The AAFP told a federal agency recently to be careful of moving too far in its proposal to expand the number of clinicians who can assess whether commercial vehicle operators who have diabetes are fit to drive.
Interstate commercial drivers who have diabetes currently must be examined by a board-certified or board-eligible endocrinologist to apply to drive through the Federal Diabetes Exemption Program. A proposed rule(www.federalregister.gov) from the Federal Motor Carrier Safety Administration (FMCSA) -- an agency of the U.S. Department of Transportation (DOT) -- that was published in the Sept. 9 Federal Register would allow the examination to be conducted by a doctor of medicine, doctor of osteopathy, nurse practitioner or physician assistant who prescribed insulin to the driver and is knowledgeable regarding the treatment of diabetes.
The AAFP applauds expanding the rule to include primary care physicians, Board Chair Wanda Filer, M.D., M.B.A., of York, Pa., told FMCSA associate administrator Larry Minor in a letter dated Oct. 19,(2 page PDF) because "primary care physicians are dedicated and trained in treating the whole person and are more than capable of managing and treating patients with diabetes."
But neither nurse practitioners nor physician assistants should conduct diabetes exemption examinations without a physician's involvement, she wrote.
"The AAFP supports physician-led, team-based care models since they have proven to be most effective in improving quality and efficiency," the letter states. "Research shows patients value and rely upon the additional education and training that physicians receive and they want a physician in the decision-making process."
An estimated 34 percent of ambulatory care visits to physicians by patients with diabetes were made to family physicians or general practitioners, the AAFP had previously told the DOT.
The AAFP first raised the issue of allowing primary care physicians to conduct the diabetes exemption examinations in July 2015. In December 2015, the AAFP joined with other medical organizations to renew the push.
In a response received Aug. 25,(1 page PDF) the DOT told the AAFP that it received more than 1,250 comments about the proposed rule, many of which supported the Academy's position.
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