OSAKA - The number of young doctors entering cosmetic medicine immediately after completing their initial medical training is rapidly increasing in Japan, raising concerns within the healthcare industry about the future of medical care and the training of physicians.
These doctors are known as "chokubi," referring to physicians who move directly into cosmetic medicine after finishing their two-year initial residency, without gaining experience in insured medical fields such as internal medicine or surgery. The trend has been driven in part by the harsh working conditions of hospital-based medical care and the higher income available in private cosmetic clinics.
At the same time, some healthcare professionals warn that the shift may leave gaps in basic medical training and raise questions about how doctors will respond if complications occur. If the number of physicians focusing on cosmetic medicine continues to grow, there are fears that patients facing life-threatening conditions could struggle to receive timely treatment.
Fujisawa, who now serves as director of a cosmetic clinic in Kobe, previously worked as a pediatric surgeon at a university hospital about a decade ago. Although the work of saving children's lives was rewarding, the shortage of doctors in the field meant the burden on each physician was heavy.
In emergency situations, Fujisawa sometimes worked shifts exceeding 30 hours. While he managed the workload in his younger years, he eventually began to worry about sustaining such a lifestyle over the long term. In his eighth year as a doctor, in his thirties, he decided to switch careers and move into cosmetic surgery.
The move brought major changes to his work and personal life. Cosmetic medicine offered higher pay and predictable working hours, allowing him to spend more time with his family. Fujisawa says the surgical skills he developed during his years in pediatric surgery remain an important foundation in his current work.
Meanwhile, physicians working in hospital-based medicine continue to face demanding conditions. At Hyogo Prefectural Amagasaki General Medical Center, about 30 doctors work in the cardiology department, treating patients with heart disease and responding to emergency cases around the clock.
Doctors there handle both hospitalized patients and emergency arrivals 24 hours a day, 365 days a year, often working overnight shifts about six times a month. Because cardiovascular treatment requires teamwork, multiple physicians must coordinate closely to treat each patient.
With limited staff, the workload placed on each doctor can become overwhelming. Some physicians say that once working hours stretch too far, even higher salaries cannot compensate for the lack of time to spend on personal life.
Becoming a doctor in Japan requires graduating from medical school, passing the national medical licensing exam, and completing two years of initial residency across multiple specialties. Afterward, physicians typically choose a specialty such as internal medicine or surgery and undergo further training.
In recent years, however, more doctors have chosen to enter cosmetic medicine immediately after their initial residency.
According to the Ministry of Health, Labour and Welfare, the number of such doctors has increased roughly tenfold over the past decade.
Ishida Taro, director of a cosmetic clinic in Tokyo, is one of those doctors who entered the field immediately after his residency. He says hierarchical systems at university hospitals sometimes limit opportunities for younger doctors to perform surgeries, with many spending long periods assisting senior physicians without gaining hands-on experience.
Ishida originally entered medical school with dreams of becoming a pediatrician like his father, who runs an internal medicine clinic. However, observing the intense working conditions of senior doctors during his training led him to reconsider his path. The significantly higher salaries in cosmetic medicine also played a role in his decision.
Hospital doctors may earn around 4.5 million yen annually, he says, while large cosmetic clinics can offer starting salaries of around 25 million yen, even for new physicians.
The difference stems from how medical fees are determined. In insured medical treatment, which covers most illnesses, the government sets the prices for procedures. Cosmetic medicine, by contrast, is classified as private practice, allowing doctors and clinics to set their own fees. As a result, profit margins—and doctors' incomes—tend to be higher.
However, some physicians working in insured medical care express concern about the trend. They question whether doctors who move directly into cosmetic medicine have acquired sufficient basic medical skills and how they would handle serious complications if they occur.
Ultimately, the greatest risk, they say, falls on patients.
At the same time, Ishida argues that simply criticizing the trend will not solve the problem. If the working conditions and compensation in insured medical care remain difficult, young doctors will continue to choose alternative paths.
In response to these challenges, some hospitals are introducing reforms aimed at improving doctors' working environments.
Kobe University Hospital has begun implementing "task shifting," a system that transfers certain duties traditionally handled by doctors to other medical professionals. Clinical laboratory technologists, for example, now conduct some examination procedures that were previously performed by physicians.
In the cardiology department, where around 50 patients are hospitalized and more than 100 are treated including outpatients, doctors had struggled to manage the heavy workload of examinations, paperwork, and patient care.
By delegating tasks such as electrocardiogram testing and other examinations to specialized staff, doctors are able to focus more on diagnosis and treatment.
The changes have also brought benefits for patients. Doctors say they now have more time to speak with patients and concentrate on treatment, improving the quality of care.
Taniguchi, a cardiologist with more than 20 years of experience, says improving work-life balance in the medical field is essential if hospitals hope to attract young doctors.
Although the job is physically demanding, Taniguchi says the moment when a patient who arrived in critical condition walks out of the hospital healthy again remains deeply rewarding.
He hopes younger doctors will be able to experience that sense of fulfillment as well.
If the number of physicians choosing cosmetic medicine continues to grow, some warn that emergency care could become harder to access when lives are on the line. The rise of "chokubi" doctors has exposed deeper contradictions within the healthcare system—one in which dedication alone cannot sustain the workforce.
Improving working conditions and creating an environment where doctors want to continue practicing insured medical care has become an urgent challenge for Japan's healthcare system.
Source: YOMIURI
