This study reports on a survey of all Boards of Medical Examiners in the 50 United States, pertaining to actions taken for physician drug abuse. During the year 1976, we could obtain verification of only 37 actions taken against American physicians for drug abuse; in contrast, 142 actions were taken in Canada the previous year. Response rate to the questionnaire was 72 per cent, however, only 18 per cent of the responses gave actual figures regarding action taken. The study also surveyed legal reporting requirements for physician drug abusers in the United States. Factors affecting therapeutic management of physician abusers are discussed in light of difficulties encountered by therapists and peers. Collective data from the authors’ treatment of eight physician abusers are reported. Physician abuse is a significant but under-reported problem. Without an impaired physician program, colleagues have difficulty in dealing with physician drug abuse which is characteristically of long duration and known to spouses and colleagues. Few physician abusers voluntarily seek treatment. This study emphasizes the need for continued support and the development of impaired physician programs.