This paper is a report of the findings of a 1978 follow-up survey on senior medical students in North Carolina tracing changes in their professional orientations since their freshman year. The professional orientations concern four health care problem areas: physicians' relationship with patients, political and economic change in the medical profession, the treatment of women physicians and patients, and geographic and specialty maldistribution of physicians. Medical students generally become more conservative on political and economic issues in the profession and less committed to choosing a practice based on patient need. Although most seniors have maintained their desire to help people, they are more realistic about physicians' limitations than they were during their freshman year. Seniors have more definite opinions on issues concerning women physicians and patients, some becoming more sympathetic with women and some representing a conservative backlash.