Impairment of physicians' ability to practice medicine safely and effectively is relatively common. Chemical dependency, the leading cause of physician impairment, has a lifetime prevalence of approximately 10%-15% among physicians. Statistics from physician health programs indicate that family physicians are overrepresented among impaired physicians. It is therefore important for family practice residencies to monitor for and deal with physician impairment. Over the past 11 years, we have worked with eight impaired residents: five with chemical dependency, two with cognitive impairment, and one with an affective disorder Seven of the eight residents are currently practicing medicine, six in family practice. Based on our experience and the literature, we have developed an algorithm that includes the recognition, intervention, and aftercare of impaired residents. The long-term success of the majority of impaired residents with whom we have worked suggests that the trials and tribulations of working with this potentially difficult group of residents are well worth the effort.