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A “Necessary Evil”? Keeping Women Out of Medical Schools Won't Fix What Ails the Japanese Medical Profession
Published online by Cambridge University Press: 14 March 2025
Abstract
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News sources revealed in August 2018 that Tokyo Medical University has been systematically tampering with its entrance exam scores to reduce the number of female students at the institution. This scandal led to a government investigation into medical faculties, and initial reports suggest that such gender discrimination is widespread in medical faculty admissions. This issue relates to several stubborn problems facing Japanese society today: It reflects how a more general context of gender discrimination threatens to impede new solutions to the crises facing medicine in Japan as a workplace and as a place of care, and how recent efforts to counter discriminatory practices and encourage “diversity” lack accountability. This article shows how the gender gap in the medical field points to deeper problems in the profession, how recent research suggests that gender diversity may improve medical outcomes in terms of patient care, and how this entrance-exam scandal highlights the inadequacy and lack of accountability behind recent efforts to promote “diversity.”
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References
Notes
1 Japanese names are written according to Japanese conventions, with last name first, except in cases in which the last names are published last in scholarly journals and English-language publications.
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4 “Tokyo Idai ni ‘josei katsuyaku’ hojo 8000 man en genten giwaku no jiki, kuni kara 3 nen de kōfu [Tokyo Medical University received a government grant of 800 million yen for three years to support ”women's activities,“ a period in which it is suspected of reducing scores]”Tokyo shimbun (August 4, 2018) (accessed August 6, 2018).
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26 Liselotte Dyrbye, Sara Burke, Rachel Hardeman “Association of Clinical Specialty with Symptoms of Burnout and Career Choice Regret Among US Resident Physicians” JAMA 2018 320(11): 1114-1130.
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30 Ibid. 139.
31 Ibid., 90-91.
32 Makiko Ozaki, Seiji Bito, Shinji Matsumura “Developing a Japanese hospital physician satisfaction scale” International Journal of Health Care Quality Assurance (2008) Vol. 21, Issue 5: 517-528.
33 Yasuharu Tokuda, Keiko Hayano, Makiko Ozaki, Seiji Bito, Haruo Yanai, Shunzo Koizumi “The Interrelationships between Working Conditions, Job Satisfaction, Burnout and Mental Health among Hospital Physicians in Japan: a Path Analysis” Industrial Health (2009) 47: 166-172.
34 Kato Ken, Kazunobu Yamauchi, Makoto Miyaji, et al “Factors relating to doctor's desire to change hospitals in Japan.” International Journal of Health Care Quality Assurance. Vol. 25, No. 1 (2012): 19-40, 35.
35 Ibid., 27.
36 Scott North, “Karōshi Activism and Recent Trends in Japanese Civil Society” in Going to Court to Change Japan: Social Movements and the Law in Contemporary Japan. Ed. Patricia Steinhoff (Center for Japanese Studies, The University of Michigan: 2014): 45-72, p. 47.
37 “Josei ishi kyaria shien moderu fukyū suishin jigyō no seika to kongo no torikumi ni tsuite / shiryō 3 [On the results and future initiatives of the project to promulgate and promote career support for female doctors / document 3]” Ministry of Health, Labour and Welfare (March 14, 2018) (accessed November 20, 2018).
38 “Josei ishi kyaria shien moderu fukyū suishin jigyō no seika to kongo no torikumi ni tsuite / shiryō 3 [On the results and future initiatives of the project to promulgate and promote career support for female doctors / document 3]” Ministry of Health, Labour and Welfare (March 14, 2018) (accessed November 20, 2018)
39 “Josei ishi no kinmu kankyō no genkyō ni kan-suru chōsa hikaku shōsai han [Investigation into present conditions of women doctors work environment: comparative detailed edition]” (https://www.med.or.jp/joseiishi/2018hikakusyosai.pdf) Nihon ishikai danjo kyōdō sankaku iinkai / Nihon ishikai josei ishi shien sentaa [Japan Medical Association gender equality plannning committee / Japan Medical Association women doctor support center] (June 2009) (accessed on November 20, 2018)
40 Kosuke Yasukawa and Kyoko Nomura. “Ishi ni okeru seibetsu yakuwari bundan: shinryō jikan to kaji rōdō jikan no danjo kikaku [The division of labour by sex among Japanese physicians: comparison between men and women in time spent on clinical care a and time spent on housework]” Igaku kyōiku [Medical Education] (2012): 42: 315-319.
41 Aoki Hiroe, Hoshino Naoko, Kanda Asuka et al. “Danjo igakusei wa dono yōna kyaria ninshiki o yūshiteiru no ka? Intabyū chōsa kara miete kita mono [How do male and female medical students perceive their own career? Implications from a student viewpoint]” Nihon puraimari kea rengō gakkaishi [Journal for the Japanese Primary Care Association] (2016) 39(4): 191-204.
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44 Yusuke Tsugawa, Anupam Jena, Jose Figueroa, John Orav, Daniel Blumenthal, Ashish Jha. “Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.” JAMA Internal Medicine (Feb. 2017) 117:2: 206-213.
45 Ibid., 212.
46 Kim C, McEven LN, Gerzoff BR, et al. “Is physician gender associated with the quality of diabetes care?” Diabetes Care. (2005) 28(7): 1594-1598; Berthold KH, Gouni-Berthold I, Bestehorn KP, Böhm M, Krone W. “Physician gender is associated with the quality of type 2 diabetes care.” J Intern Med. (2008) 264(4): 340-350.
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49 Ken Kato, et al “Factors relating to doctor's desire to change hospitals in Japan.” International Journal of Health Care Quality Assurance. Vol. 25, No. 1 (2012): 19-40, 12.
50 “191 multiple refusals of pregnant women found.” The Japan Times (Sept. 28, 2007) (Accessed Nov. 20, 2018) In the United States, the law requires all hospitals with emergency rooms to care for women in labor, although some rural facilities without obstetrics units violate this law. Julie Lasson-Fromowitz, “Despite law, hospitals turn away women in labor” Courier Journal (March 3, 2017) (Accessed March 1, 2019)
51 Relative poverty means that a household earns an income that is less than fifty percent of the average median incomes.
52 Alana Semuels, “Japan is no place for single mothers” The Atlantic (September 7, 2017) (accessed August 8, 2018).
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55 There is not an equivalent group for “female leaders,” but the Gender Equality Bureau began holding events to train women for leadership in 2017. “Josei riidaa ikusei [Training female leaders]” Gender Equality Bureau Cabinet Office (accessed December 4, 2018).
56 “Igakubu no josei sabetsu, tarōsei sabetsu mondai matome” Igakubu juken baiburu October 18, 2018 (accessed December 4, 2018).
57 “Jutendo and Showa universities' medical faculties suspected of rigging entrance exam results based on gender” () Japan Times (October 14, 2018) (accessed December 3, 2018)
58 Yajima Daisuke and Doi Shinpei “Nichidai igakubu to kantō no shidai, futekisetsu nyūshi ka monkashō ga shiteki [Ministry of Science and Education identifies inappropriate entrance exams at Nihon University's medical faculty, private universities in the Kantō region]” Asahi shimbun digital (December 12, 2018) (Accessed January 31, 2019
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