A cognitive divide in active surveillance acceptance persists between surgeons and endocrinologists managing low-risk thyroid cancer.

To quantify the specialty-specific perceptions and modifiable determinants behind AS recommendations-a critical barrier rooted in physician attitudes- this study surveyed eight high-volume hospitals in Jiangsu Province, each performing ≥ 2,500 thyroid surgeries annually. A total of 58 physicians from relevant departments meeting the following criteria were surveyed: Surgery: Perform over 100 thyroid cancer surgeries annually and diagnose at least 300 cases; Endocrinology/Ultrasound: Conduct at least 300 patient consultations per year; Pathology: Issue at least 300 thyroid cancer pathology reports annually; Nuclear Medicine: Perform radionuclide scans on at least 300 patients per year. The Kruskal-Wallis test and ordinal logistic regression were used to compare attitudes toward AS across specialties and examine their association with professional title hierarchy, respectively. A survey of 41 physicians across five specialties revealed high guideline familiarity (85.37%) yet low clinical adoption. While 53.66% would biopsy AS-eligible patients, 90.2% would recommend surgery within three months of papillary carcinoma confirmation. When patients suitable for AS experience anxiety, 75% of endocrinologists would advise surgery. Attending physicians were 4.2 times more likely to endorse AS than professors (P = 0.006). This disparity stems from specialty-specific cognitive frameworks, necessitating precision interventions like medicolegal support for surgeons and anxiety protocols for endocrinologists to bridge the gap.