General internal medicine (GIM) physician practice satisfaction and dissatisfaction in large multispecialty clinics were assessed utilizing a survey designed to elicit physician perceptions of practice. 420 GIM physicians in 22 multispecialty clinics were contacted, and 168 participated in the survey. The most significant positive components of practice satisfaction were patient interactions and favorable physician colleague interactions. The prominent negative components were paperwork hassles and perceived “second-class” physician status. Coping strategies were varied and included increased political involvement, career change, and withdrawal via depression.