This study found that more than half of physicians surveyed engaged in questionable documentation practices, such as recording information that they did not personally obtain or writing notes on patients not seen or examined. The findings raise concern about professionalism broadly but also about the current educational environment for trainees, role modeling of documentation behaviors, and the greater impact of billing and medical-legal influences on documentation practices. These changing factors may in part explain why the findings also suggest that questionable practices were more common among younger providers, who may be a product of the changed environment outlined in recent years.