Health Young Japanese doctors bypass hospitals for cosmetic medicine

[thomas]

My cardiologist told me that this is currently a big issue in Japanese health care. I have always regarded medicine as a vocation, not as a way to make money.


A growing number of young doctors in Japan are choosing careers in cosmetic medicine immediately after obtaining their medical license and completing their initial clinical training. The trend has raised concerns that it is worsening staff shortages in mainstream healthcare, where treatment is covered by public health insurance.

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The career path is known as chokubi (直美), a piece of medical slang referring to doctors who move directly into cosmetic medicine after completing their initial clinical training, without first gaining experience in fields such as internal medicine or surgery. The term combines choku ("directly") and biyō ("cosmetic medicine") and has become increasingly common in Japan's debate over the growing number of young physicians choosing aesthetic medicine over mainstream clinical practice. As Japan's healthcare system comes under increasing strain, the rise of these doctors has become the focus of a broader debate over how to ensure enough physicians remain in the parts of medicine people depend on when they fall ill or are injured.

According to a government survey conducted in 2022, there were 198 Naomi doctors nationwide, roughly 12 times the level of a decade earlier. One clinic visited for the report had opened only last year. It was headed by Yutaro Ishida, who joined a major cosmetic clinic in 2023 after completing two years of initial training and opened his own practice just one year later. The clinic, decorated with a red carpet meant to evoke roses, sometimes sees as many as 100 patients a day. Ishida said he focuses on careful but fast procedures. "I have confidence in double-eyelid surgery," he said. "It is cheap, good and fast, a little like Yoshinoya. Shorter surgery times also reduce the risk of infection and shorten patients' downtime, so I want to finish procedures as quickly as possible." Ishida said he originally wanted to become a pediatrician while at university, but changed his mind after seeing the harsh working environment and strict hierarchies at university hospitals during his initial training. "For the first few years, or as long as about five years, it can really feel like life at the bottom," he said. "There are systems where doctors are made to do work that even non-doctors could do, such as paperwork, and are treated almost like slaves. I saw many seniors and classmates become mentally unwell and quit.

Young Doctors Flock to Cosmetic Medicine

A growing number of young doctors in Japan are moving directly into cosmetic medicine after obtaining a medical license and completing their initial clinical training, raising concern that the trend may be worsening staff shortages in insurance-covered medical care.

newsonjapan.com

 

[Ukigumo]

Medicine may be a vocation, but that doesn't preclude making a good living. I knew an orthopedic surgeons who had a Jaguar F-Type car with a registration of something like '74 ACL' because that's how many private Anterior Cruciate Ligament repairs it took to fund the purchase! But of course,he had to fulfill his NHS commitment of surgery too.

UK junior doctors spend 5-8 years performing NHS work as part of their training post medical school. Isn't it similar in Japan?

 

[thomas]

I asked ChatGPT: Since 2004, all newly licensed doctors in Japan have been required to complete two years of postgraduate clinical training (初期臨床研修 shoki rinshō kenshū). During this period, they are known as junior residents (初期研修医 shoki kenshūi), or simply resident doctors or medical residents in English.

Junior residents usually work at accredited hospitals, often large teaching or community hospitals, and rotate through different specialities, including internal medicine, surgery, emergency medicine, paediatrics, obstetrics and gynaecology, psychiatry, and community medicine.

Most specialist training lasts another three to seven years, depending on the field.

Where does chokubi fit in?

Normally, doctors would spend several more years training in a specialty before moving into cosmetic medicine. However, an increasing number of young doctors are taking the chokubi (直美) route. After finishing only the mandatory two-year residency, they go directly into cosmetic medicine, often joining private aesthetic clinics instead of entering specialist training in internal medicine, surgery or other hospital-based disciplines. This trend has become controversial because cosmetic clinics generally offer:

• significantly higher starting salaries,
• more regular working hours,
• fewer night shifts and emergency duties,
• and lower medico-legal risk than many hospital specialties.

Critics argue that the growing popularity of chokubi is contributing to shortages of physicians in hospitals and other parts of Japan's public healthcare system.

 

[Petaris]

I have always regarded medicine as a vocation, not as a way to make money.

I wouldn't look into the US medical environment if you don't want a big shock then.

 

[mdchachi]

In the U.S. it costs a lot of money to become a doctor so if you don't make a lot of money once you're a doctor then you have serious problems. But we have the same problem where doctors are going into cosmetic procedures or other high profit specialties causing a shortage in family physicians.

 

[thomas]

I don't know how other countries cope with it, but the shortage of general practitioners, surgeons and cardiologists, not to mention nurses and other medical staff, is becoming an increasingly serious problem in Japan. I'm sorry, but I have nothing but disdain for the chokubi trend. At a time when the healthcare system is already under strain, it seems an extraordinary waste of talent and resources.

 

[Ukigumo]

I asked ChatGPT: Since 2004, all newly licensed doctors in Japan have been required to complete two years of postgraduate clinical training (初期臨床研修 shoki rinshō kenshū). During this period, they are known as junior residents (初期研修医 shoki kenshūi), or simply resident doctors or medical residents in English.

Junior residents usually work at accredited hospitals, often large teaching or community hospitals, and rotate through different specialities, including internal medicine, surgery, emergency medicine, paediatrics, obstetrics and gynaecology, psychiatry, and community medicine.

Most specialist training lasts another three to seven years, depending on the field.

That sounds like the UK system.

 

[Ukigumo]

It's very simple: change the law and insist that hospital doctors have to fulfill their general commitments and perform private work in their spare time (after hours and at weekends). Same with dentists.

I don't know how other countries cope with it, but the shortage of general practitioners, surgeons and cardiologists, not to mention nurses and other medical staff, is becoming an increasingly serious problem in Japan.

By making those fields less appealing by reducing the ability to earn will make them less attractive. Humans are humans and although doctors do care about people, they feel their responsibly should allow them to be able to send their kids to good schools, go on nice holidays and have a nice home. Mrs Ukigumo was until a few weeks ago a specialist hospital doctor. We live in a modest house (in need of repairs), she has a hybrid Toyota Corolla and we rarely go on holiday but this is because she refused to do private work and her NHS pay was about £70k ($93,800).

I'm sorry, but I have nothing but disdain for the chokubi trend. At a time when the healthcare system is already under strain, it seems an extraordinary waste of talent and resources.

Do Japanese medical students have to pay for their education or is it government funded?

 

[mdchachi]

she refused to do private work

So you're saying she's selfish

 

[Ukigumo]

So you're saying she's selfish

No, she was trying to preserve what little free time she had for herself rather than making money.

I'm trying to persuade her to do the odd week of private work now she's retired from the NHS to fund various projects around the home-but so far she's refused As a locum, British consultant doctors can earn (gross) £17,000 per week !

 

[mdchachi]

No, she was trying to preserve what little free time she had for herself rather than making money.

I'm trying to persuade her to do the odd week of private work now she's retired from the NHS to fund various projects around the home-but so far she's refused As a locum, British consultant doctors can earn (gross) £17,000 per week !

That was my point. She's selfishly prioritizing herself. The least she could do is work more so that you can fix the house and go on vacation. Or, at least fund your next trip to Japan while she stays home and works.

 

[Ukigumo]

That was my point. She's selfishly prioritizing herself. The least she could do is work more so that you can fix the house and go on vacation. Or, at least fund your next trip to Japan while she stays home and works.

…….. The selfish female canine! I need to talk to her

 

[Petaris]

…….. The selfish female canine! I need to talk to her

Where's the tombstone emoji when you need it?

 

[johnnyG]

Not cosmetics, but the surgeon who set up and runs this clinic in tokyo was well known and considered to be a valuable asset at the local uni hospital--said to have "the hands of god". Afaik, that clinic runs outside the national health system, at least it did initially, and I think the idea was to cater to the rich not only here but visitors/medical tourists.

It caused quite a stir, maybe 20 or more years ago when he quit and took a couple people with him to do that. Lots of comments to the effect that he'd left behind the system that supported and trained him to that level of heart surgery.

 

[Ukigumo]

It sounds like medical student training is paid for by the government. Is that the case?

In the UK, students pay £9700/year for their training (via a loan) although the actual cost is considerably more. In the last Biomedical Science dept where I worked, students paid £9700 a year but they each cost us £11,500 to train. I should imagine medical training would cost considerably more.