Satoshi Umemura Meets Inspiring Individuals by Lohas Medical (Part 2 of 2)

In a recent discussion, Dr. Satoshi Umemura, a member of the House of Representatives and an internal medicine physician, engaged with Dr. Tetsuya Tanimoto, Director of Navitas Clinic Kawasaki, to explore strategies for supporting patient autonomy.

Dr. Tetsuya TanimotoDr. Tanimoto graduated from Kyushu University School of Medicine in 1997. He has served at the National Cancer Center Hospital and Tottori University Hospital. From 2007 to 2012, he was a medical reviewer at the Pharmaceuticals and Medical Devices Agency (PMDA). Currently, he is the chairman of the Accessible Railway Medical Services Tetsuikai Medical Corporation and the director of Navitas Clinic Kawasaki.

Dr. Satoshi UmemuraDr. Umemura, a member of the House of Representatives, is also an internal medicine physician and chairman of the Tekijuku Medical Corporation. He graduated from Osaka University School of Medicine in 2001. After serving two terms in the House of Councillors, he transitioned to the House of Representatives in October 2024. He currently serves as the head of the Japan Innovation Party's COVID-19 Countermeasures Headquarters.

Their conversation delved into the importance of continuous professional development for physicians, the role of grassroots study groups in medical education, and the evolving landscape of medical research and practice in Japan. They emphasized the need for flexible and inclusive platforms that allow medical professionals to engage in research and knowledge sharing, regardless of their career stage or practice setting. This dialogue highlights the ongoing efforts to enhance patient care through the empowerment and continuous education of healthcare providers.

Umemura: By the way, I took entrance exams for junior high school.

Tanimoto: Oh, really?

Umemura: Yes, I attended a cram school called Hamagakuen.

Tanimoto: That’s a renowned school.

Umemura: Yes. They even told us to skip elementary school classes if we wanted to attend.

Tanimoto: Really?

Umemura: There were so many students that there were incidents of people getting crushed on the staircases. Back then, it was all about attending cram schools and learning directly from the instructors. But recently, I came across a YouTube video that not only explained in great detail how to solve a math problem from the entrance exam of a prestigious junior high school but also outlined how to study to be able to solve such problems. It was free, and I thought, “You don’t even need cram schools anymore.”

Tanimoto: That’s how it is now.

Umemura: In the past, there were trade-offs. For example, kids who played baseball didn’t have time to study, and kids who focused on studying couldn’t join baseball teams. But with so many tools now available, those trade-offs are no longer inevitable. For doctors as well, with AI and other informational tools, it’s possible to access a wealth of information. So, there’s no longer a need to compartmentalize doctors as private practitioners, hospital physicians, or researchers. Your initiative, I believe, is a great example of a seamless society, inspiring many doctors to think, “Maybe I could write a paper too.”

Tanimoto: Exactly. In the beginning, we met in person, so only those living nearby could attend. But after the COVID-19 pandemic, we shifted to a hybrid format, and now we have participants from places like Ibaraki, Hokkaido, and Toyama—quite remote areas. Similarly, inviting lecturers used to require significant time and expense, including travel and accommodation, not to mention coordinating their schedules, which could take years. Now, with online platforms, we’ve had lecturers from the U.S. and U.K. deliver sessions multiple times. This makes it possible to learn without constraints like organization, location, or nationality, and we’re trying to leverage this to produce more published papers.

Umemura: Exactly. In the past, you’d need to pay for airfare and hotel stays, and securing a lecturer’s availability was a huge challenge—sometimes requiring bookings years in advance. But now, in the most extreme case, you could simply ask them to join from their dining table for 15 minutes before dinner.

Tanimoto: That’s right.

Umemura: At the moment, I think many participants in your study group are likely those who wrote medical papers using traditional methods in the past, then took a break, and are now revisiting their skills. They might feel nostalgic and think, “I’ll try writing a paper again.” But moving forward, I imagine a new generation of younger doctors will emerge who see your seamless study group as the standard. They won’t rely on university departments or need to secure public research funding; instead, they’ll consider writing papers through such study groups as a natural and normal thing. What’s your perspective on this?

Tanimoto: I agree entirely.

Tanimoto: I completely agree. Personally, I enjoy running this study group on a volunteer basis, but when it comes to career development, there are certainly challenges. For those aiming to establish themselves in academic medicine, there’s still a strong need to belong to a university department and complete graduate studies. Without that foundation, it’s difficult to secure an academic position.

Umemura: I graduated from medical school 24 years ago. Last year, a classmate of mine was appointed as a professor at a university, and we created a group chat to organize a celebration for them. Looking at that group, I realized that only 10% of us are still at universities continuing research. It’s well known that the number of medical papers coming out of Japan has dropped significantly. From a policymaker’s perspective, I believe that if the 90% of us who have moved outside academia were to even partially re-engage with research, it could broaden the base of medical research and spark a revival. Seeing that, younger doctors might be inspired to think, “Maybe I’ll try doing some research alongside my clinical work.” Even if it’s just 5% of their effort, if everyone contributed a small portion, I think it could lead to something very exciting.

Tanimoto: I completely agree.

Umemura: It’s like in baseball—encouraging people to play catch or join a local league on their days off. It’s about expanding the grassroots.

Tanimoto: That’s exactly it. I believe that the broad grassroots support for baseball in Japan has played a significant role in producing a player like Shohei Ohtani.

Umemura: This might seem like a tangent, but in the Diet, I often ask why medical schools in Japan are restricted to students with a science background. Because of this requirement, only about one-third of potential applicants are eligible to apply. In Japan, two-thirds of high school students are in humanities tracks, which effectively eliminates their chance of entering medical school. While ministries like the MEXT and the Ministry of Health, Labour and Welfare don’t officially address this in their answers, they’ve informally suggested that a science background is necessary to write research papers and think scientifically. But I think that’s flawed reasoning. Plenty of people with science backgrounds lack logical thinking skills, and conversely, many in the humanities excel in this area. What really matters is training. Instead of restricting access at the entry level, we should focus on fostering experiences like academic writing, which I believe is far more important.

Tanimoto: I agree wholeheartedly. Expanding the base of participation and encouraging lifelong engagement is crucial. Learning to articulate ideas logically and coherently—whether in English or Japanese—is extremely valuable.

Umemura: What are your plans for this study group moving forward? Are you planning to expand it?

Tanimoto: Given my own limitations, I’m thinking of continuing it on a small scale. Compared to other industries, I think doctors are still quite privileged. As long as you work diligently, you can earn a decent living. But simply being content with that—ending your career as a private practitioner without exploring beyond it—feels like a missed opportunity to me. Engaging in academic activities, like writing papers, not only keeps you updated with the latest advancements but also helps you understand other fields.

Through this study group, I get to interact with doctors I wouldn’t normally encounter in my clinical practice and hear about areas of medicine I’d never come across otherwise. It’s incredibly stimulating. While Japan’s population is declining, there’s still a wealth of untapped potential and resources. I’d like to help uncover and harness those through our activities.

Umemura: If grassroots initiatives like yours form a sort of pyramid across various fields, I think it could really open up new possibilities for the future. In the National Diet, we frequently discuss issues like the shortage of physicians or the uneven distribution of medical professionals. The Ministry of Health, Labour and Welfare proposes various measures, but none of them have ever really succeeded. Things like capping the number of positions in certain specialties or forcing practitioners to work in specific areas.

Tanimoto: Yes, we hear about those kinds of policies quite often.

Umemura: I always say, “That’s never going to work.” Earlier, you mentioned that more young doctors are going into cosmetic surgery. That trend is often criticized negatively—people say things like, “Medical schools are publicly funded, so it’s disgraceful for graduates to forget the public good and enter the world of private practice.” But my perspective is the opposite. I think it’s wiser to create an environment where even those working in private practice can contribute to society. Money and resources always circulate back into the system. For example, how about encouraging those in private practice to share their insights and experiences in the form of papers, giving back to society that way? Creating environments like your study group could facilitate that.

Tanimoto: That’s an interesting point.

Umemura: You mentioned earlier that you’re running this on a small scale, but I think the way you’ve built a system where people in different roles can give back to patients and society is remarkable. Simply demonstrating that such a model exists is probably your greatest contribution.

Tanimoto: I’m humbled to hear that. I believe it’s important for participation to be entirely voluntary—people should feel free to engage in whatever way suits them. Unlike university departments, where once you join, it’s hard to leave, and you must conform to organizational structures, my study group is more flexible. Participants can choose any theme they like, and they’re free to participate or not. It’s a loose framework by design.

Umemura: That’s exactly what’s so amazing. Those who join university departments to write papers are usually in their 20s or, at most, early 30s. At that age, it’s very hard to decide definitively, “This is the path I’ll follow for the rest of my life.”

Tanimoto: Absolutely.

Umemura: The reality is that only a handful of people succeed as research physicians. Those who realize it’s not for them often drop out, but once they leave, they’re essentially barred from returning. That creates a sense of alienation for many private practitioners. What we need is a system that allows people to move in and out freely, broadening the base of participation. At the same time, we should emphasize that there isn’t just one way to contribute to society. I hope you’ll continue sharing that message. And if you ever have the chance, I’d love to participate in one of your sessions again.

Tanimoto: Thank you very much.

Originally published in Lohas Medical, Winter 2024 (Vol. 171).