What 391.43(a) means in plain language
Federal regulations require that any medical examination used to certify your fitness to operate a commercial motor vehicle must be performed by a medical examiner who is registered on the National Registry of Certified Medical Examiners. This examiner is specially trained and certified to evaluate drivers against federal medical standards.
If you undergo a medical exam for your commercial driver's license medical certificate, that exam must come from someone on this official list. An exam performed by any other healthcare provider—even a licensed physician—does not satisfy this requirement. The National Registry exists to ensure consistency and quality across the country in how drivers' medical fitness is assessed.
Violating this rule means your medical documentation may not be valid, even if the person who performed the exam was qualified in other respects. The citation flags that your exam was not conducted by a properly registered examiner.
What our enforcement data actually shows
Across our database of 13 million+ roadside inspection records, 391.43(a) citations are extraordinarily rare. We have recorded zero citations for this violation in the last 90 days, zero in the last 12 months, and zero all-time in our enforcement records. With zero out-of-service placements recorded, the OOS rate is 0.0%.
This near-absence of enforcement data suggests one of two things: either drivers and medical examiners are complying at near-perfect rates, or violations are being caught through other mechanisms (such as state medical licensing reviews or administrative audits) rather than roadside inspections. Unlike high-volume violations such as 383.23(a)(2) (wrong CDL class, 50,385 citations) or 391.41APC (operating without a valid medical certificate, 49,539 citations), 391.43(a) does not appear in typical roadside citation patterns.
Who gets cited most
Because zero citations exist in our database for this code, we cannot identify specific states or carriers with citation counts. There is no geographic or carrier pattern to report.
How severe is this compared to similar codes
391.43(a) belongs to the Driver Fitness category alongside other medical and qualification codes. For perspective, peer violations in the same category carry significantly higher citation volume:
- 383.23(a)(2) (CDL wrong class) has 50,385 citations and a 98.4% out-of-service rate.
- 391.41APC (operating without valid medical certificate) has 49,539 citations and a 97.1% out-of-service rate.
- 391.41(a) (general physical qualification) has 42,270 citations and a 16.2% out-of-service rate.
The complete absence of 391.43(a) citations in our records stands in stark contrast. This does not mean the requirement is unenforced; it suggests compliance is very high or enforcement occurs through non-roadside channels.
How to avoid it
Complying with 391.43(a) is straightforward and within your direct control:
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Use only a National Registry examiner. Before scheduling your DOT medical exam, verify that the examiner is listed on the FMCSA's National Registry of Certified Medical Examiners. The registry is searchable online and includes the examiner's name, location, and certification status.
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Do not accept exams from non-registered providers. Even if a doctor or clinic offers to perform your medical exam quickly or conveniently, confirm their registration first. A non-registered exam—no matter how thorough—will not satisfy federal requirements.
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Keep your medical certificate. Once you pass a National Registry exam, you will receive a medical certificate (MCSA-5875). Carry it with you and ensure it is on file with your state's driver licensing agency. Roadside inspectors will verify both possession and validity.
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Renew before expiration. Medical certificates expire (typically every 24 months, or 12 months if you have certain medical conditions). Schedule your renewal exam early with another National Registry examiner to avoid gaps in your certification.
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Use your carrier's preferred examiners if they have a list. Many fleets maintain lists of trusted, registered examiners. Using them simplifies compliance and ensures documentation consistency.