Economic burden of becoming a dentist in Thailand

The study addresses the question of how large the financial burden is for Thai undergraduate dental students and whether these costs act as barriers to entry, especially for students from lower socioeconomic backgrounds. In Thailand, public universities’ tuition is subsidized and student loans are available, yet loan amounts often do not cover total tuition and living costs, rendering dental education unaffordable for many families. Prior work in other countries has documented high costs and their socioeconomic impacts, but no systematic evaluation existed for Thailand. Given Mahidol University’s large share of national dental graduates, the study aims to quantify students’ financial burden over the six-year program and describe the socioeconomic profile of dental students to inform policy and equity debates.

International literature documents substantial costs of medical and dental education and associated student debt burdens in countries such as the USA, UK, Canada, and New Zealand. High debt can influence school choice, career paths away from rural/primary care/academia, and potentially clinical behavior. Reduced socioeconomic diversity among students is also reported, with implications for care in underserved communities. In Thailand, comparable systematic assessments were lacking prior to this study.

Design and setting: Cross-sectional survey conducted January 2016 among all 658 undergraduate dental students (years 1–6) at the Faculty of Dentistry, Mahidol University. Eligibility: All registered dental undergraduates; exclusions included students from other faculties/universities, alumni, and staff. Recruitment/data collection: Non-lecturer research staff distributed a self-administered paper questionnaire after classes; verbal and written informed consent obtained; confidentiality assured. Pilot testing: Conducted with 20 dental students (not in main study) for acceptability and validity; no major changes required. Instrument: Two sections—(1) Background: household income, hometown (urban/rural), residence during study (home vs rental), and financing sources (fully family-funded, family+loan, family+scholarship); (2) Expenses: living costs (food, transportation, rent, utilities/laundry, social/recreation) and education-related costs (textbooks, stationery, extra laboratory equipment, uniforms, student activity fees). Expense categories were based on Thailand Household Socio-Economic Survey and refined via focus group (12 students). Tuition and licensure exam fee data were provided by the Education Management Department. Currency: Costs presented in THB and USD (THB35 = 1 USD) and adjusted using 2016 Big Mac Index PPP. Outcomes: Yearly expenses computed as living costs + tuition + education-related costs + license exam fees (years 4–6); total six-year cost estimated and then adjusted to include opportunity cost of two additional years of study using the minimum monthly civil servant salary for Bachelor’s graduates (THB15,000). Statistical analysis: To mitigate upward bias from high-spending students, medians for item costs were used as proxies for actual costs. ANOVA assessed mean differences of expense variables between groups (e.g., accommodation type); first-year food expenses analyzed separately due to campus differences. Linear regression modeled associations between yearly expense and determinants (accommodation type as main exposure), with sequential adjustments for household income, hometown area, year of education, and gender. Significance set at p < 0.001. Software: SPSS v18.0. Ethics: Approved by MU-DT/PY-IRB (project 2015/DT076; COA.NO.MU-DT/PY-IRB2016/004070).

• Response: 486 completed questionnaires (75.0% response); 71.8% female. 87.9% from Bangkok Metropolitan Region/municipal areas. - Financing: 93.2% reported full family funding; only 5.0% (23/487 referenced in text) received partial support (government Student Loan Fund or other scholarships). Median additional support among aided students: THB30,000 (USD ~857). - Yearly expenses by accommodation (medians): Students at home vs renters had significantly different yearly costs (p < 0.001 across years). Estimated yearly living costs: home THB135,800–148,700 (USD ~3,880–4,249); rental THB198,482–260,300 (USD ~5,671–7,437). - Relative burden: Dental students’ yearly living costs alone were at least 54.2% of the average Thai household’s total annual expenditure. - Cost composition: Tuition comprised ~19.5–20.8% of total yearly expenses for students living at home and ~11.41–14.89% for those renting; living costs were the dominant component. Fourth- and sixth-year students had higher education-related expenses (clinical uniforms and laboratory equipment). - Total cost (six years): THB905,027 (USD 25,857.91) for home-residing students and THB1,463,027 (USD 41,800.77) for renters; including opportunity cost (two extra study years at THB15,000/month), adjusted totals were THB1,265,027 (USD 36,143.63) and THB1,823,027 (USD 52,086.49), respectively. - Socioeconomic profile: Only 6.4% of students reported household income < THB30,000/month, versus 73.3% nationally in that bracket; 78.5% of participants were from the two richest national deciles. - Regression: Type of accommodation (rental vs home) was strongly associated with higher yearly expenses in crude and adjusted models (p < 0.001).

Findings demonstrate that the financial burden of dental education in Thailand is driven primarily by living costs rather than tuition, especially for students who must rent in central Bangkok where no university dormitory is available. Even for students living at home, living expenditures represent a large share of an average Thai household’s annual outlays, indicating substantial affordability challenges. The overwhelming reliance on full family funding and the concentration of students from higher-income households suggest constrained socioeconomic diversity, consistent with international literature linking high educational costs to inequitable access and downstream workforce effects. Elevated costs may influence school selection, deter applicants from lower-SES backgrounds, and skew career choices away from rural or primary care settings, potentially exacerbating Thailand’s existing dentist maldistribution. The results emphasize the need for targeted financial aid and policy reforms to mitigate living-cost burdens and prevent tuition increases from becoming a further barrier to entry.

The estimated adjusted six-year cost of an undergraduate Dental Degree is THB1,265,027 for students living at home and THB1,823,027 for those renting, underscoring a major financial barrier for low-SES students. The study highlights that living expenses dominate total costs and that current financing mechanisms inadequately support equitable access. As tuition fees have risen substantially since the study period, impacts on access and diversity may intensify. Future research should assess longitudinal expense trajectories with inflation, compare dental education costs to other disciplines, and evaluate the effectiveness of enhanced, needs-based financial aid and admissions policies incorporating socioeconomic criteria.

• Sample representativeness: A high proportion of respondents were from wealthier households (two richest deciles), potentially overestimating typical costs. - Cross-sectional estimation: Total six-year cost inferred from class-specific yearly snapshots rather than tracking cohorts; real costs may vary with inflation, though national average inflation (~1.3%) suggests limited bias for the study period. - Single-institution setting: Conducted at one prominent Bangkok-based faculty without dormitory housing; results may not generalize to other schools or regions. - No direct comparison with other fields of study, limiting inference about whether dental costs exceed other higher-education programs.