Despite the growing rate of deaths caused by firearms, it is not clear what role physicians should play in counseling patients about firearm safety. This study aims to delineate the perceptions and experiences of family physicians regarding firearm safety counseling. Data were gathered as part of the 2020 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine practicing physicians. Participants were practicing physicians and members of one of four major academic family medicine organizations comprising CERA. The survey was delivered to a sample of 3,665 family physicians between January 15, 2020, and March 2, 2020. This was a mixed-methods epidemiological study that analyzed quantitative and qualitative survey data. We calculated a χ2 test of independence to examine interactions between demographic characteristics and beliefs and perceptions about firearm safety counseling. The overall response rate for the survey was 32.52%, with 92.7% answering questions in the firearm safety set; 93.7% of study participants viewed firearm safety as a public health issue and 95.3% felt family physicians should have the right to counsel patients on firearm safety. Family physicians who had received formal training on firearm safety counseling were significantly more likely to indicate a higher level of comfort with asking their patients about firearms (P<.0001). Firearm safety is an important public health issue and family physicians would benefit from receiving formal training on firearm safety counseling early in their training. More education is needed around physician-initiated firearm safety counseling.