To the Editor: After investigating the New Orleans bus crash, the national transportation safety board (NTSB) warned that “Individuals who are authorized to perform medical examinations... may lack knowledge and information critical to certification decisions.” It recommended that examiners not only should have specific training in performing the examinations but also “should have a background permitting them to adequately evaluate all common medical conditions or medications for their potential to impair a driver.”1 The medical review board (MRB) has focused on addressing the magnitude of the annual death toll on the nation's highways, with specific recommendations regarding qualifications to perform commercial driver medical examinations. Although Mr Delaney notes a lack of data about physician assistants (PAs), it is a fact that PAs obtain only 2 years of training in all of medicine. The typical physician has 7 or more years of training, including 3 or more years in specialty training. These stark differences translate to greater breadth and depth of training and expertise in the management of complex medical disorders (or combinations of conditions) that are highly relevant to more fair and accurate decisions on fitness to drive. The MRB sought to define qualification standards on the basis of relevant medical training and expertise, prompting serious consideration to limit these examinations to MD/DOs, in line with current federal aviation administration practice. The letter by Mr Delaney incorrectly infers that PAs have unlimited abilities to clear commercial drivers to drive. In fact, the current guidelines and regulations already preclude them in certain conditions, for example, insulin use. Unfortunately, necessary actions for improving driver safety have not been implemented. The Safe, Accountable, Flexible Efficient Transportation Equity Act: A Legacy for Users legislation2 required the National Registry of Certified Medical Examiners (NRCME) to be run under the MRB, yet the Federal Motor Carrier Safety Administration (FMCSA) did not operate the NRCME as the legislation directed. Furthermore, the Medical Examiner Handbook3 primarily relies on information that is 20 years old, despite an original intent to address training requirements. This material also does not respond to the NTSB's directive to provide updated information for examiners.1 Recognizing these needs, the MRB worked to address nearly all of the NTSB's medically related recommendations.1,4 We hope the FMCSA puts aside politics and begins to make decisions that address the NTSB's concerns, answer the recommendations of the MRB, and advance the safety of the highways. Meanwhile, the evidence-based recommendations forwarded by the MRB already serve as guidance for trucking companies and others to implement. Sincerely, Kurt T. Hegmann, MD, MPH Gunnar B. J. Andersson, MD, PhD Michael I. Greenberg, MD, MPH Barbara Phillips, MD, MSPH Matthew Rizzo, MD