This paper elaborates the conceptual frameworks and major results to date from an ongoing longitudinal study of alcohol problems in male and female future physicians. A medical student cohort was surveyed at medical school entrance and in the 2nd and 3rd years of training. Relative to life span developmental orientations, a sizable proportion of premedical school problem drinkers “matured out” of their earlier patterns after entrance into occupational training roles. Relative to occupational selection versus stress perspectives, medical school problem drinkers were equally divided between those manifesting onset prior to the initiation of training versus those manifesting onset during medical training. Overall, both male and female problem drinking declined during the preclinical years (in contrast to premedical school levels) but manifested a trend in the direction of a reversal of the previous decline after the initiation of clinical training. The major psychosocial predictor of alcohol abuse during clinical training involved social-relational deficits or narcissistic personality styles. Moreover, this relationship was mediated by social support deficits and patient care-related stressors. This cohort is currently being re-surveyed in the last year of medical school and will be followed again during residency training.