Abstract
Evaluating and treating impaired physicians is a complex yet essential task that involves navigating clinical, ethical, and legal responsibilities. Mental health and substance use disorders among physicians are often hidden due to stigma, yet addressing these issues is vital for both physician well-being and patient safety. This article explores three critical approaches to managing physician impairment: early treatment before impairment, fitness for duty evaluations (FFDEs), and disability determinations. Early intervention focuses on preventing workplace impairment by promoting mental health care and resilience. FFDEs assess whether physicians can safely perform their job duties, requiring thorough evaluations to balance urgency with ethical considerations. Disability determinations evaluate functional impairments within legal frameworks, emphasizing the im portance of objective assessment free from the potential conflicts inherent in the treating physician's role. [Psychiatr