Background: Artificial intelligence (AI) is increasingly being used in healthcare. Despite its promise, physicians and trainees remain cautiously optimistic. This systematic review and meta-analysis aimed to assess knowledge and attitudes toward AI and to provide recommendations for AI buy-in by physicians. Methods: Searches of PubMed-OVID-IEEE-Scopus, and Web-of-Science for studies in 2013–2024 identified 11,437 records. One-hundred-and-fifteen met inclusion criteria. Fifty-three studies reported quantitative data on physicians’/trainees’ knowledge and were included in the meta-analysis. Results: Our meta-analysis estimated that only 19.6% of physicians and trainees have high overall AI knowledge, while 36.3% have low knowledge. Fifty-five studies evaluated the depth of AI knowledge. These studies consistently concluded that most physicians or trainees possess only moderate conceptual knowledge of AI, and their technical knowledge is usually limited. Qualitative evaluations also highlighted that a high level of conceptual AI knowledge is associated with greater receptiveness to AI implementation in medicine. We identified five major barriers to translating AI to the bedside with physician buy-in. Conclusion: Although physicians and trainees are generally receptive to AI, many barriers hinder adoption. To address them, we recommend establishing standardized AI education and workforce training, involving clinicians early in AI design, clarifying legal and regulatory issues, leveraging insights from clinical decision support system implementation to reduce workflow challenges, and integrating patient-centered communication principles to enhance trust and transparency.