DOT physicals and certified medical examiners

A DOT physical may only be performed by a medical examiner listed on the National Registry of Certified Medical Examiners. Examiners are not listed here yet: the full registry list has been requested from FMCSA. Until it arrives, this page sets out what the rules require and how to find an examiner on FMCSA’s own registry search.

Only one kind of clinician can do this

49 CFR 391.43(a) is short and absolute: except as provided in paragraph (b), the medical examination must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners under Subpart D of Part 390. There are exactly two exceptions, both in 391.43(b). A licensed ophthalmologist or optometrist may perform the vision portion covering acuity, field of vision and color recognition specified in 391.41(b)(10). And a certified VA medical examiner may only examine veteran operators.

Registry listing is not a formality. 49 CFR 390.103(a) requires the applicant to be licensed under state law to perform physical examinations, to register and receive a National Registry number before taking the training, to complete a training programme meeting 390.105, and to pass a test administered under 390.107 whose results reach FMCSA no more than three years after the training. 390.111 then sets a ten-year credential with periodic training due between years four and five and again with a retest between years nine and ten. 390.113 lists the grounds for removal, and 390.115 the procedure.

The professions eligible are wider than most people expect. 390.103(a)(1) names advanced practice nurses, doctors of chiropractic, doctors of medicine, doctors of osteopathy, physician assistants, and other medical professionals authorised by state law to perform physical examinations.

What the examination is actually against

49 CFR 391.41(b) is a list of thirteen standards, and the examination is against those standards rather than against a general impression of fitness. They cover limb loss and impairment, insulin-treated diabetes, a named list of cardiovascular conditions, respiratory dysfunction, high blood pressure, rheumatic and orthopedic disease, epilepsy or any condition likely to cause loss of consciousness, psychiatric disorder, vision, hearing, drug use, and alcoholism.

Three of them have their own alternative route rather than being simple bars. Insulin-treated diabetes goes through 391.46; a driver who fails the worse-eye acuity or field standard goes through 391.44; limb loss or impairment can be addressed by a skill performance evaluation certificate under 391.49. And the drug standard in 391.41(b)(12)(ii) has an explicit exception for a non-Schedule I substance prescribed by a practitioner familiar with the driver's history who has advised that it will not adversely affect safe operation. That exception is a reason to raise a prescription before the appointment rather than at it.

The full list, with the vision and hearing thresholds as the rule states them, is on our page about every standard in 49 CFR 391.41(b).

How often, and the cases where it is not two years

"Every two years" is the default rather than the rule. 49 CFR 391.45 lists eight situations requiring examination, and the 24-month case in 391.45(b) applies only when none of paragraphs (c), (e), (f), (g) or (h) does. Three of those set twelve months: a driver authorised only within an exempt intracity zone under 391.62; a driver with insulin-treated diabetes certified under 391.46; and a driver using the vision alternative standard under 391.44. Two set no interval at all: impairment by physical or mental injury or disease under 391.45(g), and a finding of not physically qualified under 391.45(h).

That last one has a consequence people do not expect. Under 49 CFR 391.43(g)(3), where an examiner finds a driver not physically qualified, all certificates previously issued to that person are no longer valid and no longer satisfy 391.41(a). A failed examination does not leave the old card running to its printed date; it ends it. See how often you need a DOT physical.

What this directory does not know

The National Registry itself is the authority, not this page. No examiners are listed here yet: the registry can only be searched one query at a time on FMCSA's own site, and the full list has been requested from FMCSA rather than copied out of the search. For a definitive answer on whether an individual examiner is currently certified, ask the clinic for its National Registry number and check it on the registry search at nationalregistry.fmcsa.dot.gov.

It also does not know what a given clinic charges, whether it can refer for the vision portion under 391.43(b)(1) without a second appointment, or whether it files the MCSA-5850 results form by the next-day deadline in 391.43(g)(5)(i)(B). Those are questions for the phone, and they are the right questions because the rule creates them.