Physician recommendation is a major determinant of colorectal cancer screening. The purpose of this study was to examine physician attitudes and self-reported colorectal cancer patient screening. In a physician survey, perceived patient barriers included preparation for the tests and patient dislike of the blood stool test. Physician semistructured interviews revealed that perception of patient barriers included cost, time off from work, and transportation. Most physicians reported low knowledge of insurance coverage for screening, and self-reported screening rates among physicians themselves were not optimal. Evidence-based interventions to increase physician recommendations for screening, such as reminder and tracking systems, may be of value. Interventions that target physician knowledge of insurance coverage and encourage physicians to adopt screening themselves could also be considered. Copyright © 2009 by the American College of Medical Quality.