A new national survey of more than 1,000 physicians reveals that healthcare affordability has overtaken documentation burdens as the top policy concern — and the ramifications are rippling directly into exam rooms across the country.
For years, the conversation around healthcare affordability focused on patients — the uninsured, the underinsured, those forced to choose between a prescription and a grocery bill. But a striking shift is underway. According to athenahealth’s fifth annual Physician Sentiment Survey, the doctors treating those patients are now sounding the same alarm.
The survey, fielded by The Harris Poll on behalf of athenahealth and its research hub athenaInstitute, polled 1,045 primary care physicians and specialists across the United States in late 2025. Its findings paint a nuanced but urgent portrait of a profession caught between technological progress and systemic strain.
Affordability Climbs to the Top of Physician Concerns
The headline finding is hard to ignore: 52% of physicians now cite access to affordable healthcare as their top policy concern — a 14-point jump over just three years, rising from 38% in 2024 to 44% in 2025, and now past the majority threshold. It has surpassed documentation burden, which had dominated prior surveys, to claim the number-one spot.
The implications are significant. When patients cannot afford medications, skip preventive screenings, or delay follow-up visits because of high deductibles, it doesn’t just affect their health — it affects the physician’s ability to do their job. The financial barrier, physicians are saying, has become a clinical barrier.
“Persistent structural barriers — like affordability challenges, care fragmentation, and information overload — continue to shape the daily realities of care delivery.”
— Nele Jessel, Chief Medical Officer, athenahealth
Technology Is Helping — But Optimism Remains Elusive
There is genuine good news in the data. AI is no longer just a buzzword in clinical settings — it is becoming a practical utility. Forty-two percent of physicians report that AI has actively reduced their administrative burden, up from 37% the previous year. Meanwhile, 62% say their electronic health record (EHR) makes them more efficient. These are meaningful gains.
Yet for the third consecutive year, overall optimism about the future of the U.S. healthcare system sits at roughly 30%. Technology is improving life at the practice level, but it has not dented physicians’ skepticism about the system at large. The message from doctors is consistent: tools are getting better; structures are not.
An AI Divide Is Opening Between Large and Small Practices
One of the more troubling patterns in the survey is a widening gap in AI adoption between large and small practices. Sixty-five percent of physicians at enterprise organizations report comfort with AI tools, compared to just 43% at small practices. This disparity threatens to concentrate the efficiency gains of new technology in settings that already have more resources — leaving independent and community practices further behind.
Financial anxiety compounds the picture. While 67% of physicians currently feel confident about their practice’s financial health, 90% of small practices express fear of losing their independence. Persistent reimbursement pressure from Medicare and Medicaid means that today’s relative stability may give way to consolidation if policy and payment structures don’t change.
Rural Medicine Is Reaching a Breaking Point
The survey’s most urgent findings concern rural healthcare. Compared to their urban and suburban counterparts, rural physicians report significantly higher burnout rates (67% vs. 52%), greater concern about affordable care access (63% vs. 51%), and are more likely to be considering leaving medicine altogether (69% vs. 51%).
Interoperability difficulties and low confidence in EHR tools are especially acute in rural settings. These physicians, often already isolated and under-resourced, face the double burden of systemic affordability challenges and inadequate technological infrastructure. The concern is not hypothetical: if a large proportion of rural doctors exit the profession, the continuity of care in those communities collapses.
Key Findings at a Glance
- 52% of physicians name access to affordable healthcare as their top policy concern — up 14 points over three years
- Overall system optimism remains at ~30% for the third year running
- 42% of physicians say AI has reduced their administrative burden (up from 37% last year)
- 62% report their EHR improves efficiency
- 65% of enterprise physicians are comfortable with AI vs. 43% at small practices
- 90% of small practices fear losing their independence
- Rural physicians: 67% report burnout vs. 52% of urban/suburban peers
- 69% of rural physicians are considering leaving medicine entirely
What This Means
The athenahealth Physician Sentiment Survey captures something that policy conversations often miss: the lived experience of the doctors at the front lines of American healthcare. When physicians — not just patients — identify affordability as their primary concern, it signals that the financial structure of the system is actively undermining care delivery itself.
Technology can help — and this survey shows it is helping. But without structural reform around reimbursement, care access, and rural health infrastructure, the gains made in efficiency and AI adoption risk being swamped by forces that no software can fix.
Source: athenahealth 2026 Physician Sentiment Survey, conducted by The Harris Poll (October 14–29, 2025). N=1,045 U.S. physicians (752 PCPs, 291 specialists). Full release: athenahealth.com/press-releases/access-to-affordable-healthcare