Some people might think, "The 'Chokubi' problem? Why now?"

Akihiko Ozaki, M.D., Ph.D. Physician at the Medical Governance Research Institute

To explain it again, "Chokubi" is a term for doctors who go "straight" or “direct” (choku) into aesthetic medicine (bi) immediately after finishing their initial clinical residency, without first passing through a university medical department or a general hospital. Reports last year indicated that several hundred doctors annually are choosing this path.

I (the author) have been interested in this problem from an early stage and published an article analyzing the "Chokubi phenomenon" in a British medical journal in October 2024. This led to coverage by Toyo Keizai, and I also served as a commentator on TV Asahi's "Morning Show." I was interviewed by Taiwanese media in August and appeared on a live TV broadcast in October, gaining further opportunities for commentary. The fact that awareness of this issue has not faded means that this phenomenon has compelling "reasons" that continue to attract people.

First, the demand for aesthetic medicine is growing. Plastic surgery and cosmetic treatments are no longer considered special, and more people are openly discussing them on social media. Aesthetic medicine has gained public acceptance, becoming an established market. As this market demand expands, the demand for doctors continues to grow with it.

Second, the environment surrounding insurance-covered medical care is deteriorating. Stagnant medical reimbursement fees, tight hospital budgets, and career constraints imposed by the new specialist certification system—these structural problems are pushing young doctors toward the aesthetic field. "Chokubi" is not merely an issue of individual doctors' career paths; it is also a mirror reflecting systemic fatigue.

In reality, while "Chokubi" doctors tend to be viewed critically, some doctors working in the aesthetic field say, "They are actually working hard, in their own way." In the past, dangerous procedures and troubles caused by inexperienced doctors were conspicuous, but it is said that such cases have decreased in recent years. In fact, many doctors become independent after one or two years of training and run stable practices by performing relatively simple procedures like Botox, liposuction, and double-eyelid surgery. For the younger generation, this is increasingly seen as a rational choice, one that includes future career development.

When this topic comes up, the discussion tends to drift toward providing uniform incentives for specialties that are often shunned, such as surgery. However, as a fellow surgeon, I find it difficult to agree with such a sweeping, one-size-fits-all bonus. Rather, as a surgeon, what I want to ask is, "Have we made the changes and efforts necessary to be chosen by young doctors?"

While it may be for the sake of safe surgical care, it is undeniable that long working hours and treatment bordering on power harassment toward young staff have been tolerated. There was also a tendency to view young doctors as human resources rather than subjects for education, prioritizing organizational convenience. "We endured it, so the younger generation must too." That logic is no longer valid.

With a declining population and an aging society, the number of surgeries is relatively decreasing, and surgery is a field where contraction is inevitable. That alone makes it less attractive. It has fallen into a negative spiral: young doctors leave, the workforce shrinks, and conditions on the front lines become even tougher.

So, how can we retain young doctors? The key lies in factors other than money. I am responsible for the initial residency program, and in my interactions with young doctors, I sense they have a strong desire for a sense of fulfillment while also valuing work-life balance. We need an attitude of thinking together with them about how to shape what they value, rather than imposing our own values.

Therefore, in our hospital's initial residency program, we have increased flexibility as much as possible. We recommend that they spend more than one year of the two-year program training outside the hospital, and we have prepared training locations both within and outside Fukushima Prefecture. These range from Okinawa in the south, Ehime in the west, to Aomori in the north. If they wish to learn, we incorporate remote islands; we accept requests for training in emerging countries; and starting next year, training in Nepal will begin. The "now" of the younger generation is the reality, and we have no choice but to start from there.

Even in surgery, there is much that can be done before resorting to incentives. How can they build a good career in surgery? What would make them want to enter surgery? It is crucial to think from the perspective of young doctors. Some may think they are too busy and have no time. But if we don't, is there any future for surgery?

There is, indeed, much to learn from "Chokubi."

This article was originally published in Japanese in Iyakukeizai (Pharmaceuticals and Economics) on Oct 15, 2025.