globalresearch--2019-04-01--Japan A Necessary Evil Keeping Women Out of Medical Schools Wont Fix What Ails the Japanese Med

Japan, A “Necessary Evil”? Keeping Women Out of Medical Schools Won’t Fix What Ails the Japanese Medical Profession

On August 2, 2018 an article in the Yomiuri shimbun broke the news that Tokyo Medical University has been systematically tampering with the scores of entrance exams to benefit male applicants. The news emerged in the course of an investigation into the university administration’s bribe of a high-ranking official at the Ministry of Education, Sano Futoshi.1* Officials at the university apparently boosted the entrance exam score of Sano’s son in exchange for his help in securing a grant to improve the university’s public image. Along with this case of cronyism, it came to light that the university routinely padded the scores of all male applicants except those who had been applying for four or more years. Apparently believing that women would not do as well in the medical profession, Tokyo Medical University systematically reduced their chances of admission for at least a decade. It seems that rising rates of successful female applicants prompted university officials to impose a system of automatically increasing male applicants’ scores to reduce the ratio of female students at their institution. The revelations prompted a government investigation of 81 schools, which revealed in December 2018 that at least nine other medical faculties engaged in similar practices.2  And yet, in 2013, the university began receiving a national grant to “support women.” Over three years, Tokyo Medical University was awarded over 80 million yen (about 720,000 USD) through this grant. Two university executives at the center of the admissions scandal – former chairman Usui Masahiko and former university president Suzuki Mamoru – played key roles in the Office to Promote Diversity, founded at the university in 2016. In Usui’s opening remarks at an event to celebrate the first anniversary of the Office in 2017, he called on the university staff to promote “diversity.”3 At the time, the school presented an increase in female admissions from 26.9% to 32.4% as evidence of its efforts, even as it was actively taking steps to deny admission to women with qualifying scores.4 That meant that the university was not only taking money from the government to promote female admissions but also taking money from individual female applicants whom it artificially failed (sitting a university entrance exam in Japan costs 40,000 to 60,000 yen, about 360 to 540 USD). A group of 24 women denied admission to Tokyo Medical University since 2006 have joined with a team of defense lawyers to build a legal case against the school, which includes a demand for compensation for these fees, and potentially for additional damages.5  The male officials and others that implemented systematic discrimination at Tokyo Medical University have framed their actions as a “necessary evil.” The key reason cited as a defense for Tokyo Medical University’s decision to depress female admissions was their concern that too many female doctors would result in too few doctors at their affiliated hospitals when women left their work for marriage or childbirth. In his testimony to the legal team currently investigating Tokyo Medical University’s discriminatory admissions process, Usui said that the university systematically depressed female applicants’ scores because “as women get older, their activities as doctors decrease.”6 This rhetoric echoed the sensationalistic “Coeds Ruin the Nation Theory” enunciated in the pages of the Japanese tabloids in the early 1960s. Then, Waseda University professor of literature Teruoka Yasutaka declared his desire to set quotas to limit the number of women admitted to humanities departments because women would waste their educations and ruin society.7 Now, male administrators at a number of medical universities secretly impose quotas fearing that too many women in the profession will ruin medicine.8  Tokyo Medical University’s administrators sought approval for their actions through appealing to legitimate concerns about a lack of medical professionals in Japan. But rather than lobbying to increase the quotas imposed by the Japan Medical Association on the number of doctors trained, or addressing many of the workplace issues facing overwhelmed and understaffed hospitals, these powerful administrators penalized individual women, holding them responsible for a multifaceted social problem that was not of their own making.9 On November 12, 2018, Education Minister Shibayama Masahiko noted that a government investigation had found evidence of gender bias in the admissions processes of multiple medical faculties.10 The results announced in December confirmed these suspicions, and the government has subsequently cut off subsidies to Tokyo Medical University and reduced those to Nihon University, Fukuoka University, Iwate Medical University, Juntendo University, Kanazawa Medical University, Kitasato University, and Showa University based on similar manipulations of entrance exams.11  A candlelight vigil held in front of Juntendo University on December 14, 2018 to protest the insitution’s discrimination against women in its entrance examination policies. Image courtesy of the Association to Support Victims of Entrance Exam Discrimination at Tokyo Medical University and Elsewhere (Source: APJJF)  This scandal is a case study related to several stubborn problems facing Japanese society today. It reflects how a more general context of gender discrimination threatens to impede solutions to the crises facing healthcare in Japan, and how recent efforts to counter discriminatory practices and encourage “diversity” lack accountability. This article addresses how the gender gap in the medical field points to deeper problems in the profession as a workplace, how recent research suggests that gender diversity may improve medical outcomes in terms of patient care, and how this entrance-exam scandal highlights the inadequacy and lack of accountability behind recent efforts to promote “diversity.”  The conditions under which medical professionals labor in Japan are less than ideal. A study published in 2015 on the difficulties facing women in the medical profession found that it was not only women-specific issues, but also “poor working conditions involving long working hours” that result from “a chronic, nationwide medical workforce shortage” that negatively impacted female doctors’ physical and mental health.12 Indeed, the problems noted adversely affected men as well as women medical professionals. The stresses on the medical profession result from many factors, including government restrictions on the number of medical students, while female doctors face additional challenges. Women find their attention divided between their professional and their familial responsibilities because of longstanding assumptions about female domestic labor. Such social expectations hinder gender equality in many societies, but this is a particularly stubborn problem in Japan. The country consistently rates poorly in the Global Gender Gap Index. In 2018, Japan ranked 110 out of 149 countries in terms of gender parity, the lowest ranking of the Group of Seven industrialized nations.13 Anecdotal evidence about the entrance-exam interviews conducted at other medical universities suggests that prospective female students also face questions not only about their professional but also their personal goals, presumably because schools want to know if domestic commitments will interfere with their careers.14 Medical universities run hospitals, and they fear a staffing shortage if women – as they are often expected to do – leave the workplace to care for their families.  On the other hand, government policy depresses the number of doctors certified in order to control medical expenditures and prevent a possible surplus of doctors. The Ministry of Health, Labour and Welfare restricts the number of physicians and imposes a medical student quota. Yet Japan’s problem is clearly a shortage of doctors. In response to severe shortages in 2007, the government increased the maximum medical school enrollment quota from 7,625 to 8,828. Shortages nevertheless persist. In terms of number of physicians per person, Japan has 2.4 per 1,000 people. This places it 27th out of 31 OECD countries surveyed, just behind the United States (2.6 doctors per 1,000 people) and on par with Poland and Mexico.15 At the same time, Japan currently vies with Israel for the lowest rate of medical graduates: 6.8 per 10,000 inhabitants in 2017.16 The specialties with the most severe shortages are obstetricians, pediatricians, emergency physicians, and surgeons. Even though current estimates predict that the number of physicians per 1,000 population will rise to 3.14 in 2035, corresponding rise in demand with Japan’s aging population’s medical needs have prompted calls for strategies to increase the number of doctors.17  A study conducted by Japanese researchers who examined trends from 1996 to 2006 to identify the primary causes of the shortage of surgeons in Japan concluded that many general surgeons at hospitals, both female and male, left their positions not to fulfill childcare responsibilities but for another job or another medical specialty in their 30s and 40s.18 This contributed to a general lack of hospital surgeons. The study noted that “poor working conditions facing hospital doctors” may account for this trend. Studies of doctors’ average working hours in Japan find a weekly median of 54.4 to 63.3 working hours. However, more hospital doctors in Japan work more than 60 hours per week than do workers in any other profession.19  Without expanding the number of physicians, it is difficult to maintain quality care standards while ensuring that women can take even the legally guaranteed maternity leave period of six weeks prior to the expected birth date and eight weeks after birth, let alone to support needs of medical professionals with childcare obligations. The most recent statistics published by the Japan Medical Association found that 50.1% of the medical facilities surveyed offered no childcare.20 Simply leaving the burden of understaffing to male and child-free female colleagues results in a culture of resentment when already heavy workloads become even more onerous if women take time away from work to have and take care of children. Because of this perceived inconvenience women may pose to co-workers when taking maternity leave, many of the physicians (65%) who participated in a survey after the Tokyo Medical University scandal broke responded that, although they did not necessarily approve of the university’s decision to actively tamper with scores, they understood the gendered logic in depressing the number of female applicants, since “it burdens others [in the workplace].”21  There is a gender gap in terms of working long hours in the medical profession, and this gap is used by some to justify depressing rates of female doctors to maintain staffing levels at hospitals. The Ministry of Health, Labour and Work found that 41 percent of male physicians and 28 percent of female physicians work 60 or more hours a week, and 11 percent of male physicians and 7 percent of female physicians work more than 80 hours a week. Among men in their 30s, 56.9 percent work over 60 hours a week.22  These long hours, however, are also linked to health problems among doctors. The government definition of karōshi [death from overwork] is the sudden death of an employee who works an average of 65 hours per week or more for more than four consecutive weeks, or for 60 hours or more for more than eight weeks. A recently published study of first-year residents at 250 training hospitals in Japan in 2011 found that residents working 80-99.9 hours per week had a 2.83-fold higher risk of developing depression than those working less than 60 hours a week, while those working 100 hours or more a week had a 6.96-fold higher risk. Of the 1,241 first-year residents surveyed by the study, 7.8 percent worked 100 hours or more a week, of which 45.5 percent displayed “clinically significant depressive symptoms” after three months.23 Another study conducted in 2004 found that residents in Japan worked a mean of 84.9 hours a week, and 16.4 percent worked more than 100 hours a week.24  Aside from sheer number of hours, doctors in Japan are often required to work extraordinarily long shifts. When working night duty, they may work a daytime shift on either end, sometimes working almost 36 consecutive hours at one go. In July 2015, when an obstetrics and gynecology resident physician in the Shinagawa Ward of Tokyo killed himself, a subsequent investigation of hospital records showed that he had logged 143 to 208 hours of overtime in the six months before his suicide, and the four monthly night shifts he worked sometimes contributed to 30-hour shifts.25  Of course these problems are not limited to the medical industry in Japan. In the United States, the conversation often focuses on “burnout” – emotional exhaustion and cynicism in one’s work. Studies have found that resident physicians in the United States, who also work long hours, reported rates of burnout symptoms (45.2% of the 3588 second-year resident physician respondents).26 Doctors in the United States have higher rates of suicide than any other profession.27 Critics of U.S. healthcare point out that Japan might serves as a potential model for the U.S., particularly considering how universal coverage and general affordability have benefited patients in Japan.28 But Japan also faces rising demand that will place more and more stresses on the system as it has existed so far, and on the doctors who work within that system.  There have been calls to reduce physicians’ workloads by distributing more tasks to nursing staff, but Japan’s aging society has created shortages in nurses as well. Even though Japan has a relatively large number of nurses – 9.06 per thousand residents, more than the 8.30 OECD average density – Japanese health care has faced a nursing shortage since the 1990s because of rapidly rising demand.29 Although demand for care workers is high, wages are relatively low for nurses and certified care workers, perhaps because it is also a feminized workforce, while extensive pre-employment training must be paid for privately. Fewer people see care work as an attractive career option. In 2007, only 16,696 people applied for 26,095 places at 419 training institutes for certified care workers.30 The government has agreements with Indonesia, the Philippines, and Vietnam to accept foreign nurses, but the language and nursing training requirements set a high bar to clear; in 2016, among the participants in the “Indonesia-Japan collaboration on the enhancement of nursing competency through an in-service training” program, 104 of 209 (49.8%) who attempted the national exam to become a certified care worker passed, while only 65 of 447 (14.5%) who attempted the national nursing exam passed. These are both far below the national average pass rates of 72.1% for the certified care worker exam and 88.5% for the national nursing exam.31  There are only limited studies about burnout and job satisfaction among physicians in Japan, although both appear related to working conditions and seem to contribute to labor shortages at government hospitals and university hospitals.32 A 2007 found that burnout and poor mental health were directly related to job dissatisfaction and short sleeping time among doctors.33 Researchers examining physician retention at hospitals found a high correlation between frequent night duty shifts and a desire to change hospitals.34 The study found that almost 35 percent of the respondents to their survey wanted to change hospitals, and the rate was particularly high for physicians at government hospitals and university hospitals (44.3 percent and 41.5 percent respectively).35 While this study did not distinguish between male and female respondents, it did emphasize that the medical field needs to think about approaches that will allow it to retain its workforce and create a workplace in which doctors find their work satisfying in order to provide sustainable and high-quality health care.  The discussions coming out of the admissions gender discrimination scandals frame women as less committed to the workplace but does not cite the health hazards of overcommitment to the workplace. Gendered ideas about women’s responsibilities in the home and the current workplace demands in the medical field require women physicians with children to dramatically reduce their working hours. At the same time, in a work culture that encourages overwork, the demographic most vulnerable to accumulated workplace fatigue is actually male workers in their 30s and 40s. As Scott North has described in his study of death from overwork (karōshi), karōshi victims “come from all walks of life, all classes, and all occupational categories,” but are overwhelmingly male because of the gendered ideology linking masculinity and overwork.36 So a conversation about how to improve the conditions under which those in the medical profession labor is not just a conversation about improving women’s lives, although the discussion needs to include analyses of how women experience the squeeze between a workplace culture that demands long hours and societal expectations that they manage domestic and care obligations.  The pronounced M-curve in female doctors’ employment – a mid-career dip in rates of women working in the profession – is most often the result of life events like childbirth (responsible for 70 percent of female physicians’ decision to take leave) and child care (38.3 percent). According to the Ministry of Health, Labour and Work’s statistics, this means that the employment rates for women doctors reach a low of 73.4% percent twelve years after becoming certified (male doctors have an 89.9 percent employment rate twelve years after certification), then creeps up but does not match the rates of male physician employment until both are in their seventies and employment rates for both are on a downward slope. At this point, interestingly, employment rates for women overtake those for men, and there are 5-10 percent more female doctors still working in their late 70s and through to their 90s than there are male doctors. The M-curve for lifetime female employment is not dissimilar from a wider gendered tendency in employment in Japan. In the case of female doctors, however, 60.4 percent return to work within a year of taking leave.37  In short, many female doctors reduce working hours when they gave birth to children. However, the majority of female doctors who work while raising infants still work full-time – 76.5% in 2017 – somewhat lower than the 88.8% of working female doctors without children who work full-time. However, the most significant difference between the working hours of female doctors with and without children is in the hours indicated by “full time.” In 2017, of the female doctors with children ages 6-12, almost half (49.3%) worked under 40 hours a week, while only 4.7% worked 65 hours or more a week. Only about one-fifth of female doctors without children worked under 40 hours a week, while 27% of female doctors without children worked between 48 and 60 hours a week, 18% worked between 60 and 65 hours a week, and 22.6% of them worked 65 hours or more a week.39  Domestic labor in Japan is assumed to be women’s labor, and working women with children find that housework burdens them with a “second shift.” A 2012 study found that even female doctors without children spent more of their time on housework (15 hours a week) than male doctors with children (three hours a week). Unsurprisingly, female doctors with children did the most housework (36 hours a week including childcare). Adding up total work time – paid medical work and unpaid housework – demonstrates that female doctors worked the longest weeks on average, putting in over 70 hours at home and at work. While men without children worked longer hours outside the home, their paucity of housework and childcare responsibilities put their total work week at just a little over 50 hours on average.40 A recent study found that female medical students in Japan feel pressure to accommodate family responsibilities, and by the time they finish their clinical internships in their final year of medical school, their understanding is that they must choose to prioritize either family or medicine, whereas their male peers feel no similar conflict and pursue their careers based exclusively on their medical practice.41 Tokyo Medical University’s logic in reducing female admissions reflects a calculated strategy based on current gendered divisions of labor and a culture of overwork in which men can participate most fully in their professions because they participate so little in the household.  Reducing female medical school students in an effort to retain hospital physicians is not the solution to a medical industry under stress. When we think of women as a liability because of their theoretical future childbirth and care leave, we focus on only one aspect of bodies and when bodies can or cannot work. Perhaps more importantly, by defining the value of work in terms of full-time work that is inherently exhausting, with punishing hours and high levels of stress, we accept working conditions that are not healthy for any bodies, female or male. As Kyoko Tanebe put it in her editorial calling for an examination not only of gender discrimination but also of a health care funding crisis: “The current system relying on doctors who can withstand overwork is vulnerable, both as a system of labor and in terms of medical safety.”42  Japan is certainly not the only society facing a “crisis in care” that is simultaneously a labor problem and a public health issue as well as an issue of gender discrimination. The resounding criticism of the handling of gender issues in the Japanese health care system from the Western media, in particular regarding this issue, has prompted different reactions in Japan; there are expressions of shame at Japan’s failure to properly implement “modern” global standards for gender equality, but there are also accusations of Western, particularly American, hypocrisy. After all, while this scandal provides a headline-worthy smoking gun of most certainly illegal systematic sexism, the United States’ global rankings for female participation in the medical field are only slightly better than those of Japan. Japan ranks last among the 34 member countries that make up the OECD for share of female doctors (20.3% in 2015). But the United States is fourth lowest (34.1% in 2015), well below the OECD average of 46.1%.43  This is a pressing issue for those concerned about the quality of medical care, since there is evidence that more women in the medical field makes for better medicine. A study of hospitalized Medicare beneficiaries found that “elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists.”44 This study estimated that, annually, “approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians.”45 Other studies have found that female doctors performed better than male doctors in the context of diabetes care.46  In an article in The Atlantic, Ed Yong introduced research showing that more US patients suffering from a heart attack, particularly female patients, die when treated by male doctors than by female doctors. It is uncertain why this is, but it suggests that female patients stand to gain most when they have access to female doctors, and that male physicians who work with female colleagues did better at treating female heart-attack sufferers. This is not to say that women are inherently more attuned to nurturing and care, but the findings do suggest, as the University of Chicago’s Vineet Arora noted, that a gender-diverse work environment is a plus and “that female physicians are an asset not just for their patients, but for their male colleagues, too.”47  The positive impact of gender diversity can also be found in medical research. A recent study that analyzed 1.5 million medical-research papers published between 2008 and 2015 found that female co-authorship increased the likelihood that research addressed gender differences. This is important because neglecting gender-related differences in disease and treatment outcomes affects health outcomes, sometimes with life-threatening consequences.48  Similarly, if crushing workloads are the expectation for all medical workers, that presents another issue for patient safety. Several studies have found a higher risk of medical error and also traffic accidents among medical staff who have been working long hours.49 Such studies expose the links between the quality of working conditions in the medical industry and the quality of healthcare.  The problems created by a shortage of hospital physicians and a maldistribution of those physicians in Japan are also particularly dangerous for some of the most medically vulnerable. One high-profile case, in which nine hospitals turned away a pregnant woman who suffered a miscarriage after the ambulance carrying her collided with a minivan on its way to a tenth hospital, prompted investigations about hospitals refusing to provide emergency care for pregnant women. A subsequent survey of 27 prefectures found that between 2004 and 2006, there had been 2,780 cases in which a pregnant woman had been denied admission by one or more hospitals. Of those, in at least 191 cases a pregnant woman transported by ambulance had been turned away by five or more hospitals because of a lack of specialist staff or beds.50  As the points outlined above show, thinking about how to improve the healthcare industry in the future would benefit from thinking further about the healthcare industry as a workplace and about improving the overall quality of healthcare. This requires a deep questioning of gendered ideologies that assign women the roles of care and support, both in the home and in the hospital, while simultaneously dismissing women’s capabilities in what are considered more prestigious “specialist” positions. It would require recognition of women’s outstanding performance in significant areas of health care, as well as the burdens of discrimination under which they labor.  The consequences of gendered stereotypes are more serious than simply whether individual women entering the workforce can advance. Japan has the fourth-highest relative poverty rate among OECD countries, and the gender gap in wages and in full-time employment has created particularly vulnerable groups of women.51 Most single parents are mothers, and the poverty rate for working single-parent families is 56 percent. This is due in part to the gender wage gap, which is the highest in the OECD.52 The current public pension system offers generous benefits to married women and widows, but penalizes women who divorced or were never married, and hence are unable to access a pension based on a man’s “breadwinning” wages. A recent study noted that, since the 1980s, the marriage rate decreased and the divorce rate increased significantly, with the consequence that more and more elderly women will face the risk of poverty thus increasing poverty rates in general. Already in 2010, poverty rates for elderly women were almost double those of elderly men: 11.1% versus 6.1%. However, projections put the poverty rate of elderly women at 25% in the near future, more than double the predicted 10% for elderly men. For women who were never married or are divorced, the poverty rates are predicted to be 50%.53  The government-driven rhetoric of “creating a society in which women shine” does little to challenge a dominant narrative highlighting women’s unique relationship to care and femininity that perpetuates this kind of gendered and imbalanced poverty and precarity. In a September 2014 speech to the World Assembly for Women in Tokyo in which he outlined his vision for promoting women in the workplace, Prime Minister Abe Shinzō provided examples of the kinds of contributions he thought women could “bring to corporate management.” He cited examples of female employees who had suggested car doors that open wider to accommodate children, or had collaborated to design laptop computers that one can open without destroying a manicure. Abe concluded that “The most difficult part may be transforming the division of roles based on gender, something that is, unwittingly, firmly ingrained within us.”54 However, Abe’s own interpretation of that “certain perspective that only women can provide” – the woman’s touch – is precisely based on an ingrained stereotype of women’s abilities and women’s interests.  The admissions scandal at Tokyo Medical University also exposed the emptiness of various recent initiatives to promote greater gender diversity. As mentioned above, Tokyo Medical University received grant money to “promote women’s activities” and Suzuki Mamoru, then-president of the university and an initiator of the quotas on female admissions, publicly endorsed policies advocated by the Gender Equality Bureau Cabinet Office’s annual “General Assembly of Male Leaders.”55 The quotas Suzuki imposed sit uneasily alongside the “action plan” published on the Bureau’s homepage, which includes “disrupting the status quo” by taking “every chance to ask the questions below and advance changes in the mindset in the whole organization: Why are there no women? Why are women 30% or less? Why isn’t the ratio of men to women fifty-fifty (50:50)?” That he publicly subscribed to such initiatives while actively imposing a policy to cap female admissions at 30% required a powerful cynicism. Although he may have sympathized with the diversity ideal in the abstract sense, he sabotaged it in fulfilling his responsibility to train physicians.  It is in the gap between an often tone-deaf rhetoric at the level of the national gender equality initiatives and a complete lack of accountability in governance that this systematic gender discrimination persists. This story doesn’t seem limited to a few powerful men at one institution. Observers of the stubborn imbalance in acceptance rates between men and women to medical schools had already voiced suspicions that universities were controlling the student ratio. In an August 2017 report for the Japan Joint Association of Medical Professional Women, Kyoko Tanebe noted that the rates for female admissions to medical schools seemed artificially depressed over the last fifteen years in light of recent trends in other fields. So-called “cram schools” which prepare students for university admissions exams and obsessively track these statistics also observed similar gender gaps in the admissions rates at other schools. A representative from Ace Academy, a cram school for medical universities, noted the lopsided pass rate for young men and women at St. Marianna Medical University, Showa University, and Nihon University in the second round of entrance exams, which consist of interviews and written essays, in spite of general parity on earlier rounds of subject exams.56 Jutendo University was also suspected of rigging entrance exam results to favor male applicants.57 Others have called this depression of female acceptance rates to medical schools an open secret. The Ministry of Education’s nation-wide investigation into the admissions practices of 81 medical faculties confirmed these suspicions and found that several other medical faculties engaged in similarly suspect admissions’ practices, including Nihon University, Juntendo University, Showa University, Iwate Medical University, Kanazawa Medical University, Kitasato University, Kobe University, and Fukuoka University.58  Perhaps this scandal will offer an opening to debates about how to address long-standing gendered inequalities in the medical field and beyond. One hopes it will also initiate further debates about the social costs of such discrimination on the medical profession as a workplace and a place of care.  Note to readers: please click the share buttons below. Forward this article to your email lists. Crosspost on your blog site, internet forums. etc.  Our thanks to The Asia-Pacific Journal: Japan Focus for having brought this important article toour attention  Chelsea Szendi Schieder is an Associate Professor in the Faculty of Economics at Aoyama Gakuin University in Tokyo, Japan. She writes contemporary histories about contentious politics for academic and general audiences. Her book on the gendered politics of the postwar student movement in Japan, entitled Co-Ed Revolution: The Female Student in the Japanese New Left, is forthcoming with Duke University Press.  1 Japanese names are written according to Japanese conventions, with last name first, except in cases in which the last names are published last in scholarly journals and English-language publications.  3 “ ‘Daibaashiti suishin honbu kaisetsu kinen, Tokyo Ika Daigaku danjo kyōdō sankaku sokushin seminaa’ ga 1-gatsu 11-nichi ni kaisai saremashita [‘Commemoration of the founding of the diversity promotion headquarters, Tokyo Medical University gender equality promotion seminar’ held on January 11th]” Tokyo Medical University website (January 13, 2017) (accessed August 10, 2018).  4 “Tokyo Idai ni ‘josei katsuyaku’ hojo 8000 man en genten giwaku no jiki, kuni kara 3 nen de kōfu [Tokyo Medical University received a government grant of 800 million yen for three years to support “women’s activities,” a period in which it is suspected of reducing scores]”Tokyo shimbun (August 4, 2018) (accessed August 6, 2018).  7 Hara Kimi, “Joshi kyōiku no tenkai to shakai hendō [The development of women’s education and social change]” in Shakai hendō to kyōiku [Social change and education] (Tokyo: Tokyo Daigaku Shuppankai, 1976), 51–69; Nobuyuki Kuroda and Michiko Tanaka, Joshi gakusei [Women’ s education] (Tokyo: San’ichi Shobo, 1969), 158–161.  11 “Government cuts off subsidies to Tokyo Medical Unviersity over entrance exam discrimination” The Japan Times (January 22, 2019) (Accessed January 30, 2019)  12 Kyoko Nomura, Yuki Yamazaki, Larry Gruppen, Saki Horie, Masumi Takeuchi, Jan Illing. “The difficulty of professional continuation among female doctors in Japan: a qualitative study of alumnae of 13 medical schools in Japan.” BMJ Open (2015), 5(3): 1-7.  13 “Japan crawls up to 110th in global gender gap ranking but women’s participation still low” Mainichi Japan (December 18, 2018) (Accessed January 30, 2019)  14 Tanaka Shino, Kinkozan Masako. “Tōkyō idai dake janai? Nyūshi de no danjo sabetsu. Ishira ga shōgen “idai zentai ni aru to makoto shiyaka ni uwasasareteita” [Not just Tokyo Medical University? Gender discrimination in entrance examinations. Doctors’ testimony: ‘There are plausible rumors that it happens at all medical universities’]” Huffpost Japan (August 2, 2018) (Accessed January 30, 2019)  17 Koichiro Yuji, Seiya Imoto, Rui Yamaguchi, et al. “Forecasting Japan’s Physician Shortage in 2035 as the First Full-Fledged Aged Society” PLOS ONE (2012), 7(11).  18 Yasuhiro Mizuno, Hiroto Narimatsu, Yuko Kodama, Tomoko Matsumura, Masahiro Kami. “Mid-career changes in the occupation or specialty among general surgeons, from youth to middle age, have accelerated the shortage of general surgeons in Japan.” Surgery Today (2014) 44: 601-606.  20 “Josei ishi no kinmu kankyō no genkyō ni kan-suru chōsa hikaku shōsai han [Investigation into present conditions of women doctors work environment: comparative detailed edition]” Nihon ishikai danjo kyōdō sankaku iinkai / Nihon ishikai josei ishi shien sentaa [Japan Medical Association gender equality plannning committee / Japan Medical Association women doctor support center] (June 2009) (accessed on 20 November 2018)  21 “Ishi 65% ‘joshi genten rikai dekiru’ jinzai kaisha netto chōsa [65% of doctors: ‘understand reducing women’s scores’ on an HR recruitment agency’s online survey]” Asahi shimbun (August 8, 2018) (Accessed August 30, 2018).  22 “Josei ishi kyaria shien moderu fukyū suishin jigyō no seika to kongo no torikumi ni tsuite / shiryō 3 [On the results and future initiatives of the project to promulgate and promote career support for female doctors / document 3]” Ministry of Health, Labour and Welfare (March 14, 2018) (accessed November 20, 2018)  23 Ryoko Ogawa, Emiko Seo, Takami Maeno, Makoto Ito, Masaru Sanuki, Tetsuhiro Maeno. “The relationship between long working hours and depression among first-year residents in Japan.” BMC Medical Education (2018) 18: 50.  24 Tetsuhiro Maeno, Asumi Nakamura, Takami Maeno, et al. “Shinrinshō kenshū seido ni okeru kenshūi no sutoresu [Resident stress in the new postgraduateclinical training system].” Igaku kyōiku [Medical Education]. (2008) 39(3): 175–82.  26 Liselotte Dyrbye, Sara Burke, Rachel Hardeman “Association of Clinical Specialty with Symptoms of Burnout and Career Choice Regret Among US Resident Physicians” JAMA 2018 320(11): 1114-1130.  29 Sakamoto H., Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. “Japan Health System Review” Asia Pacific Observatory on Health Systems and Policies. Health Systems in Transition Series (Vol 8, No 1): 72, 86.  33 Yasuharu Tokuda, Keiko Hayano, Makiko Ozaki, Seiji Bito, Haruo Yanai, Shunzo Koizumi “The Interrelationships between Working Conditions, Job Satisfaction, Burnout and Mental Health among Hospital Physicians in Japan: a Path Analysis” Industrial Health (2009) 47: 166-172.  34 Kato Ken, Kazunobu Yamauchi, Makoto Miyaji, et al “Factors relating to doctor’s desire to change hospitals in Japan.” International Journal of Health Care Quality Assurance. Vol. 25, No. 1 (2012): 19-40, 35.  36 Scott North, “Karōshi Activism and Recent Trends in Japanese Civil Society” in Going to Court to Change Japan: Social Movements and the Law in Contemporary Japan. Ed. Patricia Steinhoff (Center for Japanese Studies, The University of Michigan: 2014): 45-72, p. 47.  37 “Josei ishi kyaria shien moderu fukyū suishin jigyō no seika to kongo no torikumi ni tsuite / shiryō 3 [On the results and future initiatives of the project to promulgate and promote career support for female doctors / document 3]” Ministry of Health, Labour and Welfare (March 14, 2018) (accessed November 20, 2018)  38 “Josei ishi kyaria shien moderu fukyū suishin jigyō no seika to kongo no torikumi ni tsuite / shiryō 3 [On the results and future initiatives of the project to promulgate and promote career support for female doctors / document 3]” Ministry of Health, Labour and Welfare (March 14, 2018) (accessed November 20, 2018)  39 “Josei ishi no kinmu kankyō no genkyō ni kan-suru chōsa hikaku shōsai han [Investigation into present conditions of women doctors work environment: comparative detailed edition]” (https://www.med.or.jp/joseiishi/2018hikakusyosai.pdf) Nihon ishikai danjo kyōdō sankaku iinkai / Nihon ishikai josei ishi shien sentaa [Japan Medical Association gender equality plannning committee / Japan Medical Association women doctor support center] (June 2009) (accessed on November 20, 2018)  40 Kosuke Yasukawa and Kyoko Nomura. “Ishi ni okeru seibetsu yakuwari bundan: shinryō jikan to kaji rōdō jikan no danjo kikaku [The division of labour by sex among Japanese physicians: comparison between men and women in time spent on clinical care a and time spent on housework]” Igaku kyōiku [Medical Education] (2012): 42: 315-319.  41 Aoki Hiroe, Hoshino Naoko, Kanda Asuka et al. “Danjo igakusei wa dono yōna kyaria ninshiki o yūshiteiru no ka? Intabyū chōsa kara miete kita mono [How do male and female medical students perceive their own career? Implications from a student viewpoint]” Nihon puraimari kea rengō gakkaishi [Journal for the Japanese Primary Care Association] (2016) 39(4): 191-204.  43 “Women make up most of the health sector workers but they are under-represented in high-skilled jobs.” OECD (March 2017) (accessed November 20, 2018).  44 Yusuke Tsugawa, Anupam Jena, Jose Figueroa, John Orav, Daniel Blumenthal, Ashish Jha. “Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.” JAMA Internal Medicine (Feb. 2017) 117:2: 206-213.  46 Kim C, McEven LN, Gerzoff BR, et al. “Is physician gender associated with the quality of diabetes care?” Diabetes Care. (2005) 28(7): 1594-1598; Berthold KH, Gouni-Berthold I, Bestehorn KP, Böhm M, Krone W. “Physician gender is associated with the quality of type 2 diabetes care.” J Intern Med. (2008) 264(4): 340-350.  47 Ed Yong, “Women more likely to survive heart attacks if treated by female doctors” The Atlantic (August 6, 2018) (accessed August 15, 2018)  49 Ken Kato, et al “Factors relating to doctor’s desire to change hospitals in Japan.” International Journal of Health Care Quality Assurance. Vol. 25, No. 1 (2012): 19-40, 12.  50 “191 multiple refusals of pregnant women found.” The Japan Times (Sept. 28, 2007) (Accessed Nov. 20, 2018) In the United States, the law requires all hospitals with emergency rooms to care for women in labor, although some rural facilities without obstetrics units violate this law. Julie Lasson-Fromowitz, “Despite law, hospitals turn away women in labor” Courier Journal (March 3, 2017) (Accessed March 1, 2019)  51 Relative poverty means that a household earns an income that is less than fifty percent of the average median incomes.  52 Alana Semuels, “Japan is no place for single mothers” The Atlantic (September 7, 2017) (accessed August 8, 2018).  53 Seiichi Inagaki. “Dynamic Microsimulation Model of Impoverishment Among Elderly Women in Japan” Frontiers in Physics (March 14, 2018) (accessed September 10, 2018).  54 Abe Shinzō, “Opening Speech by H.E. Shinzo Abe, Prime Minister of Japan, at the Open Forum, World Assembly for Women in Tokyo” (presented at the World Assembly for Women, Tokyo, Japan, September 12, 2014).  55 There is not an equivalent group for “female leaders,” but the Gender Equality Bureau began holding events to train women for leadership in 2017. “Josei riidaa ikusei [Training female leaders]” Gender Equality Bureau Cabinet Office (accessed December 4, 2018).  57 “Jutendo and Showa universities’ medical faculties suspected of rigging entrance exam results based on gender” () Japan Times (October 14, 2018) (accessed December 3, 2018)  58 Yajima Daisuke and Doi Shinpei “Nichidai igakubu to kantō no shidai, futekisetsu nyūshi ka monkashōga shiteki [Ministry of Science and Education identifies inappropriate entrance exams at Nihon University’s medical faculty, private universities in the Kantō region]” Asahi shimbun digital (December 12, 2018) (Accessed January 31, 2019


liveaction--2019-12-18--Former abortion workers: Staff with no medical training a common problem at abortion centers

Former abortion workers have admitted their facilities endangered women by hiring untrained workers to perform medical tasks. Two former abortion workers, Noemi and Jayne, told their stories in a webcast sponsored by And Then There Were None. Noemi described how syringes were filled in advance, administered without any regard for woman’s weight or medical history, and prepared by untrained workers.  Jayne, who worked at Planned Parenthood of Delaware, was asked whether workers at her facility were also untrained. She answered:  I witnessed that often…. There were not many qualified people. I thought that the phlebotomists were trained phlebotomists but they weren’t – they were just “Planned Parenthood trained”. Which means, they just trained them – how Planned Parenthood just guesses and says good, go ahead, you can stick that needle in that person.  Other workers have said similar things. Tracy Jones, who worked for Dr. George Tiller, claimed that in his facility:  Front office employees were routinely called back to the medical area to assist medical employees with direct patient care without receiving any training in this area.  Untrained staff performed medical tasks such as “washing surgical instruments and wrapping them for autoclave [the machine that sterilizes instruments], operating the sonogram during surgery, explaining aftercare instructions to patients, and preparing specimens.”  In a videotaped conference, former abortion worker Hellen Pendley said she was put in charge of managing abortion complications even though she had no medical training:  I’m not a medical doctor, I’m not trained to evaluate a woman’s problems, postoperative hemorrhaging, etc. I have no skills to enable me to make that diagnosis and to prescribe the method of treatment, but that was required of me and I did it for three years. When they called me after hours and said, “I’m hemorrhaging, what can I do?” It was my problem, not the doctors. I was the person on call, I was one who called in all the drugs, I was the person who prescribed the medication.  This obviously put women’s health and lives at risk.  READ: Not just Gosnell: Former abortion workers say untrained staff is common  Joy Davis worked at two different abortion facilities. She says of the first facility, “Our people were not very well trained — most of them did not even have a medical background.”  While working at this facility, Davis was approached by abortionist Thomas Tucker, who wanted to start a new facility with trained staff and proper medical supervision. At first, the new facility employed competent people with medical licenses. But Tucker was unhappy with the amount of money he was making and began making cuts, firing trained employees and replacing them with untrained people, whom he could pay less:  He wasn’t making enough money, so the first thing to go was the anesthetist, because they made a lot of money. Through just the few months of watching them put patients to sleep, we started putting patients to sleep ourselves and we had no idea what we were doing. We just knew what we had seen them do, so we started doing it.  Then our registered nurses that worked in our recovery room were the next people to go. Then our lab technician and on and on.  Davis was given the job of hiring new employees who had no medical background. She also began to do medical procedures, including committing abortions herself, even though she had no training or license to practice medicine:  I started interviewing people that had no medical background at all, bringing them in to do the job of anesthetist, lab technicians, nurses and even physicians. … I brought in people off the street with no medical background and trained them….  I never spent the first day in medical school. I was just an ultrasound technician. I really knew nothing about medicine, other than what I had seen other doctors do, but I started doing abortions. I started actually performing surgery on women. I did Norplants, cryosurgery, pap smears, pelvic exams — anything he did, I did.  A woman died from a botched abortion under Davis’s care. Tucker knew the woman was in distress, but left to catch a plane, and Davis was unable to stop the woman’s bleeding by herself. By the time an ambulance was called, it was too late. The facility was eventually closed.  READ: Women at risk: Former abortion workers speak out about failed inspections  Pam Whitehead of And Then There Were None, who runs the website CheckMyClinic.org, which tracks failed inspections at abortion facilities, says untrained workers are a common issue:  Most of these facilities, what we see on their inspection reports are they have unqualified, uncertified, and untrained personnel… We see people pushing IV medications [who] were not certified, not trained, not qualified to be doing that.  She mentioned one untrained woman who posed as a nurse and worked at a facility for 20 years. It is unknown how many women were hurt at this facility.  Untrained workers at abortion facilities are all too common.  “Like” Live Action News on Facebook for more pro-life news and commentary!


naturalnews--2019-02-07--EVIL MEDICINE Med school uses live pigs for medical training completely disregarding ethics or suf

EVIL MEDICINE: Med school uses live pigs for medical training, completely disregarding ethics or suffering (this is how they treat humans, too)

(Natural News) Sometimes, doing things the “old-fashioned way” is the best approach — but when it comes to animal testing, the days of yore are best left behind us. In today’s world, there are plenty of alternatives to the cruel and unethical practice of testing on live animals. Now, Brown University is under fire for using live pigs in the course of medical training, even though experts say human body simulators are actually a better choice.  The Physicians Committee for Responsible Medicine (PCRM) is petitioning the USDA’s Animal and Plant Health Inspection Service, calling upon the agency to investigate animal use at Brown U’s Warren Alpert Medical School. PCRM is known for advocating against the use of live animals in any sort of medical training, favoring the use of human body simulators instead.  According to reports, the medical school is using live pigs for emergency medicine training.  Dr. John Pippin, director of academic affairs for PCRM, says that Brown U is violating the federal Animal Welfare Act because alternatives do exist. This means that the school’s use of live pigs is neither justifiable, nor unavoidable.  In the United States and Canada, the overwhelming majority of medical training programs exclusively use human-based training methods — some 90 percent. Instead of abusing living animals, these programs use human-body simulators and cadavers.  Pippin also says that Brown U’s animal care and use committee does not oversee the use of the pigs properly, which is another violation of the welfare act.  The power of the elements: Discover Colloidal Silver Mouthwash with quality, natural ingredients like Sangre de Drago sap, black walnut hulls, menthol crystals and more. Zero artificial sweeteners, colors or alcohol. Learn more at the Health Ranger Store and help support this news site.  “The purpose of all of these training programs, including at Brown, is to produce the best possible physicians in the field of emergency medicine. Everyone agrees on that,” Pippin contends.  “What I’m claiming, and I think I can prove, is the best way to do this does not include the use of animals.”  As Dr. Pippin, a cardiologist in Dallas, explains, alternatives to animal testing have many benefits. If students make a mistake while placing a chest tube, they can do it over again, for example. He contends further that human body models are more similar to humans than live pigs; pigs have thicker skin and their organs may be placed differently.  According to reports, a spokesperson from Brown U has stated that they knew nothing about PCRM’s complaint. There was no immediate response to questions about the school’s use of live animals, either.  Pippin says that when he first contacted the medical school, the residency director told him she wouldn’t have time to even consider the issue of animal testing alternatives for at least six months. After a few more failed attempts, Pippin went straight to the USDA.  The problem of animal testing remains widespread even today. In the past, many universities have been caught doing unspeakable things to the animals they test on — including operating on them without providing proper anesthesia and not providing animals with pain medication post-op.  Even the USDA has been in hot water for their cruel and highly contested medical experiments on kittens. In mid-2018, a shocking report revealed that the federal agency had senselessly murdered hundreds of innocent kittens following medical experiments.  A USDA spokesperson said that the kittens had been purposely infected with  Toxoplasma gondii, the parasite responsible for causing toxoplasmosis. The kittens were supposedly infected “in part” so the USDA can assist in the development of a vaccine for the infection.  Internal documents from the USDA show that up to 100 kittens are killed every year. Veterinary experts agree that a simple round of antibiotics is all it takes to treat toxoplasmosis in cats — which raises even more serious concerns about the USDA’s treatment of these animals.  Not only are they raising these kittens just to infect and kill them, they are killing kittens that could have easily been adopted.  See more coverage of stories like this at MedicalExtremism.com.


sottnet--2019-06-19--Women exceed men in fair exam for Juntendo University medical school

Female applicants outperformed their male counterparts in the entrance exam for Juntendo University's medical school, which had previously rigged the system to give men an unfair advantage toward admission.Of the 1,679 women who took the fiscal 2019 exam, 139, or 8.28 percent, passed. Among the men, 170 of 2,202 applicants passed the exam for a success rate of 7.72 percent, Juntendo University said on June 17. It was the first time in seven years for women to have a higher pass rate than men at the private university in Tokyo. "This is a result of abolishing the unfair treatment of female applicants and repeat applicants," the university said in a statement.The dean of Juntendo University's medical school in December last year raised a few eyebrows when he tried to justify the rigging of the exam system.he said at a news conference.The university said it corrected its unfair practices for the fiscal 2019 exam and added female teachers to the teams that conducted interviews with the applicants.From fiscal 2013 to 2018, an average of 9.16 percent of male applicants passed the medical school's exam, far exceeding the rate of 5.50 percent among female applicants.The men's success rate was 1.67 times higher than that for women, the largest gap among 81 university medical schools in Japan that were investigated by the education ministry.In fiscal 2018, the male pass rate was 1.93 times higher than the rate for females trying to enter Juntendo University's medical school.Under the fair exam for fiscal 2019, the women's success rate was 1.07 times higher than that for men.Overall, the male applicants' pass rate was 11.89 percent, 1.08 times higher than 10.99 percent for female applicants.For the fiscal 2018 exams, the men's pass rate was 1.22 times higher than the rate for women.


truepundit--2019-04-10--University To Stop Considering Race In Medical School Admissions

A Texas Tech University System school plans to stop considering race when admitting medical students.  Texas Tech University Health Sciences Center (TTUHSC)’s School of Medicine will end affirmative-action as part of an agreement made with the Education Department’s Office of Civil Rights (OCR) in February, The Wall Street Journal reported Tuesday. The deal ends a 14-year investigation that began in 2005 after anti-affirmative action group Center for Equal Opportunity complained.  The resolution agreement “does not constitute an admission by TTUHSC” of any violations or laws enforced, but is meant to address “compliance concerns.”  The university plans to take out material mentioning race and national origin as admission factors by Sept. 1, according to the resolution agreement.  The school stopped raced-based admission in its pharmacy school in 2008 and in undergraduate admissions in 2013. The medical school, however, said considering race in admissions would allow Texas to have diverse doctors who could serve various communities, WSJ reported.  “The more schools that don’t use racial preferences, the harder it is for the remaining schools to justify their use of it,” general counsel of Center for Equal Opportunity Robert Clegg said, WSJ reported.  Education Department spokeswoman Liz Hill said the school chose to stop using race altogether, but the organization was not requiring the institution to completely halt race consideration, according to The Washington Post. TTUHSC can resume race consideration with limits, however.  The OCR has opened investigations into Yale and Harvard University over alleged discrimination against Asian-American applicants, according to WSJ.  The U.S. Supreme Court has revisited affirmative action in college admissions several times since the 1970s. The court upheld raced-based admissions by a 4-3 vote in 2016. Retired Justice Anthony Kennedy, however, wrote that colleges must go over the “positive and negative” results of their affirmative action policies regularly.  TTUHSC did not immediately respond to The Daily Caller News Foundation’s request for comment.  Content created by The Daily Caller News Foundation is available without charge to any eligible news publisher that can provide a large audience. For licensing opportunities of our original content, please contact [email protected]


npr--2019-01-20--Medical Students Push For More LGBT Health Training To Address Disparities

Medical Students Push For More LGBT Health Training To Address Disparities  When Sarah Spiegel was in her first year at New York Medical College in 2016, she sat in a lecture hall watching a BuzzFeed video about what it's like to be an intersex or a transgender person.  "It was a good video, but it felt inadequate for the education of a class of medical students, soon to be doctors," says Spiegel, now in her third year of medical school.  The video, paired with a 30-minute lecture on sexual orientation, was the only LGBT-focused information Spiegel and her fellow classmates received in their foundational course.  "It's not adequate," Spiegel remembers thinking. By her second year, after she became president of the school's LGBT Advocacy in Medicine Club, she rallied a group of her peers to approach the administration about the lack of LGBT content in the curriculum.  Spiegel says administrators were "amazingly receptive" to her presentation, and she quickly gained student and faculty allies. As a result, the school went from one and a half hours of LGBT-focused content in the curriculum to seven hours within a matter of two years, according to Spiegel. Spiegel says she doesn't think the change would have happened had the students not pushed for it.  According to a number of studies, medical schools do a poor job of preparing future doctors to understand the LGBT population's unique needs and health risks. And, a 2017 survey of students at Boston University School of Medicine found their knowledge of transgender and intersex health to be lesser than that of LGB health.  Meanwhile, LGBT people — and transgender people in particular – face disproportionately high rates of mental illness, HIV, unemployment, poverty, and harassment, according to Healthy People 2020, an initiative of the U.S. Department of Health and Human Services. And a poll conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health found 1 in 5 LGBT adults has avoided medical care due to fear of discrimination.  "The health of disparity populations is something that really should be the focus of health profession students," says Dr. Madeline Deutsch, an associate professor of family and community medicine at the University of California, San Francisco. Deutsch directs UCSF's Transgender Care program, and she says medical schools already do a fairly good job of addressing some disparities, like those based on race, ethnicity, and socio-economic status.  But, she says, "Sexual and gender minorities have historically been not viewed as a key population, and that's unfortunate because of the size of the population, and because of the extent of the disparities that the population faces." (About 0.6 percent of the U.S. population – or 1.4 million adults – identifies as transgender.)  The extent of LGBT education medical students receive varies greatly, but a 2011 study found that the median time spent on LGBT health was five hours. The topics most frequently addressed include sexual orientation, safe sex, and gender identity, whereas transgender-specific issues, including gender transitioning, were most often ignored. And some medical students receive no LGBT education at all.  "There's not really a consistent curriculum that exists around this content," says Deutsch.  As a result, physicians often feel inadequately trained to care for LGBT patients. In a 2018 survey sent out to 658 students at New England medical schools, around 80 percent of respondents said they felt "not competent" or "somewhat not competent" with the medical treatment of gender and sexual minority patients.  Even at UCSF, which has long been at the forefront of LGBT health care, Deutsch says there's still a need to insert more transgender health care into the mandatory curriculum. Right now, when medical schools teach about LGBT health issues, it's usually through special elective courses or lectures taught at night or during lunch, and often by the students themselves.  "How do we take it out of the lunchtime unit?" asks Jessica Halem, the LGBT program director at Harvard Medical School. That question drives Harvard Medical School's new Sexual and Gender Minorities Health Equity Initiative, a three-year plan to assess the core medical school curriculum and to identify opportunities to better instruct on the health of sexual and gender minorities.  "Students are getting the information. But some of them are having to do a lot of extra work to get that during their medical school experience," says Halem.  The Harvard initiative, announced in December 2018, has been ongoing for about six months, says Halem, thanks to a $1.5 million gift from Perry Cohen, a transgender man. According to Halem, Cohen hopes that Harvard's learnings will be shared with medical schools across the country, especially with ones with less robust LGBT health education programs.  Studies have shown that when medical students learn about transgender health issues, they feel better equipped to treat transgender patients. For example, when Boston University School of Medicine added transgender health content to a second-year endocrinology course, students reported a nearly 70 percent decrease in discomfort with providing transgender care.  And now, Halem says, each incoming class at Harvard Medical School is increasingly adamant that they learn about LGBT health.  "The main first driver truly was medical students organizing and saying 'Hey, I need the curriculum to reflect the kind of medicine that I came here to study,' " Halem says.  Those were the thoughts running through Spiegel's head in her own preclinical years at New York Medical College. Shortly after becoming the president of her school's LGBT health club, she joined The American Medical Student Association's Gender and Sexuality Committee as the LGBTQ Advocacy Coordinator to bring curricular change to other medical schools in the New York area.  Conversations with her transgender partner also inspired Spiegel to introduce more trans-specific topics into her school's curriculum.  "His experience definitely varied by how much providers knew," Spiegel says. It was often as simple as getting his pronouns correct, she says, and even then, the same doctors' office would mess that up again and again.  Spiegel says in the past couple of years, certain disciplines have added trans-focused topics into their specialties. In the school's behavioral health unit, for example, professors have started to address how doctors can diagnose gender dysphoria – when a person feels their assigned gender does not align with their gender identity – in their lectures.  By contrast, some disciplines have been more hesitant to change, or add content to, their existing curriculum. Spiegel's student task-force had more difficulty influencing the pharmacology department, for example. That's the content area where hormone therapy might be taught, Spiegel says.  One course includes a lecture about the endocrine system, Spiegel says, when the professor talks about a drug to treat precocious, or early puberty. That drug can also be used for kids undergoing transgender hormone therapy. Therefore, Spiegel says, including transgender health in the lecture might be a matter of just saying an extra sentence.  "There's an opportunity there – they would just have to mention that it could also be used for transgender kids," says Spiegel.  But the professor says this secondary use of the drug was "off the book," and thus, he wouldn't include it in his lecture. So Spiegel researched the drug herself, and sent the professor the Endocrine Society's guidebook that talked about how the drug can be used for transgender patients. He began including the information in his lectures.  Spiegel says her interactions with this professor exemplify the challenges that medical students all over the country face when trying to introduce changes to their schools' curricula.  "We're getting there, but it's slow," says Spiegel.


buzzfeed--2019-06-04--This Is What 10 Doctors And Medical Students Think About Abortion Rights

"I left and got my medical training ... and now I’m back to serve the women of Alabama, and they deserve better."  With the recent rash of states restricting abortion rights, doctors are often left out of the conversation around this highly politicized medical procedure. Photographer Melissa Golden attended the March for Reproductive Freedom in Birmingham, Alabama, on May 19, 2019, and spoke with doctors and medical students about their views on the new restrictions. Here are their thoughts.  “I’m here for one reason: advocating for my patients and just making sure that they have the rights to get a safe abortion in the future. Nobody should have that right taken away from them.”    “I was born in Alabama, I grew up here. I left and got my medical training in other parts of the country — and now I’m back to serve the women of Alabama, and they deserve better. That’s why I’m here today."    “I decided to become an abortion provider when I was in Africa in a country that had an abortion law that is very similar to the one that Alabama just passed, and I saw a woman die from an unsafe abortion. … It is an absolute honor and a privilege to get to do what I do. "I have trained most of my adult life to learn how to take care of women at every stage of their life, whether that’s when they are 12 and getting their first period, if they’re 35 and having a hard time getting pregnant, if they are in their twenties and having a baby for the first time, or they’re in their sixties and they’re being diagnosed with cancer — it’s an absolute honor to get to take care of women during every single part of their reproductive life. "Abortion is just as much a part of that as any of those other absolutely incredible milestones and parts of their life. If we the physicians who understand the nuances and the importance of abortion don’t stand up for our patients, then who’s gonna do it?”    “I’m a GYN oncologist at UAB Birmingham and I did my residency at Columbia, where I was very involved in family planning there and [I] owe a ton to the women who trained me to be able to safely give abortions to first and second trimester women who need them. "I continued my passion in women’s health care and as an oncologist. The fact that I could potentially have a woman with cervical cancer or some other type of cancer in their first trimester and not have the option to cure them because of a law — and if I did I would go to jail for 99 years — is extremely upsetting. So I’m here to represent women, my patients, my colleagues.”    “I’m here today as a women’s health care provider. Crazily, this is the first time I’ve actually been to a rally or march of any sort and it’s been a really impactful experience, and I’m here trying to fight for women’s safety and the ability for them to make evidence-based, patient-centered decisions about their health care, including their reproductive freedoms.”    “I’m really passionate about women’s health, about women’s issues and women’s rights, so that’s why I’m here today. I came to medical school and I wanted to be a physician because I really cared about women and their health care, and I care about everyone in general. I really wanted to impact the state of Alabama and its health care, so that’s why I’m here today — because I’m really passionate about it. "I wanted to say that abortion is health care, obstetrics is health care, and contraception and family planning is health care.”    “I’m here today because I think as a future physician I have an obligation to be informed on issues that affect our patients, and I also have an obligation to stand up for what’s right for them. So whether that’s abortion, whether that’s expanding Medicaid, whether it’s access to quality education — all those affect my patients’ health and so I think that I should be an active participant in the discussions.”


drudgereport--2019-07-25--SHORTAGE Medical students less likely to become primary care doctors

SHORTAGE: Medical students less likely to become primary care doctors...

Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields.  A record-high number of primary care positions was offered in the 2019 National Resident Matching Program — known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourth-year medical students was the lowest on record.  “I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said.  The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family medicine and pediatrics.  In their final year of medical school, students apply and interview for residency programs in their chosen specialty. The Match, a nonprofit group, then assigns them a residency program based on how the applicant and the program ranked each other.  Since 2011, the percentage of U.S.-trained allopathic, or M.D., physicians who have matched into primary care positions has been on the decline, according to an analysis of historical Match data by Kaiser Health News.  But, over the same period, the percentage of U.S.-trained osteopathic and foreign-trained physicians matching into primary care roles has increased. 2019 marks the first year in which the percentage of osteopathic and foreign-trained doctors surpassed the percentage of U.S. trained medical doctors matching into primary care positions.  Medical colleges granting M.D. degrees graduate nearly three-quarters of U.S. students moving on to become doctors. The rest graduate from osteopathic schools, granting D.O. degrees. The five medical schools with the highest percentage of graduates who chose primary care are all osteopathic institutions, according to the latest U.S. News & World Report survey.  Beyond the standard medical curriculum, osteopathic students receive training in manipulative medicine, a hands-on technique focused on muscles and joints that can be used to diagnose and treat conditions. They are licensed by states and work side by side with M.D.s in physician practices and health systems.  Although the osteopathic graduates have been able to join the main residency match or go through a separate osteopathic match through this year, in 2020 the two matches will be combined.  Physicians who are trained at foreign medical schools, including both U.S. and non-U.S. citizens, also take unfilled primary care residency positions. In the 2019 match, 68.9% of foreign-trained physicians went into internal medicine, family medicine and pediatrics.  But, despite osteopathic graduates and foreign-trained medical doctors taking up these primary care spots, a looming primary care physician shortage is still expected.  The Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032. More doctors will be needed in the coming years to care for aging baby boomers, many of whom have multiple chronic conditions. The obesity rate is also increasing, which portends more people with chronic health problems.  Studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality. Patients who regularly see a primary care physician also have lower health costs than those without one.  But choosing a specialty other than primary care often means a higher paycheck.  According to a recently published of physicians conducted by Medscape, internal medicine doctors’ salaries average $243,000 annually. That’s a little over half of what the highest earners, orthopedic physicians, make with an average annual salary of $482,000. Family medicine and pediatrics earn even less than internal medicine, at $231,000 and $225,000 per year, respectively.  Dr. Eric Hsieh, the internal medicine residency program director at the University of Southern California’s Keck School of Medicine, said another deterrent is the amount of time primary care doctors spend filling out patients’ electronic medical records.  “I don’t think people realize how involved electronic medical records are,” said Hsieh. “You have to synthesize everything and coordinate all of the care. And something that I see with the residents in our program is that the time spent on electronic medical records rather than caring for patients frustrates them.”  The Medscape survey confirms this. Internists appear to be more burdened with paperwork than other specialties, and 80% of internists report spending 10 or more hours a week on administrative tasks.  The result: Only 62% of internal medicine doctors said they would choose to go into their specialty again — the lowest percentage on record for all physician specialties surveyed.  Elsa Pearson, a health policy analyst at Boston University, said one way to keep and attract primary care doctors might be to shift some tasks to health care providers who aren’t doctors, such as nurse practitioners or physician assistants.  “The primary care that they provide compared to a physician is just as effective,” said Pearson. They wouldn’t replace physicians but could help lift the burden and free up doctors for more complicated care issues.  Pearson said more medical scribes, individuals who take notes for doctors while they are seeing patients, could also help to ease the doctors’ burden of electronic health record documentation.  Another solution is spreading the word about the loan forgiveness programs available to those who choose to pursue primary care, usually in an underserved area of the country, said Dr. Tyree Winters, the associate director of the pediatric residency program at Goryeb Children’s Hospital in New Jersey.  “The trend has been more so thinking about the amount of debt that a student has, compared to potential income in primary care,” said Winters. “But that’s not considering things like medical debt forgiveness through state or federal programs, which really can help individuals who want to choose primary care.”


theguardianuk--2019-07-06--Edinburgh gives female medical students their degrees 150 years late

Edinburgh gives female medical students their degrees – 150 years late

Seven women who were among the first females to be admitted to a British university have been awarded posthumous degrees 150 years after they started their studies.  The group, known collectively as the Edinburgh Seven, enrolled to study medicine at the University of Edinburgh in 1869. But they faced substantial resistance from their male peers and were ultimately prevented from graduating and qualifying as doctors.  Their campaign against their treatment won them national attention and prominent supporters such as Charles Darwin. In 1877, legislation was introduced to ensure women could study at university.  The seven women – Mary Anderson, Emily Bovell, Matilda Chaplin, Helen Evans, Sophia Jex-Blake, Edith Pechey and Isabel Thorne – were awarded posthumous honorary bachelor of medicine degrees as part of a ceremony at the university’s McEwan Hall.  Seven female students from Edinburgh Medical School picked up the certificates on their behalf, with the graduation among a number of events being held by the university to honour the achievements of the women.  Simran Paya, a third-year medical student who collected an award on behalf of Jex-Blake, said: “We are honoured to accept these degrees on behalf of our predecessors, who are an inspiration to us all.”  Prof Peter Mathieson, the principal and vice-chancellor at the University of Edinburgh, said: “We are delighted to confer the degrees rightfully owed to this incredible group of women.  “The segregation and discrimination that the Edinburgh Seven faced might belong to history, but barriers still exist that deter too many talented young people from succeeding at university. We must learn from these women and strive to widen access for all who have the potential to succeed.”


eveningstandard--2019-01-16--First-year medical student delivers his first baby at Warren Street Tube station

A medical student has delivered his first baby — at a Tube station.  Hamzah Selim, 21, came to the aid of the woman after hearing her cries at Warren Street station yesterday afternoon.  The first-year UCL student told the Evening Standard how he saw the mother leaning against a wall by a Northern line platform.  After rushing over to her, he realised she was in the middle of giving birth.  “It was just instinct,” he said. “The whole experience was unbelievable. It was such a mad coincidence.”  Mr Selim was about to take the Tube home after an anatomy lecture at the nearby UCL campus when he heard the woman in distress.  He said the mother told him she had been on a shopping trip with her sister and had to take the Tube when she failed to flag down a taxi.  She realised she was going into labour in front of passengers shortly before 2pm, and she told him she had given birth to three other children.  Mr Selim told the Standard: “I heard one of them shout for help. There was this woman standing there, screaming for help.  “I went over to help because it looked like she was about to faint.  “I thought ‘Oh my goodness, they didn’t teach us how to do this — how to give birth on the Tube’.”  Mr Selim said his training from the time he spent working on a maternity ward kicked in.  “The mum did absolutely great given it was the first birth I was involved in outside the textbook,” he added  Paramedics came a few minutes after the boy was born and cut the umbilical cord, Mr Selim said.  The child was later taken to hospital by medics.  A Transport for London spokesman added: “We’d like to thank the staff at Warren Street station, who did a fantastic job in assisting the customer who gave birth.  “London Ambulance Service attended and both mother and child were taken to hospital."


birminghammail--2019-04-05--Incredible new BBC series shows inspirational Birmingham surgeons remove AWAKE patients brain tumou

Incredible new BBC series shows inspirational Birmingham surgeons remove AWAKE patient's brain tumour

A series showing what goes on in a Birmingham hospital's operating theatres is returning to BBC Two.  Surgeons: On The Edge of Life is back for a second series and shows viewers what goes on on the operating table whilst you're asleep.  Or in one patient's case, whilst you're still awake!  The first episode shows surgeons operating on a 20-year-old man with a brain tumour but in order for the consultant neurosurgeon to remove as much of the tumour as possible, the patient must be awake and talking.  Viewers get a behind the scenes look at how different members of the NHS have to work together during the awake craniotomy, including a speech therapist.  Part of the therapist's job is to prompt the patient to talk and perform word tasks whilst the surgeon probes the patient's brain using electrical stimulation.  Whenever the man's speech is affect, the surgeon knows he must avoid that area of brain tissue when removing the tumour.  But having your brain operated on whilst you're awake is, understandably a scary experience and when the patient becomes distressed the surgeon has to pause the procedure.  Brain surgery isn't the only complex operation we see in the first episode.  Viewers will also see a consultant cardiac surgeon take on a risky aorta repair on a 71-year-old woman.  The patient's aorta is described as a "timebomb" and could rupture at any moment, so the surgeon has to open up her entire torso to perform one of the most extreme operations the body can handle.  The six-part series was filmed at Queen Elizabeth Hospital Birmingham and made by Dragonfly Film and Television Productions - the same producers who made Ambulance and One Born Every Minute.  Surgeons: On The Edge of Life will air on BBC Two at 9pm on Tuesday April 9, 2019.


birminghammail--2019-04-23--Birmingham surgeons remove womans six stone growth hanging below knees in BBC2 documentary

Birmingham surgeons remove woman's six stone growth hanging below knees in BBC2 documentary

The latest episode of a brand-new BBC documentary showcasing Birmingham surgeons will question whether a risk is worth taking.  In this week's episode of BBC2's Surgeons At the Edge of Life consultant plastic and reconstructive surgeon Sunil Thomas will perform the largest tissue removal ever carried out at the Queen Elizabeth Hospital.  The operation is for a patient, named Judy, who requires surgery to remove a huge growth on her abdomen.  This apron of excess tissue is thought to weigh around six stone and hangs down below her knees, leaving her to live a severely restricted life.  The operation brings with it unprecedented challenges for Sunhil and the 15-strong surgical team.  At the same time, consultant neurosurgeon and spinal surgeon Navin Furtado will attempt radical corrective surgery on a patient's back.  It involves breaking Chris's spine to remove a wedge of bone from one of his vertebrae, and then realigning his back using an extensive array of metalwork.  The operation is within millimetres of his spinal chord and risks damaging important nerves, or worse, paralysing him.  But if it goes well, Chris could eventually live a pain free life and walk again.  Surgeons: At The Edge Of Life is on BBC Two on Tuesdays at 9pm.


birminghammail--2019-05-07--Birmingham surgeons remove womans oesophagus and use stomach to replace it in BBC2 documentary

Birmingham surgeons remove woman's oesophagus and use stomach to replace it in BBC2 documentary

The latest episode of a BBC documentary showcasing Birmingham surgeons will see a woman have her oesophagus removed and replaced by stretching her stomach.  BBC2's Surgeons: At the Edge of Life introduces AnnMarie who was just a toddler when she accidentally drank bleach and severely damaged her oesophagus.  She's been struggling to cope ever since and has to visit hospital several times a year to have her oesophagus stretched.  It's an uncomfortable procedure and has led the 44-year-old to opt for an oesophagectomy.  It's a high operation and carries a 30% chance of patients suffering serious post-operative complications.  Carrying out the procedure is one of the Queen Elizabeth’s leading Consultant Upper Gastro-Intestinal surgeons, Ewen Griffiths.  He's spent years mastering what is one of the most complex and risky operations in his field.  In this three-stage procedure, the patient’s oesophagus – the 25-centimetre feeding tube, which joins the throat to the stomach - is removed and their own stomach is used to replace it.  The procedure can last up to eight hours and involves three different operating sites in the neck, chest and abdomen.  It's hoped the risky procedure will enhance AnnMarie's life.  Meanwhile, Simon Radley a consultant colorectal sugeon also performs highly specialised operations in his field of complex colorectal cancer.  His patient is 64-year-old retired grandmother Hazel, who has a colon tumour that's spread into her liver and abdominal wall.  Without the operation Hazel will have only a few months to live, but there's a possibility that surgery could remove the cancer entirely and cure Hazel of her disease.  It’s not yet clear if the cancer has advanced into other internal organs and Simon will only find out once he operates.  If it's spread further, then Simon knows he won't be able to remove it entirely but if it's confined to the bowel, liver and abdominal wall then it could be removed completely.  Surgeons: At The Edge Of Life is on BBC Two on Tuesdays at 9pm.


eveningstandard--2019-01-09--Former BBC war correspondent Martin Bell tells how surgeons rebuilt his shattered skull after he tri

Former BBC war correspondent Martin Bell tells how surgeons rebuilt his shattered skull after he tripped over suitcases at Gatwick

Former BBC war correspondent Martin Bell had his face rebuilt by surgeons after tripping over his suitcases at Gatwick airport.  Mr Bell, 80, a former independent MP known as the man in the white suit, “face planted” into the concrete floor at the airport’s train ticket office concourse.  He said he resembled “Dracula’s grandfather” after fracturing his right maxilla bone, right and left eye sockets, nose and an area at the base of his skull.  Today he joked that he looked younger and “like I’ve had Botox” as a result of two-and-a-half hours of NHS reconstructive surgery at St George’s hospital, in Tooting.  He said: “I have come through 18 wars almost unscathed and I trip up at a railway station. I have no-one else to blame for this. I feel a complete idiot.”  The incident happened on November 5 as Mr Bell returned from a cruise to publicise his new book, War And The Death Of News. One of the suitcases had been full of books, which he sold on board the ship.  He was taken to East Surrey hospital, in Redhill, before being transferred three days later to St George’s, a specialist maxillofacial centre, for surgery.  “I was not a pretty sight,” he said. “I looked like Dracula’s grandfather.”  Mr Bell, who served as MP for Tatton from 1997-2001 and later became a Unicef humanitarian ambassador, is best known for his coverage of the Vietnam and Gulf wars and the Bosnia conflict in the early Nineties, when he was wounded by shrapnel while reporting in Sarajevo.  The operation was carried out by a team led by Helen Witherow, consultant oral and maxillofacial surgeon.  She said Mr Bell had suffered a “phenomenal amount” of damage. She used a surgical saw to cut through his left maxilla to reposition his jaw bones and ensure his teeth met correctly.  Four surgical plates and 16 screws were used to re-attach his upper mouth to his jawbone and repair the fractures.  “I have never seen anyone sustain these type of fractures,” Miss Witherow said. “This is a high impact car injury-type fracture.  “The surgery involved repairing Mr Bell’s fractures using titanium plates and screws, and these remain in place permanently. We are pleased to hear he is so well, and so positive about his experience of the care our team provided.”  Mr Bell, who lives in Hampstead, said he “wanted to sing the praises” of the staff who cared for him at East Surrey and St George’s.  “I have not led a sheltered life, but like most people I know little about the specialist branches of medicine until I come to need them, usually at short notice,” he said.  “So it was with maxillofacial surgery and the people who practice it – and we are truly lucky to have them.”