The American Medical Association defines an "impaired physicain" as one who is unable to fulfill professional or personal responsibilities because of psychiatric illness, alcoholism, or drug dependency.1 Although this definition addresses only substance abuse and mental illness, medical problems that affect judgment and performance could compromise the ability to provide reasonable medical care, thus causing impairment. Likewise, issues surrounding clinical competency, such as medical knowledge, medical judgment, and clinical decision making, can compromise judgment and performance.