When Caregivers Need Care: What I Learned Working for a Physician Health Program 30 years ago

My first real job, over three decades ago now, was working for the Colorado Physician Health Program. I was twenty years old, and I spent my days around physicians who had been referred because of drug or alcohol use, mental health crises, or other conditions that put their license and their patients at risk.

Some were referred by their hospital. Some by a colleague who cared enough to make the hard call. Some by the medical board after something went wrong. And some walked in on their own, before anyone forced them to.

They were evaluated. They were monitored, closely and for years, not months. And most of them turned their lives completely around. Some of the best doctors and best humans I have ever known came through that program. That experience shaped how I think about medical professionals and healthcare for the rest of my career, and it is worth revisiting now, because the need behind it has not gone away. If anything, it has gotten sharper.

What a physician health program actually does

A physician health program, or PHP, is not a punishment. It is a structured, clinical pathway that runs in parallel to licensure and discipline, not instead of it. A typical program includes:

• Confidential evaluation by clinicians trained in addiction and physician-specific dynamics

• A treatment plan tailored to the person, often including residential or outpatient care

• Multi-year monitoring, frequently five years, with random testing and real consequences for relapse

• Advocacy back to hospitals, boards, and malpractice carriers that the physician is safe to practice

The design is intentionally strict because the stakes are high on both sides. Physicians get a real shot at keeping their license and their career if they engage honestly. The public gets a system that catches problems early instead of waiting for a sentinel event.

Does it actually work?

Yes, and the data has held up for a long time. A five-year longitudinal study of 904 physicians across sixteen state PHPs, published in BMJ, found that 78 percent had no positive drug or alcohol test over the entire five-year monitoring period, and nearly 79 percent were still licensed and practicing at the five-year mark. A separate study of emergency physicians found similarly strong outcomes, with EPs actually testing positive less often than their peers during monitoring despite entering the program with substance use disorders at a higher rate than other specialties.

It is worth noting some honest caveats. Critics have pointed out that most PHP outcome research lacks a comparison group of similarly impaired physicians who were not referred into a program, and that participation is sometimes coercive rather than voluntary, which complicates how "success" gets defined. Those are fair points, and good programs take them seriously. But even with that caveat, a program that gets three out of four physicians back to safe, monitored practice is doing something most of health care wishes it could replicate.

Why this needs to exist in every state

Here is the part people do not want to say out loud: the people we trust to care for us are often the ones least likely to ask for help themselves.

Medscape's most recent physician suicide survey found that 15 percent of physicians had contemplated suicide, up sharply from 9 percent just two years earlier, reversing what had looked like a post-pandemic improvement. Roughly a quarter of physicians report clinical depression. Physicians die by suicide at meaningfully higher rates than the general population, and a large share say they would avoid seeking mental health treatment specifically because of what it could do to their license or credentialing.

That last point is the whole ballgame. When the fear of losing your career is bigger than the fear of the illness itself, people hide instead of heal. Long hours, moral injury, administrative burden, and a culture that still treats asking for help as weakness do the rest. Self-medication is not a mystery in that environment. It is a predictable outcome of untreated stress and untreated depression in a profession with easy access to the substances involved and enormous pressure to never look impaired.

PHPs work precisely because they solve for that fear. Confidentiality plus accountability, instead of confidentiality or accountability, is what gets people through the door voluntarily instead of waiting for a crisis.

It is not only physicians

Nurses, pharmacists, EMS providers, and other licensed caregivers face the same pressures and often have less institutional support around them. Most states now have peer assistance programs for nurses that mirror the PHP model, run through boards of nursing or nursing associations, and they deserve the same visibility physician programs get. If you work in or around health care and have never looked up your state's program for your own profession, that is worth five minutes today.

Closer to home: Arizona and Iowa both have one

Given where I live and work, this is worth making concrete. Both states where I spend my time have active programs.

Arizona's is run directly through the Arizona Medical Board. The PHP handles education, intervention, post-treatment monitoring, and support for allopathic physicians and physician assistants dealing with substance use or behavioral health conditions, using board-certified assessors and dedicated monitors who manage case oversight and lab results. There is also a private-sector option, the Arizona Professional's Health Program in Scottsdale, which extends similar services to a broader set of licensed professionals.

Iowa's version, the Iowa Physician Health Program, sits under the Iowa Board of Medicine and covers physicians, acupuncturists, and genetic counselors. It has been law since 1995, and its design leans hard into the "non-disciplinary" framing: participation is confidential, self-reporting is encouraged, and the explicit goal is catching problems early so people can keep practicing rather than lose their license after the fact. Other Iowa-licensed professions, from nurses to pharmacists to dentists, have their own equivalent committees under the same Iowa Professional Health Programs umbrella.

The state of the field in 2026

Nearly every state now has a physician health program affiliated with the Federation of State Physician Health Programs, which counts fifty state PHP members. That is the good news.

The uncomfortable irony is that California, one of the largest physician workforces in the country, still does not have a state-sanctioned PHP. The Medical Board of California's original Diversion Program closed in 2008, and the state has spent most of the years since trying, and failing, to pass new legislation to replace it. A bill (AB408) cleared the Assembly and is moving through the 2026 legislative session, but until it passes, California physicians rely on a patchwork of a confidential hotline and private-sector monitoring rather than a true statewide program. Arizona and Iowa physicians do not have that gap to worry about, which is worth appreciating.

The point of telling this story

I have spent my career building infrastructure that helps health systems see the whole person, whether that is a patient in a behavioral health crisis or a community member falling through the cracks between systems. What I learned at twenty is that the same grace has to extend to the people delivering the care, not just the people receiving it.

Addiction and depression do not check credentials. The doctors I worked alongside were not weak. They were human beings in a high-stakes profession who got sick, got help, and came back better than ever. That is not a story we tell often enough, and it should be.

If you know a physician or other caregiver who is struggling, the fastest path is usually your state's PHP or peer assistance program. They exist specifically so people do not have to choose between getting help and keeping their career.