A national sample of 337 college students who initially aspired to be physicians were studied for 9 years to determine the influence of precollege characteristics, college origins, and the academic and social experience of college on the likelihood of becoming a physician. Estimates of a 14-variable causal model indicated that the major direct effects on attainment were attributable to college characteristics and the academic experience of college. The selectivity/prestige of the undergraduate institution attended, collegiate academic achievement, and majoring in the physical or life sciences each had significant direct effects on becoming a physician. The direct positive influence of college quality, however, was counterbalanced by its negative indirect effect. The greatest advantage in attending an elite institution accrued to those students with relatively high levels of academic performance. As academic performance declined, so did the positive effect of college quality. The effects of precollege characteristics on becoming a physician were largely indirect, mediated by the student's college experience. While women were no less likely than men to become physicians, being female had a significant negative indirect effect. (SW)