Medical Review Practices for Driver Licensing: Volume 1: A Case Study of Guidelines and Processes in Seven U.S. States

Lococo, Kathy H.; Stutts, Jane; Staplin, Loren · 2016 · ROSA P / United States. Department of Transportation. National Highway Traffic Safety Administration

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Summary

This report, Volume 1 of a three-part series by the National Highway Traffic Safety Administration (NHTSA), examines driver medical review practices across the United States. Motivated by an aging population and the resulting increase in medical conditions affecting driving safety, the study aims to document the strengths and weaknesses of various state approaches to identifying, assessing, and licensing medically at-risk drivers. Rather than identifying a single optimal method, the research seeks to characterize the diversity of existing systems. The researchers classified the medical review structures of 51 U.S. driver licensing agencies into four groups based on two structural variables: the presence of a Medical Advisory Board (MAB) and whether in-house medical professionals performed case reviews. The groups were: MAB with medical professionals on staff (MAB & MP); MAB with administrative staff performing reviews (MAB & Admin); no MAB with administrative staff only (Admin Only); and no MAB with medical professionals on staff (MP Only). Seven states were selected for case studies to represent these structures: Maine and North Carolina (MAB & MP); Texas and Wisconsin (MAB & Admin); Ohio and Washington (Admin Only); and Oregon (MP Only). Data were collected through electronic surveys and telephone interviews with state officials between May and November 2013, focusing on program structure, guidelines, referral sources, and processing costs. The findings reveal significant variations in practice based on structural classification. States with MABs or in-house medical professionals (MAB & MP, MAB & Admin, and MP Only) generally possessed more comprehensive medical guidelines and provided legal immunity to physicians who voluntarily reported at-risk drivers, potentially encouraging referrals. In contrast, the two Admin Only states relied heavily on the opinions of drivers’ treating physicians and local licensing office testing. Regarding decision-making, states with MABs were more likely to base licensing decisions on whether specific medical standards were met, whereas Admin Only states prioritized physician opinions. Oregon, the sole MP Only state, operated as a hybrid, using immediate suspension for mandatory physician referrals but testing and physician input for voluntary referrals. Caseloads varied, with Maine and Oregon showing higher proportions of referrals relative to their licensed driver populations, partly attributed to older demographics and proactive outreach or mandatory reporting laws. The study concludes that while structural differences influence processes, all four models allow states to determine crash risk for flagged drivers. States with MABs or medical staff generally offered a broader range of licensing outcomes, though appeals were lowest in Admin Only states. Cost analysis indicated that having medical professionals on staff or paid MABs did not necessarily result in higher costs per case, with one Admin Only state recording the lowest costs. The report emphasizes that multiple valid approaches exist for fulfilling medical review responsibilities, setting the stage for Volume 2, which tracks individual driver outcomes, and Volume 3, which details specific state guidelines.

Key finding

States with Medical Advisory Boards or in-house medical professionals demonstrated more comprehensive medical guidelines and provided legal immunity to physicians, whereas administrative-only states relied more heavily on physician opinions and local testing.

Methodology

other

Sample size: 7

Provenance

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

Topics

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• licensing policy
• fitness to drive assessment