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Like many other PAs ,I have been perforning DOT exams for decades. It's a pretty straight forward examination with well defined parameters . As of May 2014, only Certified Medical Examiners will be able to perfom DOT exams. To become a Certified Medical Examiner you must: Be licensed, certified, or registered in accordance with applicable State laws and regulations to perform physical examinations Log onto the National Registry System and receive a unique identifier Complete required training Pass the Medical Examiner certification test Report results of driver exams every month via the national registry system Submit to periodic monitoring and audits Maintain certification by completing periodic training every five years and recertify by passing the ME certification exam every 10 years As it turns out the "required training" ranges anywhere from $425-$590 for eligibility to sit for the required examination. Even for those who have been doing these exams for decades, there is no opt out of the training to qualify for the exam.(not even a self study model is offered) I have no problem with requiring competency with DOT exams, but requiring all applicants to support redundant training has raised my hackles. Leave it to the federal government to makes this process as expensive and burdensome as possible. National Registry of Medical Examiners