OBJECTIVES: Previous surveys of the alumni of Columbia University's fellowship in public psychiatry suggest that a large number of alumni fill positions as program medical directors. In contrast with agency medical directors, program medical directors work within team structures and maintain a high degree of clinical involvement. The fellowship faculty surveyed the alumni to catalog the tasks performed by program medical directors, agency medical directors, and staff psychiatrists and to determine the extent to which these tasks contribute to job satisfaction. METHODS: A survey form was developed using a list of tasks derived from the American Psychiatric Association's guidelines for psychiatrists working in organized mental health care delivery systems and from a recent article that surveyed job descriptions of psychiatrists in community mental health centers. The survey form was distributed to all current fellows and alumni in active practice (N = 89). RESULTS AND CONCLUSIONS: Seventy-two forms were returned, for a response rate of 81 percent. Respondents who were medical directors performed a greater variety of tasks and reported higher job satisfaction than those who were staff psychiatrists. Higher job satisfaction was related to a greater variety of tasks performed, especially tasks involving clinical collaboration. Most of the respondents were program medical directors rather than agency medical directors. The position of program medical director constitutes a relatively small and attainable step above that of staff psychiatrist. Agencies would do well to consider creating positions of program medical directors for their staff psychiatrists whenever feasible, and psychiatrists committed to public-sector careers should negotiate to have such positions.