BACKGROUND: The mental health workforce sustainability in China suffers high rates of attrition and the intention to leave. Among current professionals, the intention to choose the same career is an interesting way to gauge their job satisfaction and other factors, and it may affect the career choices of younger generations. We aimed to survey the intention of psychiatrists and psychiatry residents to choose the same career if they could start over and to identify associated factors. METHODS: We conducted an anonymous survey of psychiatrists in 41 tertiary psychiatric hospitals in China. We collected demographic data, work-related information, the sense of professional identity, job satisfaction, and burnout (Maslach Burnout Inventory), and we specifically asked each participant whether they would choose to be a psychiatrist again if they could. RESULTS: Among 3,783 psychiatrists we surveyed, one-quarter responded that they would not choose to be a psychiatrist again if they had a choice, with less than half (47.2%) saying they would. Those who would not choose psychiatry again were more likely to have a negative (relative to positive) professional identity (OR = 7.47, P＜0.001, 95%CI: 4.587-12.164); experience job burnout (OR = 2.945, P＜0.001, 95%CI: 2.356-3.681); be dissatisfied with their job (OR = 2.739, P＜0.001, 95%CI: 2.102-3.569) and excessive regulation (OR = 1.819, P＜0.001, 95%CI: 1.487-2.226); have a heavy workload (OR = 1.749, P＜0.001, 95%CI: 1.423-2.149) or a lower income (OR = 1.748, P＜0.001, 95%CI: 1.415-2.161); be married (relative to single) (OR = 1.604, P = 0.004, 95%CI: 1.165-2.208); be dissatisfied with strained doctor-patient relationship (OR = 1.333, P = 0.005, 95%CI: 1.089-1.632); have more night shifts per month (OR = 1.055, P = 0.021, 95%CI: 1.008-1.104) or work longer hours per week (OR = 1.016, P = 0.001, 95%CI: 1.006-1.025). CONCLUSION: Among psychiatrists in tertiary hospitals in China, those with a heavier workload, poor sense of professional identity, job dissatisfaction, and burnout were less likely to choose psychiatry again. Policymakers and hospital administrators need to take effective measures to improve psychiatrists' sense of professional identity and increase their intention to stay.