We invited all Slovak practising dentists (N = 3,884), who also have the legal obligation to be members of the Slovak Chamber of Dentists, to participate in an online survey via the umbrella Chamber in October 2020. The questionnaire we used was developed in cooperation with representatives of the participating dentists. We interviewed them and extracted issues relevant for exposure to COVID-19 risk, the impact of pandemic management on their professional and personal life, and the personal coping resources they had available. Based on that, we prepared appropriate measurements, adapted their comments and piloted the final version to assure clarity and suitability. The online invitation to participate in a survey via the Slovak Chamber of Dentists resulted in a response rate of 12.9%, in which the age and gender composition of our sample stayed quite similar to the target population, e.g., dentists registered with the Slovak Chamber of Dentists. Our sample had a slightly higher percentage of females than in the target population (66.8% vs. 61.4%), and fewer dentists over 66 years old (10.0% vs. 20.1%), the latter group being very small [2]. From 635 responses we excluded those who did not fill in any questions (n = 15), those who did not report their gender (n = 113), and those who had a different profession than dentists (2 nurses, 5 others). The final sample included 500 respondents (66.8% females, mean age/SD = 43.8/14.4). A post hoc analysis indicated that with our final sample size we could detect the explored associations with job leaving intention with a power of 95.5% at p = 0.05.

Respondents were asked if they had interrupted the provision of dental care or their clinic, or if they were considering closing their clinic at the time, with the answer’ options: 1) I quit my job; 2) I am considering quitting my job; 3) I interrupted dental care provision; 4) I am considering interrupting dental care provision; 5) I reduced dental care provision; 6) I am considering reducing dental care provision and 7) I am not considering reducing dental care provision. Those responding that they had quit/interrupted or reduced the provision of dental care or were considering quitting, interrupting, or reducing dental care provision were assigned as having job leaving intentions.

Exposure to COVID-19 risk was measured by asking respondents about (1) being at risk of COVID-19 (being in a risk group due to being 65+ years old or having a poor health condition vs. being without risk), (2) exposure to coronavirus (being infected or knowing anybody who was infected vs. not being exposed to infection), (3) exposure to quarantine (the respondents themselves or close relatives being quarantined vs. not being quarantined), (4) risk perceptions (the mean score of 7 items covering risk perception varied between 1 and 5; a higher score represents higher risk perception [23, 24]), (5) being stigmatised (people avoid the respondents and their family due to their work during the pandemic vs. not being stigmatised), (6) information overload (following pandemic news several times per day and being highly concerned, following pandemic news several times per day or being very concerned vs. following pandemic news and not being concerned), (7) availability of PPE and ability to implement anti-pandemic measures (not enough PPE and unable implement measures, not enough PPE or unable implement measures, enough PPE and able to implement measures).

The impact of pandemic management on professional and personal life was assessed by a set of items covering the pandemic-related limitations of providing health care, an item on concern about poor health care provision, and sets of items covering impact on quality of life [2]. Respondents were asked how much they were hindered in providing health care in the original quality during the first lockdown (March-June 2020) due to (a) a lack of PPE, (b) infection risk in the work environment, (c) obligatory safety measures, (d) a lack of staff and (e) client concerns in order to assess pandemic related limitations of provided health care. Answers on a Likert scale were dichotomised as partially/not limited vs. limited/significantly limited for each subcategory to enable a comparison between individuals who perceived a rather limited or no impact of pandemic management versus a stronger impact of pandemic management. The concern about poor health care provision was assessed by asking respondents whether the health care condition of their regular patients would worsen due to pandemic measures related to the possibilities of dental care provision (certainly agree/rather agree vs. rather disagree/certainly disagree). The impact on quality of life was measured by asking respondents if difficulties in providing health care due to introducing pandemic management affected their (a) family life and activities, (b) housekeeping, (c), relationships with close relatives, (d) financial situation and (e) mental well-being during the first wave of the COVID-19 pandemic. Answers on a Likert scale were dichotomized into those reporting worsening (slightly/significantly worsened) and improving (slightly/significantly improved vs. did not change) effects in a particular area of life.

We measured personal coping resources as optimism (certainly agree or agree that we would successfully handle the pandemic vs. disagree or certainly disagree), sacrifice (certainly agree or agree to provide dental care during the COVID-19 pandemic just to avoid to worsening of their patients’ health care condition vs. disagree or certainly disagree), altruistic acceptance of risk associated to COVID-19 (certainly agree or agree that they accepted the risk associated with dental care provision to COVID-19 patients vs. disagree or certainly disagree), and resilience (the mean score varies between 1 and 5; a higher score represents higher resilience The Brief Resilience Scale [25]) (Supplementary Appendix SA).

First, we described the exposure to COVID-19 risk, impact of the pandemic on professional and personal life, personal coping resources, and job leaving intentions of Slovak dentist as rates, means, and standard deviations (SDs). Second, we assessed the association of job leaving intentions with exposure to COVID-19 risk, impact of pandemic management on professional and personal life, and personal coping resources using logistic regression models adjusted for age (continuous level variable, centred age and age squared) [48] and gender per each variable separately. We used IBM SPSS Statistics 23 for Windows for all analyses.

Most dentists in our sample were owners of private dental clinics 77.8% (n = 389), while 28.2% (n = 141) work at private clinics and only 2.0% (n = 10) were from state dental clinics. Similarly, the majority of them were traditional dentists 86.2% (n = 431), who treated adult and child clients 93.4%, (n = 467). For more details, see Table 1.

A considerable portion of dentists experienced risks due to COVID-19, with rates being highest for stigmatisation (62.6%) and being exposed to COVID-19 (48.8%). Regarding the impact on their professional and personal life, dentists experienced the most concerns about poor health care provision (68.8%) and the worsening of their financial situation (85.4%). Quite a lot of them were optimistic (84.1%) and altruistic (71.8%) about the pandemic. Job leaving intentions were reported by 39.6% of the dentists. For more details, see Table 2.

Job leaving intentions were more likely to be reported by dentists who belonged to a risk group because of their age and comorbidity (odds ratio/95% confidence interval, OR/CI: 3.2/1.97–5.31), or because they perceived a higher risk of COVID-19 (4.7/3.15–7.06) than dentists who did not report any risk. Moreover, we found job leaving intentions to be increased due to a large number of factors, as shown by odds ratios in a range of 1.6–2.9. This regarded dentists who felt stigmatisation or were concerned about information overload and health care quality or the high risk work environment. It also included those who experienced the unavailability of PPE and the inability to implement measures or a worsening of their personal life (in housekeeping, relationships, financial situation, and mental well-being). Less strong associations with job leaving intentions were seen in other areas, such as their exposure to COVID-19 risk, a lack of staff, or a worsening of family life and activities (1.6/1.05–2.34; 1.9/1.19–3.00; 1.6/1.10–2.45). Regarding personal coping strategies, job leaving intentions were less likely for dentists with higher resilience (0.6/0.42–0.77), more altruism (0.6/0.37–0.89), sacrifice (0.5/0.31–0.81) and optimism (0.4/0.24–0.76). In addition, the age of our dentists was significant for almost every researched factor, except for those who belonged to a risk group, in contrast with gender, which was statistically non-significant. For more details, see Table 3.

The main strength of this study is that we reached a large national sample of dentists during the first wave of the COVID-19 pandemic. Based on this, we were able to gather information about job leaving intentions, exposure to COVID-19 risk, impact on professional and personal life, and personal coping resources. On the other hand, some limitations should also be considered. Our study was cross-sectional, so no causal relations could be established between job leaving intentions and risk perception.

A broad range of factors related to exposure to COVID-19 risk, impact on professional and personal life, and personal coping resources contributed highly to job leaving intentions among Slovak dentists. This implies that better management of such hazards might decrease exposure to risk and prevent undesirable impacts on job leaving intentions. This includes not only minimalizing the exposure to coronavirus or the protection of dentists, but also decreasing the negative impact of pandemic management on their professional and personal lives by means such as adequate access to PPE, sufficient staffing, providing a more comprehensive management strategy, including the training of HCWs (proven in the study by Labrague and De los Santos [47]), and using a communication strategy that prevents information overload and stigmatisation. Economic losses resulting from restrictive measures need to be compensated to overcome the troubles in maintaining the provision of dental care. As personal coping resources help to battle mental health challenges in difficult times like a pandemic outbreak, their development should be a part of the professional training of HCWs. The potential high impact on job leaving in this already poorly staffed sector shows a strong need for further action.