OBJECTIVE To evaluate the psychological health of ACEM Fellows and the important factors that impact on this health. METHODS A cross-sectional, mail survey utilizing validated psychological instruments. RESULTS Three hundred and twenty-three (63.5%) of 510 physicians responded. Most were recently graduated males. Compared to a general population sample, their psychological health was good with greater optimism and mastery (P < 0.001), less anxiety, depression and physical symptoms (P < 0.001), better life satisfaction (P = 0.04) and similar perceived stress (P = 0.20). The mean work stress score (1 = low, 10 = high) was 5.6 +/- 2.1 (moderate stress) although 63 (19.5%) had very high scores (8-10). The mean work satisfaction score was 6.3 +/- 2.1 (moderate satisfaction) although 43 (13.3%) had very low scores (1-3). Perceptions of control over hours worked and mix of professional activities were positively associated with work and life satisfaction (P < 0.001) and negatively associated with work stress and measures of wellbeing (P < 0.001). Most employed adaptive coping strategies. However, maladaptive strategies (alcohol/drugs, denial, disengagement) were positively associated with anxiety, depression and stress (P < 0.001). CONCLUSIONS Most physicians are psychologically healthy. However, there appears to be a subgroup that is not thriving. Workplace stress should be addressed promptly and greater flexibility provided over hours worked and mix of professional activities.