Background <p>Public distrust in physicians constitutes a significant barrier to effective healthcare utilization, particularly in China, where physician-patient tensions are well-documented. This study analyzed the association between public distrust in physicians and healthcare utilization in China.</p> Methods <p>Utilizing a longitudinal nationally representative dataset from the 2012–2022 China Family Panel Studies, the final sample consisted of 168,174 observations. This study employed a two-way fixed-effects logistic regression analysis within the framework of Andersen’s Behavioral Model to examine the association between distrust and healthcare utilization, while controlling for predisposing characteristics, enabling resources, and need factors.</p> Results <p>Rural areas exhibited a higher outpatient service utilization rate than urban areas. Urban inpatient service utilization rates rose annually from 9.43% in 2012 to 12.36% in 2018, surpassing rural rates, before falling to 9.71% in 2022, below rural levels. Rural residents who reported higher levels of public distrust in physicians showed a lower odds of accessing outpatient care (OR: 0.98, 95% CI: 0.96–0.99). Urban residents who reported higher levels of public distrust in physicians showed a lower odds of accessing inpatient care (OR: 0.97, 95% CI: 0.95–0.99).</p> Conclusion <p>Higher public distrust in physicians was associated with reduced outpatient care access among rural residents and diminished inpatient care access among urban residents. Improving physician-patient trust is a critical policy priority in China. Targeted policy interventions, including strengthening physician-patient trust in rural grassroots clinics, improving the quality of urban inpatient services, and promoting the balanced allocation of medical resources, are needed so as to narrow the urban-rural trust gap and promote the equitable and rational use of medical services.</p>