National / Social Issues | Regional voices: Chubu

Clinic founder aims to show Japan's hospitals how to become better workplaces for women

Chunichi Shimbun

Many female doctors at large hospitals operating around the clock have no choice but to put their careers on hold when they become pregnant or give birth, and eventually end up quitting without being able to gain further experience.

To change this, Chizuko Kuwae, 66, an obstetrician and gynecologist who has been raising awareness of the issue for more than a decade, set up her own clinic in Hachioji in western Tokyo in June to provide a place where such women can continue working.

After graduating from Shinshu University in Nagano Prefecture, Kuwae worked at a number of large hospitals in Tokyo. After having two children, she went on to become head of the department of obstetrics and gynecology at Tokyo Metropolitan Tama Medical Center and the National Hospital Organization Disaster Medical Center.

“More than a decade ago, when I entered my 50s and my children had grown up, I looked around and realized that only a few lucky female doctors were still working,” Kuwae said. “My husband told me, ‘You’ve kept running all this time, but look behind you. Nobody seems to be following you.'”

At the time, she said, it was normal for female doctors to work the night shift even after giving birth, and doctors were not expected to have any time off.

“I managed to raise my children with my husband, but many female doctors reluctantly left their jobs because their children were frequently sick or they had to care for their parents,” she said.

Considering the hard work and obstacles women face in continuing their medical careers, Kuwae said she was always contemplating when to quit. She even thought of giving up on having children, but her husband, Hideo, 66, who was a high school teacher at the time, offered to take on the bulk of the child-rearing duties.

“I still cry when I think of the hectic work schedule and putting my children through lonely times back then,” Kuwae said. “I don’t want younger doctors to feel the same way.”

In 2006 she submitted a written request to the Japan Society of Obstetrics and Gynecology demanding workplace improvements for obstetricians and gynecologists so mothers can continue to work as doctors.

“I made a point that changes would be beneficial for male doctors too, and that it would help increase the number of young doctors who want to become obstetricians and gynecologists,” Kuwae said. “I just didn’t want to let experienced female doctors stop working.”

Following Kuwae’s proposal, the society set up a committee to support female doctors and Kuwae became its head.

The committee surveyed obstetricians with 10 years of experience and found that only 45.6 percent of the women were still working at maternity facilities, versus 77.6 percent for men.

After more than a decade, Kuwae notes that modest improvement has been made but the fundamental problem remains.

“Basically, doctors are expected to be ready to work 24 hours a day, and the situation still is virtually all or nothing,” she said. “It’s true that there are people in decision-making positions who have an old-fashioned way of thinking.”

She says there is a vicious circle of people quitting, making the work tougher for the remaining doctors. Even if those who leave want to return after raising children or caring for their elderly parents, they are already at a disadvantage because they didn’t gain any medical experience during those times.

“Women working in the medical field — whether they are doctors, nurses or midwives — experience childbirth exactly when they are moving up the career ladder,” Kuwae said. “If they weren’t required to work the night shift or be on call during those crucial phases in their lives, they wouldn’t have to quit.”

Since she knew through her nearly 30 years working in large hospitals that it would be difficult to reform them, she decided to set up a clinic after devising a way to streamline doctors’ tasks without lowering the quality of medical care.

Minamino Green Gables Clinic has a staff of 30, with 26 women. There are two full-time doctors — Kuwae and a woman with three children — plus a part-time doctor. Another working mother is expected to join the team later this year as a physician.

At the clinic, doctors with small children are exempt from night duty or being on call but continue to conduct gynecological operations and cesarean sections to maintain and improve their medical skills.

“If female doctors continue working while raising children, they can gain experience and may be able to conduct high-risk surgeries or work in large hospitals after their children grow up,” Kuwae says. “The period when women have to reduce their working hours is short, so I want to provide a place where they can keep working instead of quitting.”

She also plans to install a system where the nurses and midwives share all the tasks in the clinic, including those related to outpatients, hospital patients and surgery.

“These tasks are usually divided among different groups of staff in larger hospitals, but if all the staff can share the work, people can cover for someone who takes leave to care for a sick child or to attend children’s events,” Kuwae said.

The clinic is reducing the workload by sharing patients’ data digitally, as well as by installing equipment that allows patients’ vital signs to be monitored from any room in the building.

Kuwae said she was concerned about recent revelations that several medical universities had manipulated their entrance exams and scores to favor men because female doctors often quit or take long leaves of absence after marriage or childbirth, leaving hospitals short-handed.

“First, I’m frustrated that people studying to become doctors are deprived of opportunities because of gender,” Kuwae said. “Second, I’m frustrated because not many people seem to be aware that there is an extremely high need for female doctors.”

She said doctors who have gone through pregnancy, childbirth and child rearing can make use of those experiences to sympathize with patients, which will be beneficial to the hospitals that hire them.

“Medical treatment involves interpersonal relationships. The hospitals are missing the mark by not giving female doctors chances,” she said. “They should definitely change their way of thinking.”

This section features topics and issues from the Chubu region covered by the Chunichi Shimbun. The original article was published Jan. 18.