OBJECTIVE: To assess factors that influence whether patients with schizophrenia are prescribed second-generation antipsychotic medications (Olanzapine, Risperidone) or traditional antipsychotics. METHODS: Data were obtained from the Schizophrenia Care and Assessment Program study. Participant information was collected through interviews and medical record abstraction (n=294). Treating physicians were surveyed about their demographic, professional, and practice characteristics (n=42). Patient and physician information was linked. Multivariate logistic regression with patient and physician-level predictors was estimated. RESULTS: The following variables were positively associated with second-generation medication use at p <0.05: a higher baseline PANSSNS score (e.g. depressed affect), having a physician who has been in practice less than five years or greater than 20 years, one who has attended more than one professional meeting in the last five years, and one who sees more than 25 patients a week. The following variables were positively associated with second-generation medication use at p <0.1 in some of the models: patient age < 35, race other than African-American or White, diagnosis of other schizophrenia , being uninsured, and having one or no prior psychotic episodes. Medicare, Medicaid, private insurance, CHAMPUS, and other insurance were not significant predictors. CONCLUSIONS: One of the perceived advantages of second-generation antipsychotic medications over traditional antipsychotics is their greater effectiveness at reducing the negative symptoms of schizophrenia. Consistent with this belief, we find that physicians are prescribing second-generation antipsychotics to patients who display more negative symptoms. There is also evidence that physicians may be prescribing second-generation antipsychotics to younger patients and those experiencing a first psychotic episode, thus using second-generation medications as first-line treatments. We also find that physician characteristics are influencing whether patients are being prescribed the second-generation medications. Finally, we do not find evidence that insurance status influences access to medications