Some do fine, some don't.
Every judgment call for every factually fuzzy or morally fuzzy issue is a risk/benefit assessment. That's true of all things, but in cases involving a vulnerable public (surgery patients, airline passengers, etc) the only risks and benefits that matter are those that concern the
potential victim:
- Risk: The addicted physician who is allowed to return to practice may relapse and harm a patient.
- Benefit: If addicts are never allowed to return to practice, self-referral may become less common.
Explicitly not listed:
- Benefit: The addict worked hard to get that far and deserves a second chance.
I also wonder if the alleged increase in self-reporting rates when return to practice is possible is really evidence based. I suspect that people who self-refer do it for reasons related to self-preservation and basic human decency and integrity. I'm skeptical that the 2nd order potential benefit of eventual return to practice is a major factor in that decision. I think people who self-refer are thinking "Oh **** I'm out of control and need help and I don't want to die" or perhaps "Oh **** I'm out of control and need help or I may kill someone" rather than "I could probably keep using for a while and get away with it but I'll probably get caught eventually and since I would like to practice medicine at an unspecified future time and self-referral improves the odds the medical board will let me and this facility will un-suspend my credentials I suppose I ought to check in to rehab" ...
The reason people who self-refer have a better prognosis for returning to practice is because, despite being addicts, they have a threshold level of insight and integrity. If there was no path back to practice, they'd probably still self-refer because of those qualities.
Anyway, as for this "playing god" notion, the entire reason licensing boards and hospital credentialing committees exist is to protect the public from quacks, charlatans, incompetents, and other assorted hazards to good care and patient safety. I think that's a better arrangement than any kind of fuzzy handwringing notion that making these hard decisions to protect the public is playing god.