To enhance dentist retention in the public healthcare system, the government should implement policies that cater to the needs of early career dentists. The living environment, amenities, and facilities are major reasons that influence early career dentists to choose and retain in the public sector. Additionally, the location of their hometown and the presence of all delay processes of authority in bureaucracy affect the dentist retention under the MoPH. Moreover, the availability of opportunities for further postgraduate education and the presence of partnerships also impacts dentists’ decisions to choose their working on other entities of public sector.

Our findings indicated that the primary consideration for early career dentists in choosing their workplace is the living environment, amenities, and facilities, both at the beginning of their career and after one-year employment. When comparing between hospitals under the MoPH and other public sector healthcare, MoPH hospitals are primarily located in rural areas with limited urbanization. In contrast, institutions like universities offer superior facilities and resources. To retain dentists in the public sector, particularly under the MoPH, the government should prioritize key aspects such as infrastructure development across all regions, providing clean water and electricity in workplace areas, offering standardized and safe housing accommodations, and facilitating convenient transportation with an efficient mass transit system connecting rural to major urban centers.

The location of dentists’ hometown significantly influences their decisions to choose or resign under the MoPH. Interestingly, dentists who initially chose their workplaces through direct application did not prioritize their hometown location. However, after one year of employment, our study revealed that 85.7% of dentists cited hometown location as the main reason for resignation. This decision to return to their hometown may be driven by a desire to live in a familiar environment from childhood to adolescence. Additionally, we observed that the delay authority in bureaucracy was another major reason for resignation, with a similar percentage to the hometown’s location. This suggests that the hometown’s location may overshadow the true underlying reasons behind dentists’ resignations, such as misalignment with attitudes towards local community healthcare and the impact of globalization in the digital era.

In Thailand, the hometown location plays a pivotal role in influencing dentists’ resignations. To address this, a quota admission track is employed to recruit students from rural areas into dental schools, ensuring that they return to their hometowns as dentists upon graduation [29]. Dentists graduating from the quota admission track are individuals from specified rural areas who are granted the privilege to study in dental schools without having to compete with students nationwide for admission. However, after completing their education, only 40% of them intended to continue working in their hometown community. This percentage is consistent with regular dental graduates who did not receive special admission privileges to dental schools. Thus, a thorough evaluation of the quota’s effectiveness is essential to assess its outcomes and appropriateness. Alternatively, implementing more restrictive contracts with these students in special projects could increase retention within this group. Moreover, the government faces challenges in providing positions for all dentists who signed contracts in the quota program, which mandates their return to serve in their hometown locations to fulfill their obligations.

Our study highlights that postgraduate education opportunities have major influence on dentists’ decisions to apply for work as a state enterprise employee in other public sectors. The chance for specialized training in further postgraduate education is also an important factor influencing dentists’ decisions to relocate or resign. In Thailand, public hospitals under the MoPH offer limited seats for dentists to undergo residency training programs as an encouragement to retain them in the public healthcare system. These opportunities are also restricted to specialized branches facing shortages within the hospitals under the MoPH. Meanwhile, the specialized training seats are more often reserved for dentists affiliated with the public sector [30]. As a result, some early career dentists choose to apply directly to other public sector entities, such as standard- to advanced-level hospitals, which often require dental specialists compared to hospitals under MoPH, encompassing primary- to secondary-level hospitals. Dentists aspiring for guaranteed study in their desired specialized field relocate to other hospitals to secure a quota or even resign from their current positions to pursue their studies. It is essential to consider whether the exclusive allocation of specialized training quotas to certain hospitals positively contributes to retaining dentists within the public healthcare system. However, continuing education (CE) or short courses training does not influence dentists’ decisions regarding their workplace or resignation.

The living environment, amenities, facilities, opportunities for postgraduate studies, hometown locations, and delays in bureaucracy influence dentists’ decisions. As a result, some dentists may choose to apply directly to work in the public sector, where they can consider familiar factors and avoid the uncertainties associated with the allocation system, in which the MoPH assigns dentists to workplaces through drawing lots.

While the salary or monetary compensation may not meet the dentists’ expectations, relying on increased salary or monetary compensation to prevent resignations may not be feasible long-term strategy, as the government has continuously announced this approach since 1987 until now [16, 18,19,20, 17]. Salary and monetary compensation increases had been implemented to match the expected minimum level of monthly income [23]. Dentists do not prioritize salary and compensation among their top three reasons for resigning, indicating that these factors have less influence on their decision. Additionally, living expenses do not significantly impact dentists’ choices of their workplace in the public sector, affecting less than 50% of the dentists. This may be attributed to the relatively low cost of living in Thailand, exemplified by Bangkok, a representative city, when compared to other countries reported by the World Bank [31]. Therefore, implementing financial policy could lead to an inefficient allocation of the government’s annual budget.

During the early stages of their careers, dentists’ decisions to resign are minimally influenced by factors such as family and close relationships outside the family core [32]. This may be because, during the initial stages of their careers, dentists focus on gaining their work experience to pave the way for their career progression in the near future. However, after three-year of CS, family and close relationships outside the family core may begin to exert influence on their work decisions, aligning with the stages of Erikson’s psychosocial development [33]. Although it is possible that a child taking over a private dental clinic from their parents might impact dentists’ decisions to resign, there is currently insufficient empirical evidence to confirm this hypothesis. From our findings, all the resigned dentists who were in relationships reported hometown as the most influential reason for their decision-making. This suggests that they may have plans to return to their hometowns to settle down and start families.

Dentists around the age of 25 to 26 may experience a quarter-life crisis phenomenon [34]. Therefore, the dentists who continue working in their original locations require supporting factors to sustain in their practice. Supportive supervisors and colleagues are crucial in providing emotional and technical assistance to early career dentists, serving as professional role models and alleviating stress and anxiety in the dental workplace. This support is vital for increasing job satisfaction among the Y, Z, and Millennial generations of dentists [35, 36].

Based on our findings, we highlight that factors influencing decisions regarding CS and resignation are integral to a fulfilling life, aligning with Maslow’s hierarchy of needs [37]. Addressing the manpower issue in the healthcare workforce requires a comprehensive approach that extends beyond healthcare measures alone, necessitating collaboration across various ministries. The CS implementation for early career dentists, with a three-year contract and penalties for contract breaches, aims to foster commitment and co-responsibility in serving the public sector. However, it may not effectively establish a strong connection between dentists and the local community because dissatisfaction can be resolved by paying the fine to free oneself from government regulations. Policymakers must conduct a thorough evaluation of the long-term benefits and drawbacks of the three-year CS policy to make informed decisions.

Some limitations in this study includes a short-term follow-up and focusing only on dentists within the public sector. Additionally, the low response rate could introduce non-response bias. It is possible that dentists with a negative view of the CS system, such as those who did not receive what they had expected or were dissatisfied with the application process, may have been less willing to respond to the survey. Further research is required to undertake in-depth investigations into the reasons why some early career dentists decide to pay the CS program-related fine rather than undergoing the CS could provide valuable insights for addressing individual limitations and concerns. We recommend policymakers to conduct long-term follow-up with dentists from various health system sectors and generations to develop comprehensive strategies that can effectively motivate dentists to work in dental public practices. This approach aims to enhance dentist retention in rural public health care facilities over the long term, benefiting both dentists’ personal and professional levels. Identifying hospitals with successful dentist retention can provide valuable insights for adapting this model to diverse hospital contexts, respecting, and valuing the unique needs of each local community.