Strategies for Medical Advisory Boards and Licensing Review

Lococo, Kathy H.; Staplin, Loren · 2005 · ROSA P / United States. National Highway Traffic Safety Administration. Office of Research and Traffic Records

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Summary

This 2005 report by the National Highway Traffic Safety Administration (NHTSA) addresses the need for standardized strategies for Medical Advisory Boards (MABs) and licensing agencies to assess the fitness to drive for individuals with medical conditions and functional impairments. The research was motivated by significant variability in how the 51 U.S. jurisdictions identify, assess, and regulate drivers with health issues, creating inconsistencies in public safety and driver mobility. The primary objectives were to document existing medical review practices across all states and to develop recommended strategies for improving the identification, assessment, and disposition of at-risk drivers. The study employed a multi-phase methodology involving data collection from licensing officials and medical staff. First, researchers conducted an extensive mail-back survey, developed jointly with the American Association of Motor Vehicle Administrators (AAMVA), followed by telephone interviews to clarify responses. This data was synthesized into narrative summaries for each jurisdiction. Second, a Relative Value Assessment (RVA) exercise was conducted with officials in 45 jurisdictions to weight the importance of 64 potential medical review program components. Finally, a 1.5-day expert meeting was held with representatives from 11 jurisdictions, NHTSA, and AAMVA to discuss high-priority strategies and implementation barriers. The findings revealed wide disparities in current practices. While most states require self-reporting of medical conditions, the depth of questioning varies significantly. Only six jurisdictions mandate physician reporting, with most limiting requirements to loss-of-consciousness disorders. MABs exist in 37 jurisdictions, but their scope ranges from reviewing all cases to handling only appeals, with physician compensation often inadequate or voluntary. The RVA exercise and expert consensus identified several critical recommendations: MABs should be staffed with compensated physicians who review individual cases rather than just appeals; national medical guidelines should be developed in consultation with the medical community; and rules should reside in state regulations rather than statutes to allow for rapid updates. Experts also recommended implementing functional ability profiles, requiring in-person renewals for older drivers, and issuing customized or restricted licenses to maintain safe mobility. Additionally, the report highlighted the need for physician immunity from liability for good-faith reporting and expanded training for police and DMV staff. The significance of this report lies in its provision of a framework for a model medical review program that balances public safety with the continuing mobility of drivers with impairments. By identifying specific barriers such as budget constraints and legislative rigidity, the report offers actionable strategies for states to improve consistency and effectiveness. It emphasizes shifting the DMV mission from solely ensuring safety to supporting safe mobility, advocating for the use of driving-rehabilitation specialists and community-based services. These recommendations aim to reduce the risk of crashes caused by medical impairments while providing clear, equitable pathways for drivers to retain their privileges under safe conditions.

Key finding

Medical review practices vary significantly across U.S. jurisdictions, with only six states mandating physician reporting and substantial differences existing in vision standards, seizure-free periods, and the use of customized license restrictions.

Methodology

survey

Sample size: 51

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified_with_issues.

Topics

Ranked by relevance to this paper. Hover a topic for its definition.

• licensing policy
• fitness to drive assessment
• cognitive impairment
• medical conditions

Information type

What kind of knowledge this paper contributes, grouped by family — independent of topic (what it is about) and method (how it was studied).

• Applied Guidance: policy recommendations
• Methodological Resource: validation psychometrics