Table Speech

The month of an increase and expansion of membership
“Is healthcare in Japan OK?

August 2, 2006

Dr. Koichi Ito,
Director of Ito Hospital

 There are 80 universities which have faculties of medicine in Japan now. They are the National Defense Medical College and fifty national and public schools and 29 private universities. Seven subjects commonly are tested by national universities in their entrance examination, and three subjects by private universities. A move is being made to add biology taught in high schools to such subjects for entrance exam. An oral interview to see personality and a short essay was also included in the entrance examination thirty years ago. Japanese medical school in Japan is a six-year education system. In six years, students learn liberal arts, basic medical science, and clinical medicine; and after finishing clinical training, they take a national examination and then  become doctors.

 To further improve clinical training courses, a system has been established since 2001 by which fourth year students are given a test before they commence clinical training. This test includes an objective test to assess basic matters and basics of clinical medicine, and a simulated diagnosis test called OSCE (a method to diagnose actors who play patients). Unless they pass this test, they are not allowed to advance to the fifth grade. This is a nationally standardized system.

 They take a graduation examination after studying for six years, but they have to subsequently pass a national examination as well. Coming next after passing a national examination is clinical training. About seventy percent of graduates enter the hospitals of their own universities or university hospitals of their hometown. They examine patients, introduce appropriate medical specialists, and provide initial treatments there. This is a new clinical training system introducing gatekeeper type primary care.

 Three basic purposes of this new clinical training system are to cultivate the personal qualities required for a doctor; to have them master holistic medical practice and basic medical treatment ability and deepening their understanding of primary care; and to arrange an environment where they can concentrate on their training without relying on part-time jobs.

 After two years of clinical training, they become members of eighteen academic conferences in the primary areas, and after engaging in medical practice for five years, they become medical specialists, although they have to pass a qualification test. The present system requires training for 8-10 year to become a doctor. Incidentally, there are 1,700 academic conferences for doctors. There is some concern that the number of doctors having aspiration for basic medicine will decrease, but at least for now, a general move is aiming toward cultivation of doctors who can treat patients centering on clinics. At present, 7,800 doctors come into the world every year, and including these new members, there are 270,000 doctors nationwide. Most of them are engaged in working at clinics in hospitals or health clinics. The average age of doctors is forty-eight. The average age of doctors working in hospitals is forty-one and that of doctors working in health clinics is fifty-eight.

 There is data collected as a result of questionnaire surveys conducted by the Ministry of Health and Welfare targeting those who have just finished clinical training. The largest group of respondents chose the answers citing “I desire to contribute to society” and “I aim to enhance clinical skills” and the number of those who responded, “I desire for higher income or status” was quite small. Looking at these responses of young clinical doctors, doctors today are not too bad.

 There are three prominent types of ideal doctors. To begin with, there are those who have good human nature. Like teachers or lawyers, they are fully qualified professionals. They should always be aware that their jobs are sacred. They are disqualified as doctors unless they have the spirit of self-sacrifice and compassion for others.

 In hospitals, people holding one or more of thirty types of national qualifications are working. Doctors have to play leading roles among them.
Capacity to think is an essential prerequisite for doctors, but that is not a matter of a simple IQ race. Rather than those who are merely intellectually gifted, those who are humane and good-natured will become good doctors.

 In the ICU, clinical doctors will gain on-the-job training in looking at a chart showing the condition of patients taking various drugs through intravenous drip, and the amount of sweat and urine, etc., in a matrix graph on a second-by-second time scale. Such chart is called a balance sheet.

 Recently, the medical profession is now in a time with a siege-mentality, because we cannot talk about it without thinking of a balance sheet in the economic sense. I would like to conclude my remarks, however, by saying that medical services in Japan have no problems given the young doctors’ pure and conscientious mind.