Background: In 2008, the BC provincial government introduced legislation that enabled pharmacists to adapt prescriptions. The purpose of this study was to examine the perceptions, attitudes and practices of family physicians as they relate to pharmacy adaptation services. Methods: Focus groups and interviews were conducted with physicians in 4 of the 5 regional health authorities of BC (Fraser, Interior, Vancouver Coastal and Vancouver Island) and transcripts were thematically coded and analyzed. Results: Forty physicians participated in the 4 focus groups and 4 physicians participated in supplementary interviews. Physicians perceived 6 key concerns arising from the initiative: compromised patient monitoring, physician liability, physician burden, pharmacists' ability to make appropriate adaptations, conflicts of interest and impact on physician-pharmacist relationships. Physicians also believed that communication about the adaptation initiative was inadequate and that they were not sufficiently included in its development. Interpretation: Most of the participating physicians had received very few, if any, prescription adaptations; hence their concerns about the potential impact of such adaptations are mostly speculative. They also indicated a lack of information concerning the details of the initiative and the scope of what pharmacists are permitted to adapt. However, whether or not their perceptions are accurate, physicians' beliefs about prescription adaptations will affect their acceptance of the initiative and thus their concerns need to be addressed. Conclusions: Physicians are essential stakeholders in the prescribing process. To ensure that physicians support pharmacy adaptation services, their concerns should be addressed in the adaptation guidelines and efforts should be made to include them in discussions and provide them with detailed communications.