BACKGROUND: This study describes physicians' perception of burden associated with herpes zoster (HZ) and postherpetic neuralgia (PHN), intentions for recommending the HZ vaccine, and perceived barriers to vaccination. METHODS: A national survey of 438 general internal medicine (GIM) and 433 family medicine (FM) physicians was conducted during November-December 2005. RESULTS: The survey response rate was 69%. Approximately 35% of GIM and FM physicians strongly agreed that HZ and PHN caused a significant burden of disease. For patients 60-79 years of age, > or =80% of GIM and FM physicians were somewhat or very likely to recommend HZ vaccine. In multivariate analyses, physicians who strongly agreed that HZ and PHN cause significant burden were more likely to recommend the vaccine to patients 60-79 years of age (odds ratio [OR], 2.75 [95% confidence interval [CI], 1.85-4.09]), whereas those who felt there was insufficient information about duration of protection (OR, 0.40 [CI, 0.24-0.67]), that the need to store HZ vaccine in a freezer was a definite barrier (OR, 0.31 [CI, 0.13-0.75]), or that their patients would not pay for the vaccine if it was not covered by insurance (OR, 0.57 [CI, 0.38-0.86]) were less likely to recommend it. CONCLUSIONS: Primary care physicians perceived a high level of burden from HZ and PHN and generally favored the HZ vaccine.