Healthcare utilization, preventive care, and structural barriers among medical students at a three-campus U.S. medical school

Abstract

Background

Medical students may delay or forgo care because of time constraints, cost, confidentiality concerns, and fragmented access. Data describing healthcare utilization and preventive care among geographically distributed medical student populations remain limited. This study aimed to characterize healthcare utilization, preventive care uptake, and barriers to care among medical students and to examine associations with selected demographic and structural factors.

Methods

Medical students across Mayo Clinic Alix School of Medicine campuses in Arizona, Minnesota, and Florida were invited to complete an anonymous survey between August 2025 and February 2026. Primary outcomes were healthcare utilization, delayed care due to academic pressure, and preventive care uptake. Secondary measures included reported barriers, insurance understanding, and suggested institutional interventions. Descriptive statistics were used to summarize the sample. Fisher’s exact tests and t-tests were used for selected bivariate comparisons.

Results

Of 480 invited students, 89 responded (response rate 18.5%). Campus data were available for 85 respondents: 53/85 (62.4%) from Minnesota, 26/85 (30.6%) from Arizona, and 6/85 (7.1%) from Florida. Among respondents with available data, 72/80 (90.0%) reported using healthcare services during medical school and 40/66 (60.6%) reported delaying care because of academic pressure. Among M3 and M4 respondents, 13/26 (50.0%) reported less frequent care during clerkships. Regarding preventive care, 49/71 (69.0%) reported being up to date on annual checkups, 42/65 (64.6%) on dental care, and 43/69 (62.3%) on sexually transmitted infection screening. The most commonly endorsed barriers were time (69/75, 92.0%), cost (36/75, 48.0%), access (15/75, 20.0%), and confidentiality (12/75, 16.0%). Students from low-income backgrounds were less likely to report any healthcare use (13/18 [72.2%] vs. 57/60 [95.0%], p=.014) and less likely to be up to date on dental care (6/16 [37.5%] vs. 36/49 [73.5%], p=.015). Women were more likely than men to report any healthcare use (49/51 [96.1%] vs. 23/29 [79.3%], p=.024), reproductive health service use (16/45 [35.6%] vs. 0/21 [0%], p=.001), and being up to date on dental care (30/38 [78.9%] vs. 12/27 [44.4%], p=.008).

Conclusions

Healthcare use among medical students was common, but delayed care and gaps in preventive care were frequent. Time and cost dominated perceived barriers, and disparities by socioeconomic background were evident. Protected time for appointments, insurance support, and student-centered access pathways may improve trainee health.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09817-0.

Background

Medical students frequently navigate demanding schedules, high rates of burnout, and limited flexibility for personal healthcare [1–5]. Prior work suggests that medical trainees often delay care, particularly for mental health and preventive services, because of time constraints, stigma, and concerns about confidentiality [6–9]. These barriers may contribute to worsening chronic illness, unmet mental health needs, and incomplete preventive care during training.

Understanding student healthcare utilization matters for both learner well-being and professional development. Untreated medical and psychiatric conditions are associated with burnout, reduced quality of life, and impaired professional functioning [10–12]. In addition, trainees who struggle to access care may have limited opportunity to build practical understanding of healthcare financing, insurance navigation, and barriers that affect patients more broadly [13–15].

Most published literature on medical student well-being focuses on distress and mental health rather than on the broader pattern of healthcare utilization, preventive care uptake, and structural access barriers across training environments [5, 16]. To address this gap, we surveyed students across a three-campus U.S. medical school to characterize healthcare utilization and preventive care, identify common barriers to care, and examine whether selected outcomes varied by structural or demographic factors, including insurance status, gender, and low-income background.

Methods

We conducted a cross-sectional anonymous survey of students at Mayo Clinic Alix School of Medicine across its Arizona, Minnesota, and Florida campuses. All enrolled students were eligible. The survey was distributed by email between August 2025 and February 2026. Participation was voluntary. The study used a minimal-risk protocol (IRB #25-010011).

The survey instrument was developed specifically for this study based on the study objectives and prior literature on medical student healthcare utilization and barriers to care. The full survey is provided as Supplementary File 1. The survey included domains covering demographics, insurance status and understanding, chronic conditions, mental health, healthcare utilization, preventive care, barriers to care, and suggested institutional improvements. Service use domains included primary care, mental health, reproductive health, chronic illness care, and acute care. Preventive care items assessed annual checkups, dental care, sexually transmitted infection (STI) screening, and vaccinations.

Primary outcomes were (1) use of healthcare services during medical school, (2) delayed care due to academic pressure, and (3) preventive care uptake. Secondary outcomes included reported barriers to care, perceived support from the institution, and suggestions for improving access. Because survey items were optional and some items were displayed only after prior responses, denominators vary across analyses (Supplementary File 2). We used available-case denominators for each item. We used Fisher’s exact tests for selected exploratory bivariate comparisons involving binary outcomes and small cell sizes. Insurance understanding items, collected on 5-point Likert scales, were compared with independent-samples t-tests after ordinal re-coding. No adjustment was made for multiple comparisons as bivariate analyses were considered exploratory. Statistical significance was defined as a two-sided p < .05. Analyses were performed in Python and SPSS.

Results

Of 480 invited students, 89 survey responses were received, yielding an overall response rate of 18.5%. Campus data were available for 85 respondents: 53/85 (62.4%) were from Minnesota, 26/85 (30.6%) from Arizona, and 6/85 (7.1%) from Florida. Year in training was available for 86 respondents; M1 students comprised the largest subgroup (38/86, 44.2%), followed by M2 (19/86, 22.1%), M3 (12/86, 14.0%), and M4 (17/86, 19.8%). Among 83 respondents to the burnout item, 69 (83.1%) reported burnout or possible burnout since starting medical school. 53 of 82 respondents (64.6%) were enrolled in the medical school’s insurance plan (Table 1).

Table 1.

Participant Characteristics

Characteristic	n/N	%
Campus
Minnesota	53/85	62.4
Arizona	26/85	30.6
Florida	6/85	7.1
Year in training
M1	38/86	44.2
M2	19/86	22.1
M3	12/86	14.0
M4	17/86	19.8
Track
MD	72/86	83.7
MD-PhD	13/86	15.1
Other dual-degree	1/86	1.2
Gender
Female	54/85	63.5
Male	31/85	36.5
Other	0/85	0.0
LGBTQ+ identity	18/55	32.7
Low-income background	19/83	22.9
Burnout or possible burnout since starting medical school	69/83	83.1
Enrolled in medical school-sponsored insurance	53/82	64.6

Values use available-case denominators due to item-level missingness

Healthcare utilization during training was common. Among respondents with available data, 72/80 (90.0%) reported using healthcare services since starting medical school. Among those that elaborated on the type of services they utilized, 66/69 (95.7%) reported primary care use, 34/67 (50.7%) mental health service use, 28/67 (41.8%) acute care use, 19/65 (29.2%) chronic illness care use, and 16/66 (24.2%) reproductive health service use. 30 of 79 respondents (38.0%) reported a mental health concern, 24/77 (31.2%) reported seeing a therapist or psychiatrist, and 31/79 (39.2%) reported chronic conditions. Mental health service use and self-reported mental health concern were distinct measures. Mental health service utilization may reflect preventive or wellness-focused care, counseling, stress management, or other supportive services rather than treatment for a self-identified mental health concern.

Delayed or disrupted care was also frequent. Among the 26 of the 29 M3 and M4 respondents that responded to the clerkship effect item, 13 (50.0%) reported less frequent care during clerkships, 9 (34.6%) reported no change, and 4 (15.4%) reported more frequent care. Overall, 40/66 respondents (60.6%) reported “definitely” or “probably” delaying care because of academic pressure.

Preventive care uptake was incomplete. Among students with available responses, 49/71 (69.0%) reported being up to date on annual checkups, 42/65 (64.6%) on dental care, 43/69 (62.3%) on STI screening, and 68/71 (95.8%) on vaccinations. When asked how the medical school affected access to preventive care, 20/74 (27.0%) said it made access easier, 15/74 (20.3%) said it made access harder, and 39/74 (52.7%) were unsure.

Time was the dominant barrier to care. Among 75 respondents who selected one or more barriers, 69 (92.0%) endorsed time, 36 (48.0%) cost, 15 (20.0%) access, and 12 (16.0%) confidentiality (Fig. 1). Mean interference ratings were highest for time (mean 2.67 on a 0–4 scale), poor availability of self (1.78), and cost of services (1.62). Students most often recommended protected time for primary care appointments (55/69, 79.7%), further subsidized insurance (45/69, 65.2%), and creation of student-specific clinics (24/69, 34.8%). In the free form section regarding other barriers and concerns not otherwise explicitly outlined in the survey, students repeatedly described scheduling inflexibility, out-of-pocket cost, privacy concerns within a small academic community, and limited mental health appointment availability (Table 2).

Fig. 1.

Reported barriers to accessing care among respondents who selected one or more barriers (n=75)

Table 2.

Healthcare Utilization, Preventive Care, and Reported Barriers

Measure	n/N	%
Used healthcare services since starting medical school	72/80	90.0
Service type among respondents with available service-type data
Primary care	66/69	95.7
Mental health	34/67	50.7
Acute care	28/67	41.8
Chronic illness care	19/65	29.2
Reproductive health	16/66	24.2
Reported a mental health concern	30/79	38.0
Reported seeing a therapist/psychiatrist	24/77	31.2
Reported chronic conditions	31/79	39.2
Delayed care due to academic pressure (definitely/probably yes)	40/66	60.6
Change in healthcare use from preclinical training to clerkships (among M3/M4 respondents)
Less frequent care	13/26	50.0
Unchanged	9/26	34.6
More frequent care	4/26	15.4
Preventive care up to date
Annual checkup	49/71	69.0
Dental care	42/65	64.6
STI screening	43/69	62.3
Vaccinations	68/71	95.8
Barrier endorsed among respondents selecting any barrier
Time	69/75	92.0
Cost	36/75	48.0
Access	15/75	20.0
Confidentiality	12/75	16.0
Recommended institutional change among respondents answering suggestion item
Protected time for PCP appointments	55/69	79.7
Further subsidized insurance	45/69	65.2
Creation of student-specific clinics	24/69	34.8

Service-type, preventive care, barrier, and suggestion denominators vary due to skip logic of survey content and item-level nonresponse

Selected bivariate comparisons are shown in Table 3. Students from low-income backgrounds were less likely to report any healthcare use than those not reporting low-income background (13/18 [72.2%] vs. 57/60 [95.0%], p=.014) and less likely to report being up to date on dental care (6/16 [37.5%] vs. 36/49 [73.5%], p=.015). Women were more likely than men to report any healthcare use (49/51 [96.1%] vs. 23/29 [79.3%], p=.024), reproductive health service use (16/45 [35.6%] vs. 0/21 [0%], p=.001), being up to date on dental care (30/38 [78.9%] vs. 12/27 [44.4%], p=.008), and having a mental health concern (24/51 [47.1%] vs. 6/28 [21.4%], p=.030). Students on school-sponsored insurance reported better overall understanding of their insurance than students on other plans (mean 3.26 vs. 2.70 on a 5-point scale, p=.036).

Table 3.

Selected Bivariate Associations

Comparison	Group 1	Group 2	Effect estimate	p value
Any healthcare use	Low-income background: 13/18 (72.2%)	No low-income background: 57/60 (95.0%)	OR 0.14	0.014
Dental care up to date	Low-income background: 6/16 (37.5%)	No low-income background: 36/49 (73.5%)	OR 0.22	0.015
Any healthcare use	Women: 49/51 (96.1%)	Men: 23/29 (79.3%)	OR 6.39	0.024
Reproductive health service use	Women: 16/45 (35.6%)	Men: 0/21 (0.0%)	Risk difference 35.6% points (95% CI, 15.8–50)	0.001
Dental care up to date	Women: 30/38 (78.9%)	Men: 12/27 (44.4%)	OR 4.69	0.008
Mental health concern	Women: 24/51 (47.1%)	Men: 6/28 (21.4%)	OR 3.26	0.030
Overall insurance understanding (1–5 scale)	School-sponsored insurance: mean 3.26	Other insurance: mean 2.70	Mean difference 0.56	0.036

For reproductive health service use, the effect estimate is reported as an absolute risk difference because the odds ratio was not estimable due to a zero cell

P values from Fisher’s exact tests for categorical comparisons and an independent-samples t-test for the insurance understanding comparison

Discussion

In this multi-campus survey, most medical student respondents reported using healthcare during training, yet delayed care and gaps in preventive care were common. More than 60% of respondents reported delaying care because of academic pressure, and approximately one-third were not up to date on annual checkups, dental care, or STI screening. Time and cost dominated reported barriers, while students most commonly recommended protected time for appointments and additional insurance support.

These findings extend prior work on medical student well-being by demonstrating that barriers to care involve not only psychological distress but also practical challenges in navigating healthcare during training [9, 17, 18]. Students may have nominal access to care yet still defer visits when schedules are inflexible, absences feel burdensome, or out-of-pocket costs are difficult to manage [4, 5, 19]. Among clinical students with available data, half reported less frequent care during clerkships. Although this estimate is based on a small subgroup, it highlights a potentially important transition point during which clinical responsibilities may simultaneously increase stress and reduce flexibility for preventive and longitudinal care [20].

The survey also suggests that access to care is not uniform across subgroups. Students from low-income backgrounds reported lower overall healthcare utilization and substantially lower dental preventive care. These differences may reflect affordability, insurance continuity, or competing financial constraints [14, 18]. Women reported higher healthcare utilization and greater uptake of reproductive care and dental care, which may reflect sex-specific health needs, differences in care-seeking behavior, or both [21–23]. Students on the school-sponsored insurance plan reported better overall understanding of their coverage, suggesting that familiarity and institutional alignment may influence healthcare navigation even when cost concerns remain [24, 25].

For medical schools, these findings have practical implications, although interventions should be tailored to local context. Protected time for preventive and primary care appointments was the most commonly recommended intervention by respondents and may be useful, particularly during clerkships [4, 5, 26]. To note, protected time alone may not address all barriers if students’ difficulty accessing care reflects perceived professional expectations, research obligations, financial constraints, privacy concerns, or local appointment availability. Additional opportunities include clearer communication about student-friendly access pathways, improved transparency around coverage and financial assistance, expanded mental health capacity, and confidential options that minimize concerns about being seen by peers or evaluators [8, 27, 28]. The consistency between structured responses and open-text comments reinforces that scheduling, cost, and privacy barriers are pervasive rather than isolated concerns.

This study has several limitations. First, it reflects a single institution and may not generalize to other medical schools. The institution’s multi-campus structure, relatively small class sizes, mentorship resources, curricular flexibility, and research expectations may shape both actual and perceived barriers to care differently than at other institutions. Second, regional healthcare access may differ meaningfully across Arizona, Minnesota, and Florida, including differences in local primary care availability, appointment access, and community-level demand for services. Third, all students were invited to participate but the response rate was 18.5% which raises the possibility of nonresponse bias. Respondents may have been more likely to participate if they had strong opinions, unmet needs, or recent healthcare experiences. The sample also overrepresented Minnesota students and M1 students, which may affect estimates of healthcare utilization and barriers. Fourth, survey items were self-reported and optional and subject to recall bias, social desirability bias, and item-level missingness. Fifth, the survey did not measure all potential contributors to delayed care, including family or caregiver responsibilities, employment, research and publication expectations, or objective time availability; therefore, “time” and “academic pressure” should be interpreted as perceived barriers rather than direct measures of objectively available time. Finally, bivariate analyses were exploratory, may be underpowered for some comparisons, and cannot establish causality.

Conclusion

Healthcare utilization was common among respondents, but delayed care and preventive care gaps were also frequent despite reported access to services. Delayed care due to academic pressure, cost-related barriers, and reduced flexibility during clerkships emerged as key challenges. Differences by socioeconomic background and gender suggest that access to care during training is not uniform. Interventions such as protected time for appointments, improved insurance transparency, and confidential access pathways may reduce barriers and support student well-being. Addressing structural obstacles to healthcare access during training may improve both trainee health and the broader educational environment. Future studies that incorporate objective measures of access, time constraints, and institutional context may further inform access and barriers to care.

Authors’ contributions

HY designed the study. HY, NL, KS reviewed the study documents. HY, DL, and HK collected the data. HY performed the data analysis and prepared the manuscript. JB supervised the research process. All authors read and approved the final version of the manuscript.

Funding

No funding was received.

Data availability

The dataset generated and analyzed during this study is not publicly available due to institutional review board restrictions but may be available from the corresponding author on reasonable request and with appropriate approvals.

Declarations

Ethics approval and consent to participate

The study protocol was approved by the Education Research Committee of Mayo Clinic. This study was reviewed and approved by the Mayo Clinic Institutional Review Board (IRB No. 25-010011: “Evaluating Healthcare Utilization Among Medical Students: Identifying Barriers, Trends, and Opportunities for Improvement”). Participation was voluntary and anonymous. Informed consent was obtained from all participants in the form of implied consent, whereby completion of the survey indicated consent to participate. No identifying information was collected. The study was conducted in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.