Kyoko Nomura

Gender inequality in Japan: a case report of women doctors

Kyoko Nomura, MD, MPH, PhD: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, and Associate professor, Teikyo School of Public Health

[Japanese version 日本語版 野村恭子、医師・医学博士、日本の男女共同参画:女性医師を事例に]

Kyoko Nomura: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, Associate professor, Teikyo School of Public Health
Kyoko Nomura: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, Associate professor, Teikyo School of Public Health

In 2016, Japan’s elderly population, aged 65 years or older, comprises 26%, which is one-fourth of total population. By contrast, the younger generation, aged 0-14 years, comprises only 14%. Why so low?

Nowadays, the birth rate in Japan is estimated at 10.3 per 1,000 population, meaning that one woman bears only one child over her lifetime on average. The Japanese Health Ministry estimates that the nation’s total population will fall to 95.2 million by 2050. The aging of Japan is brought about by a combination of low birthrate and longevity.

Now we understand that Japan faces an aging society. Who is going to take care of this quickly growing aging population? Of course, younger people and women! This is the fundamental reason why women are encouraged to work as much as men to support the aging society.

However in Japan, our traditional gender roles that men should work outside and women be good house wives is strongly embedded in our mindset and hard to get rid of.

According to the Gender Gap Index by the World Economic Forum, Japan ranks at 105th near the bottom among 135 countries in terms of gender equality, mainly due to the underrepresentation of women in economic and political leadership.

In the medical area, Japan faces a physician shortage because the number of physicians per 1000 population is 2.2 which is lower than the average of OECD countries, 3.2 per 1000 population. This means, if you reside in a remote area and suppose you have a cancer, it is less likely to find a medical doctor who can treat your cancer in your neighborhood. Hence, Japan needs higher numbers of medical doctors to meet patients’ needs and definitely women medical doctors are expected to work more to take care of patients.

Actually the number of women entering into medicine is increasing and now constitutes 20% of total number of medical doctors. But this value is still low among OECD countries (actually it is lowest) and thus, we need to set up an urgent strategy to improve working conditions for women to work as much as male counterparts and pursue their potentials as well.

Dr. Nomura conducted a surveys of alumnae from 14 medical schools and found that 98% of men worked in full-time positions, but only 70% of women worked in full time positions, and that men work longer hours per week compared to women. In her another survey with colleagues, they also found that many women quit working at the time of life events like marriage and child birth or rearing; the retirement rate from full-time labour was 44% in 5 yrs and rose up to 85% in 10 yrs. To make matters worse, once they switched from full-time to part-time positions, only one third of these people will return to full-time work.

As a consequence, women are underrepresented in medicine. We have 80 medical schools in Japan and each has one dean but there are only 2 women and women constitute only 2.6% of full professors in medicine in Japan, which is far behind of USA (19%) and UK (16%).

Dr. Nomura and her colleagues have recently published an article to the international scientific journal “Surgery” in February 2016 and this epidemiological study based on 8,000 surgeons who are members of the Japan Surgical Society demonstrated that married men earn more than unmarried women after adjusting for covariates including working hours; as the number of children increases, annual income increases only for men but decreases for women. 

In another study, she also demonstrated that the length of weekly domestic working hours is much longer for unmarried women than for married men and men do not work at home even if they have children (the average household working hours for men is only 3 hours per week).

These findings suggest that Japan’s stereotypical gender role, where men should work outside and women should be housewives still prevails even among highly qualified professionals like medical doctors.

One of the top scientific journal “Nature” recently published a special issue called “women in science”. This article states that Science remains institutionally sexist. Despite some progress, women scientists are still paid less, promoted less frequently, win fewer grants and are more likely to leave research than similarly qualified men.

Dr. Nomura has launched a women support center at her University in 2014 and provides various kinds of support to women researchers and physicians including

  • to provide a nursery for children including sick children
  • to provide social support like mentorship
  • to provide various seminars and workshops on research skills
  • to promote gender equality campaigns

With these efforts, Teikyo University has successfully increased the numbers and percentages of women faculty members. Dr. Nomura concluded by saying “in order to support women, environmental support at the workplace is not enough, but a combination of workplace support with educational intervention and career development works very well.”

Kyoko Nomura: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, Associate professor, Teikyo School of Public Health
Kyoko Nomura: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, Associate professor, Teikyo School of Public Health
Gerhard Fasol, Kyoko Nomura: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, Associate professor, Teikyo School of Public Health,  Eiji Yano, MD, MPH, DMSc, Emeritus Professor Teikyo University (from left to right)
Gerhard Fasol, Kyoko Nomura: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, Associate professor, Teikyo School of Public Health, Eiji Yano, MD, MPH, DMSc, Emeritus Professor Teikyo University (from left to right)
8th Ludwig Boltzmann Forum, Embassy of Austria in Tokyo, 18 March 2016
8th Ludwig Boltzmann Forum, Embassy of Austria in Tokyo, 18 March 2016
8th Ludwig Boltzmann Forum, Tokyo 18 February 2016
8th Ludwig Boltzmann Forum, Tokyo 18 February 2016

Kyoko Nomura, Teikyo University, Profile

Education:

MD, Teikyo University School of Medicine, Tokyo, Japan, April 1987-March 1993

Master of Public Health: Quantitative Methods, Harvard School of Public Health, MA02115, USA, June 2001-June 2002

PhD: Dep. of Hygiene and Public Health, Teikyo University School of Medicine , April 1999-March 2003

Current position:

  • Associate professor of Dep. of Hygiene and Public Health and Teikyo University School of Medicine, and Teikyo School of Public Health
  • Director of Teikyo Support Center for women physicians and researchers

Kyoko Nomura, Teikyo University, publications

Kyoko Nomura, List of publications (partly in Japanese language)

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  • Tohru Uzawa

    This was a fascinating talk:thank you very much, Nomura-sensei. It is a well accepted fact that women are discriminated against in the Japanese society, but the research here paints a very damning picture in a profession where such discrimination should be less evident.
    It is appalling to see the colossal amount of talent lost in the process There is one episode that I wanted to share here. In the 1980’s, when Japanese women were not given much chance in large Japanese companies. I was hiking with the head of Reuters Japan, and telling him how angry I was about this injustice: all the more worse since Japanese passport holders who had male stamped seemed have an extremely easy time landing on a job in major corporations. My friend’s reply was: “They are free to do so as long as they can afford it. Thanks to this policy, we are getting excellent recruits, but we have only women remaining after one year, even though we hire fifty-fifty. The only problem is when I tell them to read Nikkan Gendai, because of their excellent coverage of politics, I get looks of disbelief.” In their haste to grab “male” recruits, many major Japanese corporations hired people who were not suited for the job, and are suffering the consequences, some going out of business, a prime example being SHARP. So there is economic sense in removing the male only filter when recruiting, and promoting diversity, because we need diversity when trying to look for new problems, and also when trying to formulate problems in a meaningful way.