Etiologic research on alcohol-related impairment in physicians has elucidated various risk factors including family history of alcoholism, symptomatic distress, personality deficits, and high academic achievement. This study of medical students points to the additional salience of future practice orientations involving technological/status versus interpersonal concerns. A cohort of students was surveyed at medical school entrance and again in the second training year. Alcohol abusers (particularly medical school onset cases) manifested significantly higher technological/status and lower interpersonal concerns compared to non-abusers. Differences across future specialty choices were also found. However, additional longitudinal research is necessary to clarify the causal directionality of these relationships.