What Is the NRCME Exam? Everything You Need to Know
The NRCME exam is the certification test required by the Federal Motor Carrier Safety Administration (FMCSA) for healthcare providers who want to perform Department of Transportation (DOT) physical examinations for commercial motor vehicle (CMV) drivers.
If you’re considering becoming a certified medical examiner or have been asked to get NRCME certified, here’s everything you need to know about the exam, the process, and what comes after.
What Does NRCME Stand For?
NRCME stands for the National Registry of Certified Medical Examiners. It is a program established by the FMCSA under the U.S. Department of Transportation. The registry maintains a list of healthcare providers who have demonstrated they are qualified to perform medical fitness-for-duty examinations for commercial drivers.
Since May 21, 2014, all medical examiners performing DOT physicals must be listed on the National Registry. This means passing the NRCME certification exam and completing required training.
Who Needs to Take the NRCME Exam?
The following licensed healthcare providers are eligible to take the NRCME exam:
- Doctors of Medicine (MD)
- Doctors of Osteopathy (DO)
- Physician Assistants (PA)
- Advanced Practice Registered Nurses (APRN/NP)
- Doctors of Chiropractic (DC)
- Other practitioners as authorized by state law
You must hold a valid, unrestricted medical license in your state and complete an accredited NRCME training program before sitting for the exam.
What Does the NRCME Exam Cover?
The exam tests your knowledge of FMCSA regulations and guidelines for determining whether a commercial driver is medically qualified to operate a CMV. It covers 14 categories based on the FMCSA Medical Examiner Handbook:
- Cardiovascular conditions
- Hypertension / blood pressure standards
- Vision requirements
- Hearing requirements
- Respiratory / pulmonary conditions
- Neurological conditions (seizures, stroke, TBI)
- Diabetes and endocrine disorders
- Musculoskeletal conditions
- Psychiatric / psychological conditions
- Substance abuse and drug testing
- General medical overview and regulations
- Medications and their impact on driving
- The physical examination process
- Certification decision-making
Exam Format and Structure
The NRCME certification exam consists of 120 multiple-choice questions. You will take the exam at an approved testing center, and the test is administered on a computer. The questions are scenario-based, often presenting a clinical situation and asking you to make a certification decision based on FMCSA guidelines.
The exam is not pass/fail based on a single overall score. You must demonstrate competency across all tested categories, which means you cannot rely solely on your strongest areas to carry you through.
How to Register for the NRCME Exam
The registration process involves several steps:
- Complete an accredited training course — You must finish an FMCSA-approved training program before registering for the exam
- Create an account on the FMCSA National Registry website
- Submit your application with your medical license information and training certificate
- Schedule your exam at an approved testing center
- Pay the exam fee — The fee is paid directly to the testing organization
What Happens After You Pass?
Once you pass the NRCME exam, you will be listed on the National Registry and can begin performing DOT physical examinations. Your certification is valid for 10 years, after which you must complete a recertification process including additional training and passing the exam again.
During your certification period, you are required to maintain your medical license and stay current with any updates to FMCSA regulations and guidelines.
What If You Don’t Pass?
If you do not pass the exam on your first attempt, you can retake it. However, there may be waiting periods between attempts, and repeated failures may require additional training. Having a solid preparation strategy is the best way to avoid this situation.
If you need to retake the exam, our practice tests provides targeted study materials and a personalized approach to help you pass on your next attempt.
How to Prepare for the NRCME Exam
The most effective preparation combines studying the FMCSA Medical Examiner Handbook with practicing exam-format questions. The handbook provides the knowledge; practice questions help you apply it under test conditions.
our NRCME practice tests for access to 670+ practice questions across all 14 exam categories, full-length practice exams, and category-specific study guides.