Driver Medical Review Practices across the United States [Traffic Tech]

Sifrit, Kathy J. · 2017 · ROSA P / United States. Department of Transportation. National Highway Traffic Safety Administration

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Summary

This National Highway Traffic Safety Administration (NHTSA) report addresses the growing prevalence of medical conditions among older drivers, noting a 31% increase in licensed older drivers between 2005 and 2014. As this demographic expands, state licensing agencies face increased pressure to evaluate medical fitness to drive. The study builds upon prior research to document the strengths and limitations of various state approaches to driver medical review, specifically examining how states identify at-risk drivers, assess their fitness, and render licensing decisions. The research employed a multi-volume design. Volume 1 classified 51 jurisdictions based on four structural components: the presence of a Medical Advisory Board (MAB), the presence of in-house medical professionals, the MAB’s role in case review and guideline development, and the breadth of medical guidelines. Due to insufficient variation across all factors, the analysis focused on the presence of an MAB and in-house medical staff. Seven states (Maine, North Carolina, Ohio, Oregon, Texas, Washington, and Wisconsin) were selected for case studies based on representativeness. Volume 2 analyzed a random sample of 3,000 drivers (500 per state) referred for initial medical review in 2012 across six of these states. Volume 3 surveyed 49 of 51 licensing agencies to document guidelines and processes. Findings indicate that states with MABs or in-house medical professionals generally possessed more comprehensive medical guidelines and offered legal immunity to reporting physicians. These states were more likely to base assessments on meeting medical standards rather than relying solely on treating physicians’ opinions or local office testing. However, having an MAB did not necessarily correlate with higher physician referral rates; for instance, Oregon, which lacked an MAB but had a mandatory physician reporting law, saw physicians as the primary referral source (74%). Licensing outcomes varied significantly by referral source. Physician referrals resulted in license status changes in 90% to 97% of cases in four states, while law enforcement referrals led to changes in 77% to 84% of cases. In Oregon and Texas, over 99% of all referrals resulted in a license status change regardless of the source. The study concludes that integrating medical professionals into review processes clarifies medical information, improves assessments, and supports more comprehensive guidelines. Physician referrals are identified as the source most likely to result in license changes. However, the presence of an MAB alone is insufficient if it does not actively advise on procedures. The authors suggest that increasing physician awareness of state processes may improve referral rates. Limitations included small sample sizes for structural comparisons and the inability to sample all referral sources in every state.

Key finding

States with medical professionals or Medical Advisory Boards generally maintained more comprehensive medical guidelines and provided legal immunity to reporting physicians, yet states without these structures achieved lower appeal rates and relied heavily on physician opinions for assessments.

Methodology

mixed_methods

Sample size: 3000

Provenance

The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via bulk_ingest_rosap on 2026-05-23 (6 acquisition events logged).

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

Topics

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• licensing policy