This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.


The U.S. Surgeon General’s office estimates that more than 20 million people have a substance use disorder. Meanwhile, the nation’s drug overdose crisis shows no sign of slowing.

Yet, by all accounts, there aren’t nearly enough physicians who specialize in treating addiction — doctors with extensive clinical training who are board-certified in addiction medicine.

The opioid epidemic has made this doctor deficit painfully apparent. And it’s spurring medical institutions around the country to create fellowships for aspiring doctors who want to treat substance use disorder with the same precision and science as other diseases.

Now numbering more than 60, these fellowship programs offer physicians a year or two of postgraduate training in clinics and hospitals where they learn evidence-based approaches for treating addiction.

Such programs are drawing a new, talented generation of idealistic doctors — idealists like Dr. Hillary Tamar.

Driven To Connect With Patients In Need

Tamar, now in the second year of a family medicine residency in Phoenix, wasn’t thinking about addiction medicine when she first started medical school in Chicago.

“As a medical student, honestly, you do your ER rotation, people label a patient as ‘pain-seeking,’ and it’s bad,” Tamar said. “And that’s all you do about it.”

But in her fourth year of med school, she happened to be assigned to a rotation at a rehab facility in southern Arizona.

“I was able to connect with people in a way that I haven’t been able to connect with them in another specialty,” the 28-year-old recalled.

Working with patients there transformed Tamar’s understanding of addiction, she said, and showed her the potential for doctors to change lives.

“They can go from spending all their time pursuing the acquisition of a substance to being brothers, sisters, daughters [and] fathers making breakfast for their kids again,” she said. “It’s really powerful.”

When Tamar finishes her residency, she plans to pursue a fellowship in addiction medicine. She sees addiction medicine, like primary care, as a way to build lasting relationships with patients — and a way to focus on more than a single diagnosis.

“I love when I see addiction patients on my schedule, even if they’re pregnant and on meth,” she said. “More room to do good — it’s exciting.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Build A Program And They Will Come

Doctors with Tamar’s enthusiasm are sorely needed, said Dr. Anna Lembke, medical director of Addiction Medicine at Stanford University School of Medicine and a longtime researcher in the field.

“Even 10 years ago,” Lembke said, “I couldn’t find a medical student or resident interested in learning about addiction medicine if I looked under a rock. They were just not out there.”

But Lembke sees a change in the upcoming generation of doctors drawn to the field because they care about social justice.

“I now have medical students and residents knocking on my door, emailing me; they all want to learn more about addiction,” Lembke said.

Historically, the path to addiction medicine was through psychiatry. That model started to change in 2015, when the American Board of Medical Specialties — considered the gold standard in physician certification in the U.S. — recognized addiction medicine as a bona fide subspecialty and opened up the training to physicians from other medical fields.

Until then, Lembke said, there had been no way to get addiction fellowships approved through the nationally recognized Accreditation Council for Graduate Medical Education. And that made recruiting young talent — and securing funding for their fellowships — difficult.

Last year, ACGME began accrediting its first batch of addiction medicine fellowship programs.

“We have got an enormous gap between the need and the doctors available to provide that treatment,” Lembke said.

“At least the medical community has begun to wake up to consider not only their role in triggering this opioid epidemic, but also the ways they need to step up to solve the problem,” she said.

Laying The Foundation

When Dr. Luke Peterson finished his residency in family medicine in Phoenix in 2016, there were no addiction medicine fellowships in Arizona.

So he moved to Seattle to complete a year-long fellowship at Swedish Cherry Hill Family Medicine Residency. There he learned, among other things, how to treat pregnant women who are in recovery from drug use.

“I really needed to do a fellowship if I was going to make an impact and be able to teach others to make the same impact,” said Peterson, who went on to help found an addiction medicine fellowship program in Arizona. His program is based in Phoenix at the University of Arizona’s medical school and its teaching hospital, run by Banner Health and the Phoenix VA.

Arizona’s two addiction medicine fellowships received ACGME accreditation last year — a stamp of approval that made the programs desirable choices for up-and-coming physicians, Peterson said.

Not every doctor who plans to treat substance use disorder needs to do a fellowship, he said. In fact, his goal is to integrate addiction medicine into primary care settings.

But a specialist can serve as a referral center and resource hub for community doctors.

For example, physicians can learn from a specialist such as Peterson how to provide medication-assisted treatment like buprenorphine.

Public health leaders have been pushing to get more physicians trained in evidence-based treatment like buprenorphine, which has been shown to reduce the risk of death among people who have recovered from an opioid overdose.

“As we provide more education and more support to primary care physicians, they will feel more comfortable screening and treating for addiction,” Peterson said.

Peterson’s own journey into addiction medicine began during a rotation with a family doctor in rural Illinois.

“In moments that most doctors find uncomfortable — maybe a patient comes in to request pain medication and you’re seeing the negative side effects — he did not shy away from that situation,” Peterson said. “He addressed it head-on.”

It was a formative experience for Peterson — one he wants other young doctors to have. And he recognizes the urgency.

“In 20 or 30 years from now,” Peterson said, “those medical students are going to look back at my current generation of doctors, and we will be judged by how we responded to this epidemic,” in the same way he and his peers now look back at how doctors handled the HIV epidemic.

One of the first steps in stopping the epidemic, he said, is making sure there are enough doctors on the ground who know how to respond.

Many of today’s medical students, people like Michelle Peterson (no relation to Luke), say they feel the calling, too.

She’s in her first year at the University of Arizona College of Medicine and became interested in addiction after working at an outpatient treatment center.

She said she’s already learning about addiction in her classes, hearing from doctors in the field and seeing others classmates equally engaged.

“It’s definitely not just me,” she said. “There are quite a few people here really interested in addiction.”

It’s a trend she and her mentors hope will continue.

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

Center for Rehabilitation Services.

ECMC’s Center for Rehabilitation Services consists of a team of physicians, nurses, psychologists, social workers, speech-language pathologists, and occupational and physical therapists.

The rehabilitation services at ECMC are provided at several levels of care to ensure that each patient receives the specific support they need to achieve better outcomes—whether recovery from trauma or improved mobility after a minor injury.

The Medical Rehabilitation Unit (MRU) provides rehabilitation to patients needing the highest level of medical care. Patients treated in this unit are often recovering from the most critical injuries, including traumatic brain injury and spinal cord injury.

In the MRU, patients have access to the full spectrum of rehabilitation services, including physical therapy, occupational therapy, and speech therapy.

CONDITIONS & DISEASES    |    Rehabilitation Services

The multidisciplinary environment of our rehabilitation services center enables us to provide inpatient and outpatient therapies for a broad range of injuries and illnesses, including:

  • Amputations
  • Arthritis
  • Back, neck and other musculoskeletal injuries
  • Burns
  • Cancer-related problems with functional compromise
  • Chronic and acute neurological disorders
  • Chronic and acute pain disorders
  • Fractures
  • Guillain-Barré Syndrome
  • Medical problems with functional compromise
  • Memory problems, including early dementia
  • Muscular dystrophies
  • Normal aging with functional compromise
  • Spinal cord injury
  • Sports medicine-related injuries
  • Stroke
  • Traumatic and acquired brain disorders

TREATMENTS & PROCEDURES    |    Rehabilitation Services

Our rehabilitation physicians are available to evaluate all patients and make recommendations for further diagnostic studies. Medical rehabilitation treatments available at ECMC include:

  • Chiropractic care
  • Pediatric educational and diagnostic services
  • Electromyography (EMG) studies
  • Nerve conduction studies

CONDITIONS & DISEASES | Rehabilitation Services

The multidisciplinary environment of our rehabilitation services center enables us to provide inpatient and outpatient therapies for a broad range of injuries and illnesses, including:

  • Amputations
  • Arthritis
  • Back, neck and other musculoskeletal injuries
  • Burns
  • Cancer-related problems with functional compromise
  • Chronic and acute neurological disorders
  • Chronic and acute pain disorders
  • Fractures
  • Guillain-Barré Syndrome
  • Medical problems with functional compromise
  • Memory problems, including early dementia
  • Muscular dystrophies
  • Normal aging with functional compromise
  • Spinal cord injury
  • Sports medicine-related injuries
  • Stroke
  • Traumatic and acquired brain disorders

TREATMENTS & PROCEDURES | Rehabilitation Services

Our rehabilitation physicians are available to evaluate all patients and make recommendations for further diagnostic studies. Medical rehabilitation treatments available at ECMC include:

  • Chiropractic care
  • Pediatric educational and diagnostic services
  • Electromyography (EMG) studies
  • Nerve conduction studies

Many people love Stanford hospital and the Stanford Health Care medical group of doctors. Unfortunately, if you get your health insurance through an individual and family plan, your options to access care at Stanford are limited. Some Covered California plans may include Stanford affiliated doctors, but not the hospital. The only individual and family plan that has both the doctors and the Stanford hospital in-network is the Health Net PPO plan for 2019.

The services of the Stanford hospital and Stanford Health Care doctors is in high demand. Consequently, they are most likely to command higher reimbursement rates from health insurance plans. There are no Covered California health plans that include both Stanford doctors and hospital as in-network. However, Stanford Health Care will accept referrals from some of the Covered California health plans.

Stanford Health Care & Health Net PPO

Stanford Health Care has tried to provide as much information as possible regarding how they interact with other insurance in California for individual and family plans. ( https://stanfordhealthcare.org/for-patients-visitors/health-insurance-plans/covered-ca.html )

Valley Health Plan HMO, Santa Clara County

Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

Blue Shield Trio HMO

Stanford Health Care is in-network for hospital services. Your assigned medical group (John Muir, Hill Physicians, Sequoia Physicians, SCCIPA, or PMG- Santa Cruz) must refer and authorize all services provided by Stanford Health Care specialists. You would not be able to select a Stanford Health Care physician as your primary care physician.

Kaiser Permanente HMO

Kaiser HMO members must obtain a referral from their Kaiser primary care or specialist physician and an authorization from their health plan for any services to be covered and considered in-network here at Stanford Health Care. You would not be able to select a Stanford Health Care physician as your primary care physician.

Health Net PPO

Stanford Health Care is in-network for all hospital and physician services. This includes specialist and primary care physician services.

*This plan is not available on the Covered California exchange. You would need to purchase this plan with the assistance of a licensed insurance broker, or through Health Net directly.

The Health Net PPO, not to be confused with the EnhancedCare PPO offered through Covered California, is the only plan that will give plan members access to both the Stanford doctors and hospital. These plans are only sold off-exchange or directly from Health Net. Plan enrollment is limited to certain regions and counties within California.

Region 2: Marin, Napa, Solano and Sonoma Counties

Region 4: San Francisco County

Region 10: Merced, San Joaquin, Stanislaus, and Tulare Counties

Region 14: Kern County, partial coverage

Region 15: Los Angeles County partial coverage zip codes starting with 906-912, 915, 917, 918, 935. Los Angeles County is broken up into 2 regions. Region 15 is generally the eastern half of the county. Region 16 is the western half and Health Net PPO is not offered in Region 16.

Region 17: Riverside and San Bernardino Counties, partial coverage in each.

Region 18: Orange County

Region 19 San Diego County

Always check the provider search tool on the Health Net website to make sure the doctor is in-network with the Health Net PPO. The Health Net PPO plans will generally have rates that are 10% to 15% higher than some of their other plans in the individual and family market. If you have a family, you may want to consider enrolling only that family member in the Health Net PPO plan that needs Stanford or some of the other providers they have as in-network. The other family members could enroll in less expensive health plans.

While there is no medical underwriting for the Health Net PPO plan, you will need to provide proof of California residency. The residency must align with one of the regions that the plan is offered in. In addition, Health Net will generally not accept any third party premium payments. Either the policy holder or an immediate family member, such as in the case of a child only policy, must pay for the health plan. Carefully read the Evidence of Coverage document for all terms, conditions, and exclusions.