The article adopts the approach of a group biography in discussing the careers and ambitions of early black South African doctors selecting both those trained abroad, and the first cohorts trained within South Africa who graduated at the Universities of Cape Town and the Witwatersrand from 1945–6. It focuses on the ambiguities involved, by looking at tensions between professional altruism and entrepreneurialism in pursuing a medical career, as well as that between self-interest and selflessness in attempting to balance the requirements of a medical practice against those involved in political leadership. The paper highlights the significance of the political leadership given by black doctors in the mid-twentieth century and indicates the price paid for this in loss of medical resources under the apartheid regime. Two annexes provide original data on the medical and political contributions of individuals.