Work is forcing me do to CDL training

[Rbnz]

I work in Arizona. I help with family clinic, first assist in surgeries and also wound clinic. The hospital I work for just mandated that I have to get my CDL certificate in 2 weeks so I can do CDL physicals. Can they do that? I have no interest in doing these at all…sigh…

[sas5814]

Them that signs the checks makes the rules....

Welcome to corporate medicine.

[mgriffiths]

6 hours ago, Rbnz said:

I work in Arizona. I help with family clinic, first assist in surgeries and also wound clinic. The hospital I work for just mandated that I have to get my CDL certificate in 2 weeks so I can do CDL physicals. Can they do that? I have no interest in doing these at all…sigh…

Can your employer require you to get a certification?  Absolutely.

But, the bigger question is what is your actual job?  You work in family medicine.  That is one role.  You first assist in surgeries.  That is another role, completely unrelated to family medicine.  You work in the wound clinic, another completely separate area of medicine.  It almost seems like your job is just to fill in wherever.  If that is the case then 100% they can ask you to do DOTs.  But, that is an odd job and one that personally I would not accept as I would be concerned about being burned out being pulled in so many directions.

Last thing...make sure they pay for your CDL certification AND the time you spend completing the certification.

Edited October 20, 2021 by mgriffiths

[ventana]

just fail the test......

your SP would also need to be certified 

[EastCoastPA]

It's free real estate CME! Why not though? The coursework takes about a night, the exam is so easy they let Chiro's take it, and the visits are cake.

[Reality Check 2]

It will take much longer than 2 weeks to get trained, find a testing center, take test and get results.

I believe it is about 14 hours of training online.

My DOT cert is good until 2024 but I will not use it ever again if I can help it.

Unless your practice is well versed and MAs or nurses know how to do the items needed - nope.

Does your clinic have proper testing equipment?

This is not a little thing. It takes knowledge, resources, a plan and practice.

Not to be taken lightly. 

[sas5814]

12 hours ago, EastCoastPA said:

visits are cake.

I'm going to strongly disagree with this. I have done hundreds of DOT exams and many are very simple but you WILL find yourself in a position of failing someone and getting the full blast of their anger because YOU are taking away their ability to earn. The fact that they are grossly overweight, smoke, drink, think exercise is lifting a fork, and can't eat anything healthy because "I'm a truck driver" will mean nothing to them. They take no responsibility for their own problems and will blame you. I have been screamed at, threatened, even had my life threatened and my family's.

My DOT is current for a few more years and, as Reality said, will never do another DOT physical.

Oh yea... the alternative to the above is clearing someone who shouldn't be cleared and staying up nights wondering when the lawyer is going to call because they guy you cleared passed out behind the wheel and drove his tanker full of gas into a school bus full of children and nuns.

Never again...

Edited October 21, 2021 by sas5814

[ventana]

I have likely done >4000 DOT/CDL and school bus exams over the past 20 years

As SAS says most are easy

If you end up doing them this is how i handle the tough ones - I have the PDF link for the current medical guidelines

I print out and highlight what the guidelines are, hand to the patient and appologize that I have to fail them (or need more info) but I have to follow the guidelines

99% of this diffuses the situation

Rarely I have to actually have to say "are you truly asking me to lie and committ malpractice to pass you?"

This corrects almost everyone

Then there are a select few that just keep going - I just ask them to leave

 

I have given up getting emotionally vested in these patients - they have created their own health and well being issues, not me.  I feel back for failing them but "them be the rules".

 

 

Back to the OP

Just fail the exam - no pass, no exams....

[mgriffiths]

12 minutes ago, ventana said:

Just fail the exam - no pass, no exams....

Multiple here are suggesting this.  Is this really the best path?  What impact would this have on OP's employment.  Passing a DOT certification course can't be that difficult (haven't done it myself), and I would assume would reflect poorly on OP and as stated could impact OP's employment.

[Reality Check 2]

Failing wouldn't be in my vocabulary or thought process.

However, this is not a simple task.

I had my life threatened by the wife of a guy I failed for Meniere's - an absolute NO NO in DOT.

The OP needs to chat with admin and CP to make sure this is all done correctly or not at all. Nothing worse than a half ass DOT.

It is not a cash cow if you factor in all the headaches, tracking down sleep apnea records, rechecking blood pressures and chasing down outside specialty notes, etc. 

 

[ShakaHoo]

Decisions you will have to make with FMCSA Medical Examiner Certificate

 

1)  Patients prescribed Opiate/Benzo's looking to drive.

2)  Patients with mental illness looking to drive on several medications.

3)  Patients with Diabetes either poorly controlled, or on insulin - looking to drive

4)  Patients with numerous risk factors for OSA who have never had a sleep study looking to drive.  Do you send them?  Do you not?  

5)  Patients with diagnosed OSA - who do not wear their CPAP as directed.

6)  Patients who you try to consult with their treating clinician (per recommendations) and their treating clinician says "that is your job to determine" or "I am not putting anything in writing"

7)  Patients who will "never retire."  School bus drivers who are 75, 80, 85 years old.

8.  Patients who willingly admit to ETOH/Illicit Drug Use.  Then you asked them to take a drug test, and they flip out.

9.  Patient's who have a "medical marijuana card" and believe they can pass a CDL physical examination on the medication.

10.  Many many many others.

 

Our office charges $100 for a DOT physical examination.  I often wonder when someone will get clocked in the face by a patient... or even worse.

Talking to patients is an art.  99% of the time it goes well.  But there are those 9-10 patient's a year who literally make you never went to do another DOT physical examination in your entire life.  

[ventana]

1 hour ago, mgriffiths said:

Multiple here are suggesting this.  Is this really the best path?  What impact would this have on OP's employment.  Passing a DOT certification course can't be that difficult (haven't done it myself), and I would assume would reflect poorly on OP and as stated could impact OP's employment.

but the flip side is an employer mandating that a provider learn a new professsion is not in my realm either  -  heck they fired the first shot - remember they can not and should not force you -- no guilt just reality

47 minutes ago, Reality Check 2 said:

Failing wouldn't be in my vocabulary or thought process.

However, this is not a simple task.

I had my life threatened by the wife of a guy I failed for Meniere's - an absolute NO NO in DOT.

The OP needs to chat with admin and CP to make sure this is all done correctly or not at all. Nothing worse than a half ass DOT.

It is not a cash cow if you factor in all the headaches, tracking down sleep apnea records, rechecking blood pressures and chasing down outside specialty notes, etc. 

 

Great if the OP has Admin that will listen - but the fact they are mandating this shows they are just suits looking at cash flow....  

4 minutes ago, ShakaHoo said:

Decisions you will have to make with FMCSA Medical Examiner Certificate

 

1)  Patients prescribed Opiate/Benzo's looking to drive.

both these are very clear issues once you do them - easy answers that I will not go into here

4 minutes ago, ShakaHoo said:

2)  Patients with mental illness looking to drive on several medications.

also pretty stright forward - need consult from the treating provider, phone call or some type of documentation - we always push this responsibility back on to the patient to do the leg work.  I am paid to do the exam not chase loose ends

4 minutes ago, ShakaHoo said:

3)  Patients with Diabetes either poorly controlled, or on insulin - looking to drive

easy these days - A1C <10 if not on insulin just get whom ever is treating to do the non-insulin form, if on insulin and no MASS school bus just get them to fill out, if bus in MASS then need boarded endo to fill out form.  Forms are standardized so it is just mandating that they return the completed form.

4 minutes ago, ShakaHoo said:

4)  Patients with numerous risk factors for OSA who have never had a sleep study looking to drive.  Do you send them?  Do you not?  

neck circ, OSA simple screening test - I only worry about the obvious cases

4 minutes ago, ShakaHoo said:

5)  Patients with diagnosed OSA - who do not wear their CPAP as directed.

also very clear by the guidelines - easy - no CPAP - either no medical card or have to retake a sleep test to document no longer OSA requiring CPAP

4 minutes ago, ShakaHoo said:

6)  Patients who you try to consult with their treating clinician (per recommendations) and their treating clinician says "that is your job to determine" or "I am not putting anything in writing"

This is correct, I decide, but it only takes a brief phone call with them to get them to "See the light" that the feds mandate that the treating clincian works with me to evalute - A few times I have has some PIA, high on their horse, providers refuse.  I simply tell the patient that their treating provider is refusing to talk to me and they should go ask them why..... has worked every single time....

4 minutes ago, ShakaHoo said:

7)  Patients who will "never retire."  School bus drivers who are 75, 80, 85 years old.

follow the guidelines - in MA it is q 6m exams- just follow the guidelines

4 minutes ago, ShakaHoo said:

8.  Patients who willingly admit to ETOH/Illicit Drug Use.  Then you asked them to take a drug test, and they flip out.

Employer is responsible for drug testing - guidelines actually clearly state this - is you suspect substance abuse you have to refer for an evalution. 

4 minutes ago, ShakaHoo said:

9.  Patient's who have a "medical marijuana card" and believe they can pass a CDL physical examination on the medication.

This is the easiest one - Feds specifically ban MJ use and medical card.  Sorry nope. - I just give them the printed out regulations.  game over.

4 minutes ago, ShakaHoo said:

10.  Many many many others.

 

Our office charges $100 for a DOT physical examination.  I often wonder when someone will get clocked in the face by a patient... or even worse.

Talking to patients is an art.  99% of the time it goes well.  But there are those 9-10 patient's a year who literally make you never went to do another DOT physical examination in your entire life.  

 

 

 

 

It really comes down to a familiarity with the regulations,  i.e. s/p cardiac stent needs a neg stress < 6 months after,  after CABG you are good for 5 years then needs a stress.

 

 

A few of my memorable patients

old gentleman with likely undx parkinson - fails rhomberg - neuro said he was fine - I did pass him by the regs and he wa able to pass rhomberg a second visit

young guy smoked MJ daily - immediate fail

middle aged on 6mg klonopin for years - (this was a renewal and had  a DOT for many years)  immediate fail - I will not go in to the BZD guidelines on  a public forum but it is crystal clear)  Also patients on MTD are immediate fail - no questions asked

MH - tougher - but recent SI or HI -  which I had one - is a no go

 

most the issues come up around cardiac stents and cabg and the requirement to do stress tests
I follow guidelines and the local cards folks quickly realized they just need to stress them - now they send the paperwork already filled out.  Worth gold to reach out to them as you are starting and explain the process.

 

Only "feather in my hat" one was on a gentleman late 50's who had a previous stent - in office he was brady and I got an EKG (nope didn't get paid the $6 for EKG but who cared)   it was mostly normal, until you compared to his last one - and there were some really sig changes from prior and he never exercised even a little bit.  Cards provider refused to order stress - I refused to certify(and as stated above sent patient back to this cards provider stating I would not certify with out an updated stress)   I ended up having a conversation on the phone with said cards provider and they were pissed I was "forcing them to order it" but they did.......  + stress, ambulance ride to cath lab, widowmaker re-occulsion of LAD, stented again.....  Saved his life.  That cards provider now educated themselves about the guidelines and sends me the paperwork on shared patients before I even see them.   (not to throw stones but that cards provider was a new grad whom should not have been working with out supervision - as demonstrated by this case and a few others I shared with them....  )

 

Most patients now bring in the required paperwork and medical exams all done.  stress tests, a1c, letters from treating providers, cpap compliance reports are provided by the patient with out asking > 50% of the time now.

 

 

[Cideous]

There are few things that scare me in medicine...I mean physically scare me, but I have said for years I know what they are.  Desperate drug seekers and DOT physicals...

Desperate drug seekers are very reactional, if you call security when they threaten you generally everything turns out fine once they come down....

DOT's are another animal altogether...these guys are truck drivers of which 90% think the government is "out to get them".  They are Breitbart loving cultists who think you are failing them because you are the liberal govt agent assigned to take food out of their kids mouths.  I have had several occurrences where I had to fail a DOT applicant where he stood up and said you are taking food out my kids mouths and no one does that.....  I will kill anyone that does that. In the last 10 years I have had two patients stand up and square off on me....I am 6'3" 280lbs.....when I stand up and square off back they back down, but I would NEVER assume they were done.  I have had a clinic hire a cop to provide Security at our clinic for 6 weeks straight after a "conservative" truck driver declared he would be back to kill all of us that afternoon after I failed him for undiagnosed and untreated NIDDM.

You getting the picture yet?  NOTHING scares me more in medicine than a DOT physical I must fail according to FMCSA standards.  

 

Good luck.

[LKPAC]

On 10/20/2021 at 7:45 PM, EastCoastPA said:

the exam is so easy they let Chiro's take it.

From what I've heard, many (most) Chiros fail the exam.  After all, there are some medical questions.

[Cideous]

Two other tips when doing a DOT physical.  Never...NEVER wear your Stethoscope around your neck.... and never let the patient get between you and the door.  Always have an exit to hit on if you are attacked.

[MediMike]

12 hours ago, Cideous said:

Two other tips when doing a DOT physical.  Never...NEVER wear your Stethoscope around your neck.... and never let the patient get between you and the door.  Always have an exit to hit on if you are attacked.

You're 6'3 280? Son I'm not letting YOU between me and the door 

[rev ronin]

On 10/22/2021 at 2:31 PM, Cideous said:

Two other tips when doing a DOT physical.  Never...NEVER wear your Stethoscope around your neck.... and never let the patient get between you and the door.  Always have an exit to hit on if you are attacked.

See, I do it the other way around: I want them closer to the door, because they can't accuse me of boxing them in and detaining them unlawfully.  And, frankly, if they want to barrel out of the door, I'm going to let them.

But yeah, you need to be prepared to be in a life-or-death struggle with any of your DOT patients at any time.  I'm not a fan of it, but I'm a trained martial artist, and not a 5'2" 125 lb female, either.

[ventana]

Not sure I buy this "closest to the door" issue

 

the only times I have "gotten into it" with patients are when I did not control the situation

I realized it is not worth it (they are no psychotic or crazy, just annoyed with the regs) and now I keep it polite and appologetic and as soon as it starts to go poorly I ask to leave the room to get a copy of the regulations. I come back in with the formal federal regs and continue to work at keeping it polite and appologetic (i really do feel bad not being able to pass them) and explain what needs to be done.  There is almost never an immediate "you fail"  it is always "you need to do these steps to get your card" 

 

This "Controling the situation" and not giving "you fail" but instead "this is what you need to do to pass" allows me to never really run into any problems.   

Once I am done with the exam portion the front desk staff handles it - when the patient returns with the required papers I review them.  If they pass I fill out the papers and card.  If they do not have enough documentation I write a note and ask for more info - I almost never go back into a room with them.  This way the patient never gets a chance to unload or loose control as they are in a waiting room, talking to the office staff whom is explaining everthing.  Very occasionally I will join the office staff at front desk (like twice per year) to explain what still needs to be done - though the glass panels and very nicely and politely

 

 

overall now that I never get frustrated or upset with the DOT patients, explain that I can not lie/committ malpractice, and that they need to do XY&Z to get their medical card it is pretty darn easy....