"Surgery is on the brink of collapse. We are barely holding on," said Junichi Arita, a professor of gastrointestinal surgery at Akita University, the only medical school in Akita Prefecture, in an interview with Asahi Shimbun last November. The number of doctors choosing surgery after completing their residency in the prefecture has drastically decreased, from 10 out of 60 in 2018 to just 2 out of 48 in 2024. As the aging surgical workforce has led to fewer hospitals performing surgeries, patients have flocked to Akita University Hospital, where wait times for liver and pancreatic cancer surgeries have exceeded two months.
While young doctors are turning away from surgery, a trend known as "jikumi"—referring to doctors who head straight to cosmetic clinics after completing their two-year initial clinical training—has emerged in Japan. Essential medical fields are facing a shortage of personnel, yet doctors are gravitating toward dermatology and cosmetic medicine. This issue is not unique to South Korea.
The statistics reveal a clear trend. According to the Japanese Ministry of Health, Labour and Welfare, the number of doctors in Japan increased by 1.2 times from 2008 to 2022, but the growth varied significantly by specialty. The number of surgeons remained virtually unchanged, while obstetrics and pediatrics saw only a 1.1-fold increase. In contrast, the number of cosmetic surgeons more than tripled during the same period, with over half of them being in their 20s or 30s as of 2022.
Cosmetic Medicine Offers High Salaries and Work-Life Balance
The primary reason attracting young doctors to cosmetic medicine is financial. An analysis by the Nihon Keizai Shimbun (Nikkei) of data from the recruitment firm Progre found that the average monthly salary offered in job postings for cosmetic medicine was approximately 1.41 million yen (about $11,920) as of April this year, exceeding salaries in other fields (around 990,000 yen, approximately $8,370) by over 400,000 yen. While actual salaries may vary, the conditions offered by cosmetic clinics highlight a significant difference.
This ability to offer such salaries stems from the expanding market. According to the Yano Research Institute, Japan's cosmetic medicine market is projected to grow to 644 billion yen by 2025, a 1.6-fold increase over five years. The user demographic has also broadened; a survey by Recruit in the second half of 2025 indicated that 22.8% of men in their 20s utilized cosmetic medical services in the past year, surpassing the 21.7% of women in the same age group. As demand rises, clinics are increasingly seeking staff, with job postings for cosmetic medicine—including nurses and administrative positions—reaching 2,627 in April this year, 6.2 times higher than in April 2019.
While cosmetic medicine attracts doctors with high salaries, surgery is pushing them away. Professor Arita noted that young doctors perceive surgery as having "poor cost-effectiveness." A typical day for a gastrointestinal surgeon, as described in a public lecture by the Japan Society of Gastroenterological Surgery last May, begins at 6:30 a.m. with a 7:30 a.m. arrival at the hospital. After morning rounds and outpatient consultations, lunch is a quick five-minute meal. From 1 p.m. to 6 p.m., they perform surgeries. Even after surgeries, work continues with discussions about results and treatment plans, often extending until 11 p.m. After preparing for conference presentations, they may not leave until 1 a.m.
The Ministry of Health, Labour and Welfare estimates that by 2025, 15% of hospital doctors will work over the typical annual overtime limit of 960 hours, with that figure rising to 19-25% in specialties like surgery, emergency medicine, and obstetrics.
Despite the demanding hours, surgeons do not earn significantly more than doctors in other specialties. Tsutomu Fujii, a professor at Toyama University, stated that difficult surgeries can take up to 15 hours. However, in Japan, salary differences among specialties are minimal. Asahi Shimbun reported that since the residency system changed in 2004 to allow doctors to rotate through various specialties before choosing their focus, young doctors have gradually begun to avoid surgery upon realizing that "the workload is heavy, but the salary is the same."
Cosmetic medicine offers high pay without the burden of emergency calls during nights or weekends, making it an attractive option for young doctors seeking both financial and time benefits.
The path to cosmetic medicine often leads to urban areas, as cosmetic clinics are concentrated in major cities. In Tokyo, there are 3.5 cosmetic surgeons per 100,000 people, significantly higher than the national average of 1.0. When rural doctors seek better conditions in urban cosmetic clinics, the staffing shortages in regional hospitals become even more pronounced.
Japanese Government Takes Action
The Japanese government is not remaining idle. As of April this year, it has tightened the qualifications for hospital directors. Now, doctors completing their initial clinical training must work for at least three years in a hospital providing health insurance services to qualify as directors. This requirement aims to prevent doctors from solely performing cosmetic procedures, making it more challenging for them to return to general practice later.
However, this requirement does not prevent doctors from taking jobs at cosmetic clinics. The Yomiuri Shimbun expressed concerns that this approach might inadvertently encourage doctors to choose private practice, which is not covered by health insurance.
Hospitals are also attempting to improve salaries and working conditions. Hiroshima University has begun increasing salaries for young surgeons under 40 by 1.5 times starting in 2025. Akita University has shifted from a model where one attending physician managed all critical patients to a team-based approach, ensuring time off. They have also made efforts to attract students interested in surgery, with the number of residents choosing surgery in Akita Prefecture rising to eight this year.
Keiko Kihira, managing director at the Boston Consulting Group, told Nikkei, "Unless we improve the harsh working conditions for doctors, we will not achieve a fundamental solution to the 'jikumi' issue."
* This article has been translated by AI.
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