 CMEs at this location (Nurse Practitioners). The one I saw was the one who gave EVERY single person he saw a 60 day card and demanded a sleep study, saying he had no choice, that it was REQUIRED. He was visiting from another location and unfortunately showed up less than 5 minutes before my turn. Then the other CME went to lunch? 9 out of 12 received a 60 day card. Since our DOT phyicals are included in our tuition costs, absolutely the school owner was not happy.

Im anxious to see what happens on the new physical. Ill make sure I answer the questions on the form exactly the same way.

I am taking my at home sleep study next week. I was really happy I learned about this before I quit my current job and temporarily lost my insurance. I spoke with my doctor about this and he set me up with my appointment.

I got my 2nd opinion today which resulted in a 2 year unrestricted medical card, which was what I should have received in the first place. No health issues (other than a few extra pounds), no medications, no glasses needed (@ 53 years old even), no high blood pressure or diabetes, no surgeries, no hospital admissions other than when I had my children.

Thank you again so for the awesome advice I received. Tge folks at TT really are the best.

As a side note, I received a letter from the state yesterday stating that my (original dot card) was filled out incorrectly and they could not approve my self certification form/application for CDL testing until that was corrected. My school is faxing the new card and long form so I should be able to test to get my permit later next week. Incidentally, I'm saving my health insurer the cost of a completely unnecessary sleep study and canceling that appointment. Seriously as a healthcare professional, I understand the concern about sleep apnea and if I even remotely thought I had that issue, I'd have already jumped to get that checked out.