Assessment of Academic Achievement of Female Physicians in Japan | Health Disparities | JAMA Network Open | JAMA Network
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Figure.  Trends in the Proportion of Academic Positions for Female Physicians, Japan, 1980-2018
Trends in the Proportion of Academic Positions for Female Physicians, Japan, 1980-2018
1.
Kuhlmann  E, Ovseiko  PV, Kurmeyer  C,  et al.  Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union.   Hum Resour Health. 2017;15(1):2. doi:10.1186/s12960-016-0175-yPubMedGoogle ScholarCrossref
2.
Ash  AS, Carr  PL, Goldstein  R, Friedman  RH.  Compensation and advancement of women in academic medicine: is there equity?   Ann Intern Med. 2004;141(3):205-212. doi:10.7326/0003-4819-141-3-200408030-00009PubMedGoogle ScholarCrossref
3.
World Economic Forum. Global gender gap report: 2020. Published 2020. Accessed April 4, 2020. http://www3.weforum.org/docs/WEF_GGGR_2020.pdf
4.
Wheeler  G.  The Tokyo Medical University entrance exam scandal: lessons learned.   Int J Educ Integr. 2018;14:14. doi:10.1007/s40979-018-0039-4Google ScholarCrossref
5.
Hamel  MB, Ingelfinger  JR, Phimister  E, Solomon  CG.  Women in academic medicine: progress and challenges.   N Engl J Med. 2006;355(3):310-312. doi:10.1056/NEJMe068143PubMedGoogle ScholarCrossref
6.
Grisso  JA, Sammel  MD, Rubenstein  AH,  et al.  A randomized controlled trial to improve the success of women assistant professors.   J Womens Health (Larchmt). 2017;26(5):571-579. doi:10.1089/jwh.2016.6025PubMedGoogle ScholarCrossref
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    Research Letter
    Medical Education
    July 9, 2020

    Assessment of Academic Achievement of Female Physicians in Japan

    Author Affiliations
    • 1Faculty of Medicine, Shimane University, Shimane, Japan
    • 2Postgraduate Clinical Training Center, Shimane University Hospital, Shimane, Japan
    • 3Okinawa Muribushi Project for Teaching Hospitals, Okinawa, Japan
    JAMA Netw Open. 2020;3(7):e209957. doi:10.1001/jamanetworkopen.2020.9957
    Introduction

    Despite the global increase in the number of female physicians, there are still fewer women than men in key positions.1 In a US-based study,2 salaries of female physicians were significantly lower than those of male physicians, although there was no gender difference in income among nonphysician health care workers. Women who have worked longer face greater pay discrimination.2 A barrier to academic and financial advancement—known as the glass ceiling—still prevails globally for female physicians, and Japan is no exception.

    Methods

    Because we used only Japanese National Basic School Survey data that had already been published by the Ministry of Education, Culture, Sports, Science and Technology, this study did not require institutional review board approval or informed consent. The institutional review board of Shimane University does not consider this type of study human research and therefore does not require its review.This was a survey study and conducted in accordance with American Association for Public Opinion Research guidelines. We analyzed Japanese government statistical data to elucidate trends in the gender distribution of university academic positions, including professors, associate professors, lecturers, and assistant professors, in medical schools and university-affiliated hospitals from 1980 to 2018. We also obtained statistical data from the Ministry of Health, Labour, and Welfare to trace the changes in the rate of female physicians registered with the Ministry from 1980 to 2016. Data analysis was performed in December 2019 with Excel for Mac statistical software version 16.16.22 (Microsoft Corp).

    Results

    Our findings show that, although the proportion of female physicians in all 4 academic positions has increased over the 4 decades from 10.0% to 21.1% (Figure), the proportion of female professors was still less than 2% from 1980 to 1992; this proportion has remained stagnant since 2004, at less than 10%. Compared to the assistant professor position, the associate professor and lecturer positions had noticeably lower proportions of women in 2018, at 13.1% and 16.8%, respectively. Conversely, the proportion of female assistant professors has consistently increased since 1995. It should be noted that this proportion overtook the proportion of female physicians in 1994, eventually reaching 29.7% in 2018 compared with 21.1% for female physicians.

    Discussion

    The study had some limitations. We lacked detailed information about some variables, such as the number of new female professors; however, our national data were highly comprehensive and suggest that the promotion of female physicians in Japanese academic medicine is stifled (ie, the glass ceiling). Japan has aligned its gender policies with the international community in terms of the mainstreaming of gender issues and has implemented the Equal Employment Opportunity Law in 1986 and the Basic Act of Gender Equal Society in 1999. These laws may have led to an increase in the proportion of female physicians and faculty members. However, there has not been much progress toward eliminating gender disparity. According to a 2020 report,3 Japan’s Global Gender Index was the second lowest among Organisation for Economic Co-operation and Development countries and the worst among G7 countries. Moreover, a 2018 study4 reported that several Japanese medical schools continued to systematically discriminate against female applicants in the entrance examination by unfairly reducing test scores by as much as 20%. Thus, recent data suggest that Japanese medical schools continue to maintain a gender bias that goes against basic ethics and human rights.

    To overcome these problems, we believe the following initiatives are important and should be implemented: (1) establishment of a program to support women’s advancement in academia (eg, by providing in-hospital childcare centers or exempting women from night shift and overtime work); (2) sponsorships for strong mentors to act as role models for junior women on faculties that traditionally offer fewer opportunities for women because of shorter working hours5; (3) promotion of leadership and research skills among female faculty members6; and (4) establishment of proportion targets for female physicians among faculty members in Japanese medical schools. These should be monitored to ensure accountability in achieving these initiative goals and to protect basic ethical principles.

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    Article Information

    Accepted for Publication: April 29, 2020.

    Published: July 9, 2020. doi:10.1001/jamanetworkopen.2020.9957

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Kono K et al. JAMA Network Open.

    Corresponding Author: Takashi Watari, MD, MS, MCTM, Postgraduate Clinical Training Center, Shimane University Hospital, 89-1, Enya-cho, Izumo shi, Shimane 693-8501, Japan (wataritari@gmail.com).

    Author Contributions: Dr Watari and Ms Kono had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Watari, Tokuda.

    Acquisition, analysis, or interpretation of data: Kono, Watari.

    Drafting of the manuscript: All authors.

    Critical revision of the manuscript for important intellectual content: Kono, Watari.

    Statistical analysis: Kono, Watari.

    Administrative, technical, or material support: Watari, Tokuda.

    Supervision: Watari, Tokuda.

    Conflict of Interest Disclosures: None reported.

    Additional Contributions: We thank the Ministry of Internal Affairs and Communications for providing National Basic School Survey data. Kazumichi Onigata, MD, PhD (Shimane University, Shimane, Japan), provided supervision for the study. Nobuhiro Nagai, BA (Faculty of Medicine, Shimane University), helped create the figure. They were not compensated for their contributions.

    References
    1.
    Kuhlmann  E, Ovseiko  PV, Kurmeyer  C,  et al.  Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union.   Hum Resour Health. 2017;15(1):2. doi:10.1186/s12960-016-0175-yPubMedGoogle ScholarCrossref
    2.
    Ash  AS, Carr  PL, Goldstein  R, Friedman  RH.  Compensation and advancement of women in academic medicine: is there equity?   Ann Intern Med. 2004;141(3):205-212. doi:10.7326/0003-4819-141-3-200408030-00009PubMedGoogle ScholarCrossref
    3.
    World Economic Forum. Global gender gap report: 2020. Published 2020. Accessed April 4, 2020. http://www3.weforum.org/docs/WEF_GGGR_2020.pdf
    4.
    Wheeler  G.  The Tokyo Medical University entrance exam scandal: lessons learned.   Int J Educ Integr. 2018;14:14. doi:10.1007/s40979-018-0039-4Google ScholarCrossref
    5.
    Hamel  MB, Ingelfinger  JR, Phimister  E, Solomon  CG.  Women in academic medicine: progress and challenges.   N Engl J Med. 2006;355(3):310-312. doi:10.1056/NEJMe068143PubMedGoogle ScholarCrossref
    6.
    Grisso  JA, Sammel  MD, Rubenstein  AH,  et al.  A randomized controlled trial to improve the success of women assistant professors.   J Womens Health (Larchmt). 2017;26(5):571-579. doi:10.1089/jwh.2016.6025PubMedGoogle ScholarCrossref
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