Introduction: Addictions among physicians are a matter of public health interest because of their negative impact on the physician’s well-being and the potential risk of malpractice. Physicians’ Health Programmes (PHP) have been developed in several countries to address this issue. Although they share some similarities, they differ in organisational and clinical aspects. Objective: This study aimed to describe the clinical outcomes of the Integral Treatment Programme for Addicted Physicians of The Galatea Care Programme for Sick Physicians (PAIMM). Methods: A prospective naturalistic longitudinal study was conducted using data from electronic medical records of 126 physicians registered at the Barcelona Medical Association-Council and admitted to the PAIMM between 2008 and 2016. All patients received addiction treatment supervised by a specialised team with individual visits (psychiatrist and psychologist), had regular and random drug screening, attended a 3-step intervention with 2 intensive initial phases and 2–5 year weekly group psychotherapy, and were monitored when they returned to practice. Results: All admitted physicians completed the intensive intervention, and 87.3% were subsequently monitored. The mean treatment length was 48 months. Overall, 72.2% of sick physicians remained abstinent at last contact. Good adherence to follow-up psychotherapy groups predicted both lower risk of lapse during the treatment process and higher rates of abstinence at follow-up. Conclusions: Initial intensive treatment, long-term follow-up and drug screening, group therapy attendance, and a case management approach are common factors that may explain the positive clinical outcomes for physicians with addictions in treatment at PHPs, regardless of the country.

Flaherty JA, Richman JA. Substance use and addiction among medical students, residents, and physicians.
Psychiatr Clin North Am
. 1993 Mar;16(1):189–97.
O’Connor PG, Spickard A Jr. Physician impairment by substance abuse.
Med Clin North Am
. 1997 Jul;81(4):1037–52.
Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions.
Mayo Clin Proc
. 2017 Oct;92(10):1486–93.
Berg S. 5 reasons physicians are less likely to seek support. AMA Wire. 2018. Available from:
Gerada C. Clare Gerada: doctors and their defences.
. 2019 Mar;364:l871.
Merlo LJ, Gold MS. Prescription opioid abuse and dependence among physicians: hypotheses and treatment.
Harv Rev Psychiatry
. 2008;16(3):181–94.
The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence.
. 1973 Feb;223(6):684–7.
Lusilla P, Gual A, Roncero C, Bruguera E, Marcos V, Valero S, et al. Dual diagnosis in inpatient physicians: prevalence and clinical characteristics.
Ment Health Subst Use
. 2008 Feb;1(1):10–20.
Dupont RL, Skipper GE. Six lessons from state physician health programs to promote long-term recovery.
J Psychoactive Drugs
. 2012 Jan-Mar;44(1):72–8.
Talbott GD, Wright C. Chemical dependency in health care professionals.
Occup Med
. 1987 Jul-Sep;2(3):581–91.
Talbott GD, Martin CA. Treating impaired physicians: fourteen keys to success.
Va Med
. 1986 Feb;113(2):95–9.
Brown RL, Schneidman BS. Physicians’ health programs—what’s happening in the USA?
Med J Aust
. 2004 Oct;181(7):390–1.
Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia’s Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty.
. 1987 Jun;257(21):2927–30.
Arboleda-Florez J. The mentally ill physician. The position of the Canadian Psychiatric Association.
Can J Psychiatry
. 1984 Feb;29(1):55–9.
Puddester DG. Canada responds: an explosion in doctors’ health awareness, promotion and intervention.
Med J Aust
. 2004 Oct;181(7):386–7.
Brewster JM, Kaufmann IM, Hutchison S, MacWilliam C. Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study.
. 2008 Nov;337:a2098.
Khong E, Sim MG, Hulse G. The identification and management of the drug impaired doctor.
Aust Fam Physician
. 2002 Dec;31(12):1097–100.
Schattner P, Davidson S, Serry N. Doctors’ health and wellbeing: taking up the challenge in Australia.
Med J Aust
. 2004 Oct;181(7):348–9.
Casas M, Gual A, Bruguera E, Arteman A, Padrós J. [Program for the Integral Care of the Physician (PAIME) of the Official Medical College of Barcelona].
Med Clin (Barc)
. 2001 Dec;117(20):785–9.
Kmietowicz Z. New helpline set up by doctors for doctors.
. 2002 Oct;325(7369):854.
Oxley J, Brandon S. Getting help for sick doctors.
. 1997;314:7092.
Oxley JR. Services for sick doctors in the UK.
Med J Aust
. 2004 Oct;181(7):388–9.
Practiotioner Health. Looking after your wellbeing in confidence [Internet]. 2014 [cited 2019 May 9]. Available from:
DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs.
J Subst Abuse Treat
. 2009 Mar;36(2):159–71.
McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States.
. 2008 Nov;337:a2038.
Brown AM, Bohler R. Achieving a 15% Relapse Rate: A Review of Collegiate Recovery and Physician Health Programs.
Alcohol Treat Q
. 2019 Jan;37(1):109–22.
Lenzer J. Physician health programs under fire.
. 2016 Jun;353:i3568.
Federation of State Physician Health Programs [Internet]. 2018 [cited 2019 May 9]. Available from:
Gerada C. The Wounded Healer: Report on the first 10 years of Practitioner Health Service. London; 2018.
NHS. NHS Practitioner Health Programme [Internet]. 2017 [cited 2019 May 9]. Available from:
PAIMM [Internet]. 2016 [cited 2019 Jun 6]. Available from:
Braquehais MD, Valero S, Matalí JL, Bel MJ, Montejo JE, Nasillo V, et al. Promoting voluntary help-seeking among doctors with mental disorders.
Int J Occup Med Environ Health
. 2014 Jun;27(3):435–43.
Braquehais MD, Tresidder A, DuPont RL. Service provision to physicians with mental health and addiction problems.
Curr Opin Psychiatry
. 2015 Jul;28(4):324–9.
OMC. Consejo General de Colegios Oficiales de Médicos. El PAIME marca el horizonte a países latinoamericanos en la protecció de salud de sus profesionales [Internet]. 2017 [cited 2019 May 9]. Available from:íses-latinoamericanos-en-la-protección-de-salud-de-sus-profesionales.
Colegio Médico del Uruguay. Programa Bienestar Profesional: en Pro de la Salud de los Médicos [Internet]. 2018 [cited 2019 May 9]. Available from:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR). 4th editio. Washington DC: American Psychiatric Association; 2000.
WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects [Internet]. 2018 [cited February 11]. Available from:
StataCorp. Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC. 2017.
DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs.
J Subst Abuse Treat
. 2009 Jul;37(1):1–7.
Warhaft NJ. The Victorian Doctors Health Program: the first 3 years.
Med J Aust
. 2004 Oct;181(7):376–9.
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015.
MMWR Morb Mortal Wkly Rep
. 2016 Dec;65(50-51):1445–52.
Huerta C, Abbing-Karahagopian V, Requena G, Oliva B, Alvarez Y, Gardarsdottir H, et al. Exposure to benzodiazepines (anxiolytics, hypnotics and related drugs) in seven European electronic healthcare databases: a cross-national descriptive study from the PROTECT-EU Project.
Pharmacoepidemiol Drug Saf
. 2016 Mar;25 Suppl 1:56–5.
Dupont RL, Merlo LJ. Physician Health Programs : A Model for Treating Substance Use Disorders The PHP System of Care Management.
Judges J
. 2018;57(1).
Baxter L, Demitor M, DuPont C, DuPont H, Fortner N, Gitlow S, et al. The new paradigm for recovery: Making Recovery - and Not Relapse -the Expected Outcome of Addiction Treatment. Washington DC; 2014. Available from:
Dupont RL. Creating a New Standard for Addiction Treatment Outcomes. Rockville, MD; 2014. Available from:
Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs.
J Addict Med
. 2012 Dec;6(4):243–6.
Candilis PJ. Physician health programs and the social contract.
AMA J Ethics
. 2016 Jan;18(1):77–81.
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