OBECTIVES: Documented gaps between best practice (determined by scientific evidence) and actual patient care has led efforts to modify physician behavior with varying, but often modest, results. Researchers in this field have suggested implementation of strategies based on the behavior change theory, the Transtheoretical Model (TTM) of change. The TTM suggests that individuals exhibit varying stages of motivational readiness for change on a behavior and that targeting an intervention to his/her stage of change is crucial to achieving change. The aim of this systematic review was to examine research applications of the TTM for explaining, predicting or guiding interventions aimed at changing physician patient care. METHODS: One researcher conducted a systematic search of several databases (MEDLINE, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, Social Science Abstracts, PsycInfo, and others) using a three-tiered approach with increasing specificity at each level for the period, 1995 through 2004. Peer-reviewed manuscripts, of any study design, seeking to influence, explain and/or predict physician behavior using stage of change were included. RESULTS: Twelve studies employing at least some TTM constructs were identified. Six used surveys to explain physician behavior, four studies employed a TTM assessment to predict the success of interventions to improve screening rates (chlamydial, colorectal cancer), and two employed interviews or focus groups to explain physician counseling behavior (smoking cessation and psychological counseling) and prescribing behavior (beta blockers for myocardial infarction). CONCLUSIONS: Stage of change constructs have been used to explain and / or predict physician behavior, but no studies have been reported which actually tested TTM-based interventions in an experimental design. Because TTM-based interventions have been successful in achieving behavior change in other target behaviors, and since stage of change has been shown to predict physician behavior, future research to test such interventions for changing physician behavior towards evidence-based medicine is warranted.