Despite its potential, the use of e-mail for physician-patient communication has not been widely adopted. Our purpose was to survey the experiences of physicians who are early adopters of the technology. Physicians, identified through a professional Internet information portal, completed a survey, including an assessment of satisfaction with using e-mail with patients. We identified 204 physicians who reported using e-mail with patients on a daily basis. Average age of the respondents was 49 years, 82% were male, and 35% were primary-care physicians. Among the 204 frequent users, commonly reported e-mail topics were new, nonurgent symptoms, and questions about lab results. Despite their daily use, 25% were not satisfied with physician-patient e-mail. The most important reasons for using e-mail with patients among those who were satisfied were "time saving" (33%) and "helps deliver better care" (28%) compared with "patient requested" (80%) among those who were not satisfied (p <.01). Dissatisfied physicians reported concerns about time demands, medicolegal risks, and ability of patients to use e-mail appropriately. Although the majority of these "vanguard" physicians reported benefits, some did not recommend that colleagues adopt this new technology. Increasing integration into practice to enhance time-saving aspects and improve patient education might lead to more sustained use of this promising communication tool.