Why physicians resist artificial intelligence: A systematic review through the lens of diffusion of innovations.

BACKGROUND: Artificial intelligence (AI) enabled systems hold significant promise for transforming health care delivery. These technologies are frequently developed and commercialized by firms focused on creating innovative products or services and positioning them as essential solutions for clinical and organizational needs. However, despite their transformative potential, the integration of artificial intelligence into routine clinical practice has been met with notable resistance from physicians. PURPOSE: The purpose of this systematic review was to examine the factors contributing to physicians' resistance to AI-enabled technologies in clinical practice. Rogers' Diffusion of Innovations (DOI) theory was employed as the guiding theoretical framework to analyze how perceived innovation attributes shape physician resistance. METHODOLOGY/APPROACH: We conducted a PRISMA-guided systematic literature review across five databases, examining sixteen empirical studies from the United States published in English. CONCLUSION: We identified resistance factors for AI among physicians in clinical practice using a deductive approach guided by Rogers' Diffusion of Innovations (DOI) framework, focusing on perceived relative advantage, compatibility, and complexity of AI-enabled technologies. PRACTICE IMPLICATIONS: These findings show that physician adoption of AI tools depends on whether innovations demonstrably improve clinical quality, efficiency, and workload compared with existing practices. Adoption is strengthened when hospital leaders make benefits visible through data, pilots, physician champions, and collaborative testing environments that build trust and reduce uncertainty about the technology's value.