Dear Administrative Reform Minister Yoshito Sengoku,

In a country that dares to be a democracy, your courageous ideas are certain to attract controversy and debate. Please let me offer tentative support for your proposal to allow qualified international doctors to practice medicine without taking the national licensure exam in Japanese.

I should first disclose that I am a doctor employed by Fukushima Medical University. My diplomas are entirely American, including an M.D., a Ph.D in biochemistry, residency in the specialty of pathology, and fellowship in the subspecialty of transfusion medicine. I maintain American Board of Pathology certification in both clinical pathology and transfusion medicine, and I am licensed to practice medicine and surgery in the state of California.

Mid-career, an opportunity arose to practice in Australia as an “Area of Need” specialist. This entailed a fair bit of paperwork, but no further examinations.

My job at the Australian Red Cross Blood Service came with one government-mandated caveat: A qualified Australian citizen could displace me. After three years, a fine Aussie doctor, eager to repatriate from the U.K., applied for my job, and an orderly transition was organized. The government mandate that displaced me had further repercussions for the Australian Red Cross, because my successor quit for another opportunity after less than one year.

At the time, I was coauthor with Japanese colleagues on a soon-to-be- published manuscript. When I explained to professor Hitoshi Ohto why my Red Cross affiliation would have to be edited out of the manuscript, he politely asked if I would join his department in Fukushima. I have been here since January 2008, and soon after was accepted as a member of the Japan Society for Transfusion Medicine and Cell Therapy. I have represented that society, the university, and Japan at professional engagements on five continents since moving to Fukushima.

To actually practice medicine, current government policy allows me to request “advanced clinical training” for a maximum of two years, after which I would have to leave Japan for a pre-arranged job in America. We started the paperwork, but as my research and teaching responsibilities evolved, long-term employment became attractive to me and to Fukushima Medical University.

In my subspecialty, it is possible to guide other physicians without being directly involved in patient care. Surgery, the specialty of an American doctor at Jichi Medical University, is much more hands-on. My Jichi colleague and I find great satisfaction teaching the next generation of Japanese doctors, but patients today might benefit from direct medical care provided by multinational groups of true peers.

Welcoming the clinical and surgical services of top-flight international doctors is not a sign of weakness or inadequacy. Rather, it would show the world that Japan is, in the good-natured way of academic medicine, both competitive and cooperative on the world stage.

For the record, I do aspire to master Japanese well enough to pass the medical licensure exam. This may take until retirement age or beyond, but the principle of lifelong learning is taught best by example.


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