The Federation of State Medical Boards first identified alcoholism and drug
addiction among physicians as a disciplinary problem in 1958 and called for a
model probation and rehabilitation program to be adopted by individual state
The AMA did not formally recognize physician impairment as a serious
problem until the 1970s, when the AMA Council on Mental Health issued its
landmark policy paper "The Sick Physician: Impairment by Psychiatric
Disorders, Including Alcoholism and Drug Dependence."
By 1974, the AMA had acknowledged that substance abuse was an illness and
devel-oped model legislation that offered a therapeutic alternative to
discipline for physicians with alcoholism and drug addiction, according to an
The AMA in 1975 held its first conference on physician health to address
issues of impairment. At a 1977 conference on the issue, the AMA officially
recognized that physicians can also be impaired by psychiatric problems.
By 1980, 51 of the 54 U.S. state and jurisidictional medical societies had
authorized or implemented impaired physician programs, according to the AMA.
Today, all medical societies have impaired-physician programs "that
operate within the parameters of state regulation and legislation."
The AMA initiatives and the success of several state physician health
programs focusing on rehabilitation and monitoring of impaired physicians led
to the creation of the Federation for State Physician Health Programs (FSPHP)
The FSPHP's members represent 42 states. Psychiatrists are medical
directors of at least seven impaired-physician programs, FSPHP officer
Terrance Bedient told Psychiatric News. He is also executive director of the
New York program in Albany.
Every state has some mechanism to address physician health, said Bedient.
They range from committees on physician health operated by the state medical
society to programs operated by the state medical licensing board. Some
programs, such as the one in Texas, are set up to address chemical dependency,
mental health, behavioral health, sexual misconduct and/or boundary
violations; physical illness; and stress management. Others, like the program
in Vermont, address chemical dependency only, according to their online
FSPHP President and forensic psychiatrist Michael Gendel, M.D., told
Psychiatric News that physician health programs are designed primarily to
conduct comprehensive assessments, make recommendations regarding treatment,
and monitor physicians' compliance.
John Fromson, M.D., chair of APA's Corresponding Committee on Physician
Health, Illness, and Impairment, told Psychiatric News that the number of
referrals to the Massachusetts Physician Health Services program, which he
directs, has increased dramatically in the last five years.
"This shows that health care leaders are less willing to tolerate
aberrant behavior by physicians, are more concerned about medical errors and
patient safety, and know about state physician health programs," Fromson
A history of the FSPHP is posted online at<www.ama-assn.org/ama/pub/category/print/5706.html>.
A list of state physician health programs is posted at<www.ama-assn.org/ama/pub/category/6020.htm1>.