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Dynamic Chiropractic – March 12, 2010, Vol. 28, Issue 06
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A Billion Dollar Opportunity for Chiropractors

By Michael Megehee, DC

Truck driver exams, Department of Transportation (DOT) and non-DOT alcohol and drug testing are the vehicle for all chiropractic physicians to significantly increase their income and fill open appointments.

The chiropractic profession has a significant competitive edge over all other providers. That competitive edge will cause a detour in where upwards of $1 billion per year will be spent.

Currently, the great majority of the 4.2 million driver medical exams performed annually are provided by MDs, DOs, ANPs and PAs. Along with those four professions, chiropractic physicians serve as DOT medical examiners and can perform the DOT driver medical exam with little preparation, but that is due to change this fall when the Federal Motor Carrier Safety Administration's National Registry of Certified Medical Examiners (NRCME) is expected to finally become effective. All medical examiners will be required to attend mandatory training, pass a certification test, and attend recurrent training every three years. This will be a hurdle for all providers, but it provides an opportunity for the chiropractic profession to benefit the most.

It is an unfortunate fact that many chiropractic offices are underutilized; however, this actually is a tremendous advantage in terms of exam scheduling. Many drivers allow their medical exam to expire, resulting in a mad rush to get a new one. In many cases, this alone determines which office is chosen. It seems that every driver and motor carrier wants an appointment today. In most chiropractic offices, same-day appointments are business as usual.

Even the relative reimbursement for a driver medical exam favors the chiropractic profession. If a physician can charge more performing a different procedure, they are likely to follow that strategy. As the cost for a typical office visit soars in medicine-based clinics, fewer will choose to perform medical exams. However, with most chiropractors charging $45 to $120 per exam, reimbursement is frequently greater than other chiropractic procedures, making the medical exam the procedure of choice.

Price is an important consideration for drivers and motor carriers alike, usually second only in times of urgency. The lowest price does not guarantee getting the client, but it helps start the conversation. Chiropractic offices have low overhead. Our malpractice and rent are less, and we employ fewer staff and generally pay them less. (The only RN or PA in a chiropractic office is a patient.) The result is that chiropractors can meet or undercut the price of just about every other provider. Chiropractic offices can still make a profit when others are losing money.

Compared to the other professions, chiropractors are the least recognized for being authorized to serve as DOT medical examiners. Most of this comes from DCs being the smallest participating group. Another reason may be a perceived difference in capability. Here the NRCME provides the answers. The training course and certification test are the same for all professions. No one gets an easy test. Everyone who passes will be a certified medical examiner and will be listed in the national registry as an authorized provider. There will be a level playing field.

Once an office is providing the medical exam, the natural progression is to add alcohol and drug testing. More DOT drug tests are required per year than medical exams. And although DOT alcohol tests are fewer in number, there is a nationwide shortage of professionals who can perform the test. These services can and should be performed by clinic staff. As most chiropractic staff are underutilized, this can be done without increasing clinic overhead.

Once offered to trucking, there's no reason not to offer it to all other types of employers. The alcohol and drug testing market for non-DOT employers is estimated as being seven times larger than the DOT market and represents a substantial revenue generator. Being a one-stop shop is a marketing advantage, and every person who comes in for an exam is a potential chiropractic patient.

DOT services also tend to be unaffected by a downturn in the economy. The client-physician relationships are typically long term. Incorporating DOT services won't be for every chiropractor, but every chiropractor with unfilled appointments should at least consider it as an income and patient generator.

It will not be long before trucking companies begin scrambling for new providers. DCs who start now will deter providers around them from participating in the NRCME. Training is available through chiropractic colleges, nationwide physician networks, and third parties.

The FMCSA estimates that 40,000 certified medical examiners will be needed within 2-3 years. If you are looking for a new revenue source, DOT services are the one area where the chiropractic physician has all of the competitive advantages.

For background information on the NRCME and requirements for certification, read "Paving the Road to Equal Opportunity" in the Jan. 15, 2009 issue.

Dr. Michael Megehee was appointed by the FMCSA in 2005 as a member of the National Registry Brainstorming Sessions. He served on the NRCME Survey Team that established the basis for NRCME certification, and was a member of the NRCME Education Team that developed the core curriculum for the accredited physician training. Dr. Megehee is president of TeamCME, a nationwide network of DOT medical examiners.

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