Nineteen US physicians were interviewed in 1987 to identify how they defined and addressed the changes facing them. Attitudes and problem-solving approaches of physicians who remained satisfied were compared with those deemed dissatisfied. In this ten-year follow-up study, the original subjects were re-contacted and asked to describe changes in their practices, and other questions regarding their professional lives. They were rated by themselves and the authors for satisfaction. Eighteen responded and could be rearranged into three groups by ratings of satisfaction. Representative responses delineate each group and explore various aspects differentiating responses within the grouping. Conclusion: past satisfaction with medical practice is no predictor of current satisfaction. Only those who either embraced change or found a means of escape from the issues facing them earlier were judged satisfied. The majority describe strategies to reduce fatigue, and to maintain some control over their professional lives.