Physicians with addiction or behavioral problems can report themselves to physician health programs (PHPs), state-based organizations that oversee treatment and in many cases offer protection from disciplinary action, as long as the physician cooperates with the program and completes the required rehabilitation measures.

An addiction program typically lasts 8-12 weeks. PHPs generally use just one or two addiction facilities. Physicians reside at the facility, paying $50,000 or more out-of-pocket for the treatment. They receive individual and group psychotherapy, as well as treatment for drug or alcohol addiction. On release, they are regularly monitored for 5 years.

Only about 20% of treated doctors relapse within the 5-year monitoring period, according to a report from the PHPs. ^[1] But these programs are not without controversy. Some doctors who went through a PHP program claim that they were railroaded into a system that they describe as a "Kafkaesque nightmare." ^[2]

On the other hand, there is no dearth of testimonials from doctors who have gone through such a treatment program and praise the work of PHPs. Says orthopedic surgeon William Park III, MD, of Alabama's PHP, "I have been blessed to have this wonderful program advocate for me and monitor me with random drug screens since 1996."

One problem with PHPs is that if the doctor falls off the wagon during the lengthy monitoring period, their license could be revoked. Some doctors choose to avoid the chance of this outcome by entering a private treatment program instead.

Before making your decision, check reviews of the center, interview a center representative, and take a tour of the facility. Find out whether your health insurance will cover the care, what credentials the facility and staff have, and what the patient-to-counselor ratio is.

Make sure the program addresses your needs. The range of needs include medical, psychological, spiritual, social, and health and wellness issues.

Another way to ensure that treatment is confidential is to enter psychotherapy with a psychiatrist, psychologist, or psychiatric social worker.

Any of these professionals should be able to help you cope with burnout. If you also have an addiction problem, however, you might want to consider a psychotherapist who has specific training in treating addictions.

Once you know that a psychotherapist has professional training in psychotherapy and a credential to prove it, then it is important to assess his or her personality and degree of skill.

Although it may take weeks or months to ultimately judge a therapist's effectiveness in treating you, you can tell in the first session whether the therapist listens, explains, and tries to develop a set of common goals for your treatment. You can also tell pretty quickly whether you happen to like the therapist.

Twelve-step programs include Alcoholics Anonymous (AA), but there are many programs patterned after AA that focus on a particular addiction, such as cocaine, heroin, marijuana, and pain pills.

Some physicians may bridle at AA's overt religious tone, although some research shows that AA is nonetheless effective in helping agnostics and atheists become sober. ^[3] Secular Organizations for Sobriety is a resource for nonreligious programs. AA has not released any surveys that provide percentages of success for members, but anecdotally, many people say that AA has kept them sober.

Some physicians prefer 12-step programs that only treat physicians, and there are a few of them around the country. When Cheryl Karcher, MD, was trying to recover from an oxycodone addiction in New York, "I would listen to another physician addict, but anyone else, I believed, would not understand," she says. A small group in New York met her needs. ^[3]

For some doctors, self-care may be the best solution, as it was for Adam B. Hill, MD, a pediatric palliative care specialist in Indianapolis, Indiana. Writing in the New England Journal of Medicine, Dr Hill, a recovering alcoholic, revealed his history of depression and suicidal ideation. ^[4]

Dr Hill used counseling, meditation and mindfulness activities, exercise, deep breathing, support groups, and even hot showers to develop self-awareness of his own emotions and triggers that had derailed his life.

He found that building a support network was the key to his recovery. "You can start small and gradually add trusted people, from your spouse and family to friends, counselors, support groups, and eventually colleagues," he explains. "Then when you fall flat on your face, there will be someone to pick you up, dust you off, and say, 'Get back out there and try it again.'"