Medical school scandal points to wider discrimination

Reports surfacing in early August that a Japanese medical university systematically manipulated entrance exam results of women candidates to reduce the number of female doctors came as little surprise in Japan. Placing caps on female graduates is not uncommon, according to Japanese media reports.

Japan’s education ministry is now conducting a survey of all the country’s medical school entrance exam practices in a bid to root out discrimination.

The scandal emerged when Tokyo Medical University admitted on 10 August to manipulating the entrance exam results of female candidates. According to Japanese media reports, female applicants’ scores were reduced by around 10% in some years, in a practice that appears to have been in place since at least 2011, after the proportion of successful women candidates reached 38% the previous year. Lawyers investigating the university say some evidence dates back to 2006.

The daily newspaper, Yomiuri Shimbun, quoted people linked to the institution as saying the exams were rigged because women were more likely to leave the profession when they have children, and that the university was within its legal rights to choose who to accept.

Recent data confirms that on average only 30% of female applicants qualify in national medical exams and there have been suspicions that Tokyo Medical University is not alone in manipulating scores.

A study published by Japan’s financial newspaper, The Nikkei, last week found that men were more likely than women to pass entrance tests at three-quarters of Japan’s medical schools.

Kyoko Tanebe, an executive board member of the Japan Joint Association of Medical Professional Women, told Kyodo News agency it was likely that other medical institutions in Japan have similar policies that discriminate against female applicants.

Survey of exam pass rates

As a result of the furore over Tokyo Medical University, the ministry of education has sent questionnaires to some 81 medical universities in Japan asking them to report their entrance exam pass rates over the past six years. The institutions will have to explain any significant disparities in pass rates between men and women, or between different age groups.

The ministry also wants universities to clarify their criteria for marking and disclosing scores to unsuccessful applicants, and will check whether admission decisions are made without knowledge of candidates’ names and gender.

Kenji Nakai, a lawyer on the investigation team that revealed the discriminatory practices at Tokyo Medical University, told a press conference in early August that the university would have to conduct reforms from scratch. “All the officials involved in this fraud will have to be replaced,” he said.

“This discrimination against women is something that should never have happened. We will abolish it,” Executive Regent at Tokyo Medical University Tetsuo Yukioka said at a news conference in early August.

How the scandal was revealed

The exam-rigging allegations apparently surfaced while the university was being investigated after the arrest in July of Futoshi Sano, a director general of the ministry of education suspected of extending a government financial subsidy to the medical university, allegedly in exchange for a place for his son.

Lawyers for the university had conducted an internal investigation and issued a report, which was made public in early August, noting that the university engaged in systematic discriminatory exam scoring against women candidates.

The autonomic computer scoring system had deducted points from all female applicants possibly since as far back as 2006. The university also admitted to adding extra points to the results of 18 students, apparently in return for donations to the institution. These included an extra 20 points to the son of Sano.

Yoshimasa Hayashi, the education minister, has condemned Tokyo Medical University’s exclusion of women, saying the government would consider cutting its subsidies.

But systematic discrimination against women candidates points to a much broader problem in the medical profession. Lawyer Sakura Uchikoshi launched a hotline for women doctors after the scandal surfaced, and says she fielded many questions from overworked women and appeals for better treatment.

Uchikoshi is now preparing to officially request a disclosure of the exam results and also the return of exam fees to the women discriminated against by Tokyo Medical University.

Wider problem within the medical profession

In 2015, only 20.3% of medical doctors were female in Japan – the lowest proportion among the rich industrialised countries of the Organisation for Economic Co-operation and Development (OECD), compared to an OECD average of around 45%. Women account for 40% of the overall workforce in Japan.

Female doctors point to deep-rooted discrimination. They say working to change the gender bias has become even more difficult against a tougher working environment where conditions demand long hours in the workplace.

“Working conditions for medical practitioners are so exacting that women who start families are viewed as not being valuable employees. It is they who want the system changed,” said Dr Rumiko Inoue, president of Matsuura Seikei Geka (Matsuura Orthopaedic Surgery Hospital).

Women doctors are also discouraged by the current system where medical universities have large hospitals, Inoue said. Graduates of these universities tend to find employment in those hospitals and the preference is for men.

Masahiro Kami, chief director of the Medical Governance Research Institute and a visiting professor at Seisa University, says it is important to change the current law and remove the clause in Article 39 titled Standards for Establishment of Universities on the obligation of medical universities to give employment to their own graduates.

“If this closed environment is changed then medical teaching faculties can concentrate on education rather than producing employees for their affiliated universities,” he said.

Inoue, an orthopaedic surgeon, blames the current system where she says, for example, doctors in the surgery sectors in particular are often required to work 24 hours consecutively.

“I believe it is time for serious discussion that takes into consideration reforming the working environment for doctors. This will increase the number of female doctors who can keep working,” she said.

Women doctors report that they have been asked to leave the hospital by male managers when they were pregnant or warned about being able to fill the hospital working conditions to keep up with male colleagues.

According to a 2014 survey by the health ministry, the proportion of women was markedly low at 7.8% in surgery and 5.2% in neurosurgery.