According to the official FSPHP website (http://www.fsphp.org):

"The Federation of State Physician Health Programs, Inc. (FSPHP), is a nonprofit corporation whose purpose is to provide a forum for education and exchange of information among state programs, to develop common objectives and goals, to develop standards, to enhance awareness of issues related to physician health and impairment, to provide advocacy for physicians and their health issues at local, state, and national levels, and to assist state programs in their quest to protect the public."

Through a cooperative effort of the American Medical Association (AMA) and the most individual state medical boards, most states now have established "diversion programs" in order to provide a therapeutic avenue for licensees to access treatment confidentially and with protection from professional investigation and/or disciplinary action based on the diagnosis of chemical abuse or dependency.  The vast majority of these so-called "Physician Health Programs", or PHP's, are members of the FSPHP.

Here's what the FSPHP don't tell you up front.  While signing up for an individual state's PHP is supposedly "voluntary", getting out of the program is not.  Enrolling in these programs requires signing an extended contract (generally lasting about five years) and agreeing to allow the PHP to report you to your state medical licensing board for noncompletion or noncompliance with their program -- which almost invariably results in public disciplinary action against your license, reporting to the National Practitioner Data Bank, and permanent (often public) sanctioning of your license in every state where you practice medicine (past, present and future).

Nearly all physicians who sign up are required by their state's PHP to undergo a one-month inpatient "comprehensive multidisciplinary assessment", at their own expense (generally $10-30,000 or more, plus lost income for a month), at a pre-approved spiritually-based 12-step addiction treatment facility.  These facilities have a built-in financial incentive to over-diagnose and over-treat "chemical dependency", usually catering to well-paid professionals, often requiring several months of residential treatment at a cost of tens of thousands of dollars more, again at the professional's own expense.  During this evaluation, regardless of your individual history, if you deny being chemically dependent you risk being labeled as "early in the disease process" or "in denial of chemical dependency"; if you admit being chemically dependent you are simply labeled as "chemically dependent."  According to former FSPHP chairperson Susan V. McCall, MD, MPH, "Given that the workplace is normally the last arena for symptoms of addiction to emerge, a greater than 90% probability exists that when suspicions arise, they prove to be true".  [McCall SV.  Chemically Dependent Health Professionals.  Western Journal of Medicine 2001;174(1): 50–54.]  Regarding the initial month-long inpatient assessment, Dr. McCall was also quoted in the Portland Tribune (4/7/2006) as saying, "You have to have that complete assessment up front to know what you're really dealing with."  Dr. McCall is currently the Medical Director for Oregon's PHP (the Health Professionals Program, or HPP). 

Physicians who sign up for their state's PHP also must agree to submit to routine random drug testing of urine ("witnessed collections"), blood, saliva, and hair.  This is also at their own expense -- at a cost of several thousand dollars per year for the 5-year duration of the program.  A physician who "slips" or "relapses" (has even a single trace positive drug or alcohol test, perhaps by inadvertently eating stew cooked with red wine or a muffin containing poppy seeds) may be immediately ordered back into months of residential addiction treatment, again at their own expense, generally at a cost of tens of thousands more dollars, plus lost income. False positives can also be caused by cold medicines, mouthwashes, "non-alcoholic" beverages (contain measurable traces of alcohol), and many other accidental ingestions/exposures. If a physician happens to drink a couple of cups of coffee or cans of soda before a urine drug test, or happens to be on a prescribed diuretic, or happens to be diabetic, their urine test may come up "dilute" -- which the PHP (and state medical licensing board) assume is evidence that the Licensee has intentionally diluted his/her urine by ingesting large quantities of fluid before providing the sample, and then may use as grounds to suspend or revoke that physician's license to practice medicine. 

Despite what you may have been told in the past by various authorities, as a physician in the United States of America you do have a number of different treatment options for the diagnosis of "substance abuse" or "chemical dependency".  The following programs are examples of those which may be considered "approved alternatives" to the spiritually-based 12-step treatment strategy (Alcoholics Anonymous) historically promoted by state PHP's. Some of these alternative programs do have residential treatment options available. Many of their treatment centers are COMPLETELY confidential (primarily out-of-state facilities where you may actually be able to find HELP without risk of being reported to your state's PHP).  Consider these programs or other alternatives if you object to the 12-step approach based upon personal religious, intellectual, or philosophical reasons.  Because the U.S. Constitution guarantees freedom of religion, and because of a recent 9th Circuit Court of Appeals ruling that Alcoholics Anonymous qualifies as a "religion", the courts have asserted that no state agency can legally compel you to undergo 12-step treatment if you object to the 12-step philosophy based on your personal religious beliefs. (Inouye v Kemna, 9th Cir. 2007).  Your objections are also supported by your medical peers: according to a 2006 review by the widely respected Cochrane Review, "The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments."  [Ferri MMF, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005032. DOI: 10.1002/14651858.CD005032.pub2]

Caduceus Clubs, which may also be promoted by your state's medical licensing board or Physician Health Program, are spiritually-based 12-step recovery programs for health professionals (basically just closed and monitored AA meetings which are often are not officially affiliated with AA).  Don't attend their meetings unless you are willing to risk being reported to your state's medical licensing board or Physician Health Program.  These meetings are NOT guaranteed to be confidential!

For a more detailed history of the Federation of State Physician Health Programs (FSPHP) and its relationship to Alcoholics Anonymous (AA) and the American Society of Addiction Medicine (ASAM), click on the tab labeled "AA & ASAM & FSPHP" in the upper left-hand corner at the start of this page.

If you are a physician struggling with substance abuse, "chemical dependency", disability, physical and/or mental illness, we strongly encourage you to consider getting professional help.  It may just save your life (and/or the life of one of your patients).  Get help BEFORE you become impaired (in most states, you are legally required to report suspected physician impairment -- even if this is in yourself).  If you hesitate to seek help because you are concerned about the possibility of losing your privacy, consider getting treatment in a different city or state, paying cash, and/or using an alias. Unfortunately, for the time being, there may be no better way to protect yourself from state medical licensing board injustice.  If you ever learn that you are being investigated by your state licensing board, immediately contact a reputable and experienced licensed attorney for guidance and counsel.  You may also be able to find support and advocacy from your state medical association, your county medical society, and/or your individual specialty board.  You are not alone!   

SMART Recovery® (Self Management And Recovery Training) helps individuals gain independence from addictive behaviors (substances or activities). Their efforts are based on scientific knowledge and evolve as scientific knowledge evolves.