Physicians have been extremely successful in attempts to quit smoking cigarettes. On the basis of their psychological awareness and espousal of the reality principle, one might expect psychiatrists to be the most successful in changing this maladaptive behavior. But psychiatrists as a group are the physicians with the highest prevalence of cigarette smoking and the least success in quitting. In contrast, internists have been among the most successful. Survey data suggest that this disparity is related not to differences in cognitive awareness of risk or in denial of personal vulnerability but to differences in the degree of difficulty anticipated in quitting, the example-setting role, and exposure to the consequences of smoking in their patients.