Affordable care overtakes paperwork as physicians top concern, athenahealth survey finds

Access to affordable health care has displaced administrative burden as the single biggest policy concern among U.S. physicians, according to athenahealth’s fifth annual Physician Sentiment Survey. The shift signals the industry’s growing concern over systemic cost and coverage pressures, stretching well beyond the exam room.

The survey, conducted online by The Harris Poll in October 2025 among 1,045 primary care physicians and specialists nationwide, found that 52% of physicians now consider access to affordable health care to be the most pressing issue they want policymakers to address. That figure was 44% in the 2025 survey and 38% in 2024, a 14-point climb in just two years. For the first time in the survey’s five-year history, the issue overtook minimizing excessive documentation requirements, which fell to 46% from 49% in 2024.

“Physicians today are more receptive than ever to adopting new tools and innovative ways of working, signaling a positive shift within clinical practices,” said Nele Jessel, M.D., chief medical officer at athenahealth and athenaInstitute co-chair. “Yet persistent structural barriers — like affordability challenges, care fragmentation and information overload — continue to shape the daily realities of care delivery.”

In a conversation with Medical Economics, Jessel pointed to two policy developments that were top of mind when the survey was fielded: proposed Medicaid cuts in the budget reconciliation legislation passed by the House in July 2025, and the then-looming expiration of the Medicare telehealth reimbursement parity exception, which was set to lapse at the end of January 2026 before being renewed through December 2027.

“Access to care had dramatically expanded during the pandemic through the use of telehealth services,” Jessel told Medical Economics. “And after the pandemic, the levels of telehealth services provided didn’t really drop that significantly, because telehealth is a beautiful way of increasing access to care.”

Rural physicians feel the strain the most. In the survey, 63% of rural physicians flagged affordable access as a top priority, compared with 51% of their urban and suburban peers. Rural respondents also reported substantially higher burnout (67% vs. 52%), and 69% said they had considered leaving medicine, compared with 51% of physicians in urban and suburban settings.

Are physicians optimistic?

Despite incremental improvements in some daily practice metrics, physician confidence in the broader U.S. health care system has barely budged. Just 32% of respondents said they are optimistic about the future of health care in the United States, a figure that has hovered around 30% for three consecutive years.

Jessel called the number concerning. “Only 32% of physicians in our most recent survey expressed optimism for the future of U.S. health care,” she said. “That makes me, personally, very concerned.”

Close to half of physicians (45%) described their daily workload as unsustainable, down slightly from 48% in 2025 and 49% in 2024. More than half (53%) reported feeling constantly burned out, and just 32% said they have a good work-life balance on a weekly basis. Still, one trend offered a sliver of encouragement: the share of physicians who have considered leaving medicine dropped to 52%, down from 62% in 2024.

The rise of AI, especially among younger physicians

The survey’s most pronounced positive movement came around artificial intelligence (AI). More than half of physicians (54%) now say they feel comfortable using AI in their practice, up from 46% in 2025. The shift was especially sharp among millennial physicians, whose comfort level jumped to 65% from 48% the prior year, compared with 49% among Gen X and baby boomer physicians.

Jessel attributed much of the change to ambient clinical documentation tools, which she described as the product that broke the ice.

“Even though initially, the early ambient note solutions didn’t create many time savings, the perception was that of reduced burden, because it allowed physicians to again refocus on the patient during the visit,” she said.

Physicians reported increasing their use of AI across several categories: clinical documentation (38% increased use), clinical and patient care (31%), nonclinical and administrative tasks (23%), patient outreach and communication (21%) and revenue cycle management (13%).

Skepticism is fading, as well. The share of physicians who agreed that AI will complicate health care dropped to 30% from 46% in 2024.

The survey also found a notable correlation: physicians who are comfortable with AI were roughly twice as likely to be optimistic about the future of U.S. health care (42% vs. 20%) and far more likely to believe AI is reducing administrative burden (63% vs. 16%). However, only 43% of physicians in small group practices reported being comfortable with AI, compared with 65% at enterprise organizations.

Are physicians financially stable?

Two-thirds of physicians (67%) said they believe their practice is on solid financial footing. That confidence may be surface level, though, as 52% still expressed concern about their organization’s long-term financial health, and 75% said they worry at least once a year about the financial feasibility of running their practice.

“Health care is probably the only industry where prices aren’t actually controlled by the vendor offering the services, but prices are controlled by third parties,” Jessel said. “Practices have very limited ability to absorb cost increases, and those cost increases don’t just include supplies — they also include staffing costs.”

Lower reimbursement from Medicare and Medicaid was the top financial concern (56%), followed by the cost of staff retention and recruitment (47%) and labor shortages (46%). Nearly half of physicians (49%) said they are more worried about claim denials than declining reimbursement rates, with the concern sharpest among small group practices (66%) and lowest among enterprise organizations (36%).

Nine in 10 small practices (88%) expressed fear about the difficulty of staying independent.

Value-based care: Interest high, risk tolerance low

The survey revealed a persistent gap between physician curiosity about value-based care and willingness to actually take on shared financial risk. Nearly seven in 10 physicians (69%) said they want to learn more about value-based care, and 55% acknowledged it could carry financial benefits for their practice, but only 36% said they are comfortable with shared risk models, and just 33% are confident value-based care will improve their practice’s sustainability over the next five years.

Millennial physicians expressed more openness, with 39% expressing comfort with shared risk, compared with 28% of baby boomers. And 53% of millennials said they believe value-based care is improving the health care industry overall, compared with 31% of boomers.

The leading barriers to adoption were administrative burden and reporting requirements (43%), uncertain revenue (31%) and patient engagement challenges (29%).

Jessel said practices already engaged in value-based care contracts report less financial anxiety than those that are not, and she pointed to the model as a long-term necessity. “We firmly believe that the future will look like value-based care, and practices will have to be able to play in both worlds,” she said.

Interoperability: Better data, or just more data?

For three consecutive years, more than nine in 10 physicians in the survey have said that stronger connectivity between health information systems would improve both patient outcomes (92%) and their own experience (91%). And for three consecutive years, progress on the ground has been slow.

Nearly three in four physicians (73%) reported difficulty exchanging patient data across different electronic health record (EHR) platforms. Eight in 10 said gaps in cross-system data sharing increase their stress. And while 81% feel they have adequate patient history when entering an exam room, more than half admitted they struggle to find relevant information for a given visit, and 63% said they are overwhelmed by the volume of data in patient charts.

Jessel described the problem as having flipped. “For many years, interoperability was a challenge in that we couldn’t get access to data,” she said. “Now what that has led to is actually the opposite problem of information overload for clinicians.”

The report found that 80% of physicians agree that more clinical data is not always the answer to higher quality care, and 92% said what matters is getting the right data at the right time. Both figures have held flat for three consecutive years.

Jessel said she has high hopes that generative AI tools will help address the problem. “I believe generative AI is finally that tool in our tool set that will allow us to transform the EHR into what it should have been all along — a helpful tool that will enable physicians and clinicians everywhere to take better care of patients,” she said.

athenahealth’s fifth annual Physician Sentiment Survey captures the profession balancing cautious optimism about its own tools with deep skepticism about the system those tools exist within. Physicians are warming to AI, growing more comfortable with their EHRs and expressing real curiosity about value-based care, but the structural pressures that shape their daily lives — rising costs, flat reimbursements, fragmented data and an affordability crisis that now affects their patients and their practices — remain largely unchanged.

Whether the technology gains of the last two years can translate into broader system-level progress may be the defining question heading into the rest of 2026.