Physician health programs in most states are designed to help doctors with substance-abuse problems get the care they need and, when appropriate, return to work while protecting patient safety. But two doctors who have been involved with the Massachusetts program say there is too little oversight of programs across the country and no clear standards.

Doctors referred to such programs have no choice but to participate in the treatment in order to preserve their careers, so the programs are coercive, J. Wesley Boyd and John R. Knight, both of Harvard Medical School and Boston Children’s Hospital, said in a review published this month in the Journal of Addiction Medicine.