A young surgeon in the second year of her career performed laparoscopic surgery on a colorectal cancer patient at Yokosuka Kyosai Hospital in Kanagawa Prefecture one day last summer.

It took Mayu Kitamoto, 27, about three hours to finish the operation under the guidance of a supervisory surgeon.

“May I cut this here?” she asked the supervisor.

“There could be a blood vessel near the fatty tissue,” the adviser said. “What about cutting it in two stages?”

Kitamoto said she performs about three operations a week, including on difficult cases.

Young surgeons who are looking for opportunities to perform operations are naturally drawn to this hospital in Yokosuka in the prefecture.

“Declining no emergency patients” is the stated goal of Yokosuka Kyosai Hospital, where 7,500 surgical operations are conducted annually, including 1,500 emergency surgeries.

Many of these are in the realm of gastroenterological surgery, as they involve, for example, a hole in the intestine and a stomachache from a blow.

However, gastroenterological surgery, the clinical department in charge of operations on the stomach and the intestines, is facing an alarming shortage of surgeons like Kitamoto.

The Japanese Society of Gastroenterological Surgery (JSGS) has estimated its membership count will halve in the coming two decades, which means that patients may have to wait longer to undergo operations and emergency patients may no longer be easily accepted by hospitals.

Kitamoto said she chose to be a surgeon partly because she likes the way that removal of a lesion is visibly evident and partly also because she liked attending an operation when she was undergoing practical training.

She said she feels happy when she sees how patients she has performed surgery on go on to eat properly and leave the hospital under their own power. 

But Kitamoto said she is busy. She said she spends a lot of time studying even outside her working hours, such as when she watches videos of surgeries on her way home and before going to bed.

Yokosuka Kyosai Hospital reorganized its operations about 10 years ago so the hospital now has only two surgeons on duty on weekends--Saturdays and Sundays--and anything that may happen is left up to the pair to deal with.

Kitamoto said she has to go to work on weekends only once a month, when she is on duty. She said she has opportunities to refresh herself, such as by going on overnight trips.

But she quoted one classmate from her university years as telling her, “Oh no, I won’t be a surgeon.”

Many surgeries take nearly 10 hours to finish. Surgeons also have to attend to many emergency operations.

There is also the entrenched image that surgeons cannot take a day off on weekends.

Dermatology and anesthesiology remain popular clinical departments among aspiring doctors. Orthopedics, in which it is relatively easy to start an independent practice, also continues to enjoy popularity.

At least one classmate has gone into aesthetic medicine, Kitamoto added.

“It is true that you have a lot of work to do if you are in gastroenterological surgery, even though this specialty is attractive precisely because it covers so many diseases,” said Kaoru Nagahori, director of Yokosuka Kyosai Hospital, who is a gastroenterological surgeon himself.

Yusuke Yoshikawa, a first-year surgeon at the Yokosuka hospital, also said he has to attend to so many emergency surgeries that he often has to postpone other duties that were in his plans.

Yoshikawa, 27, said, however, that he is getting a sense of fulfillment from his job that is more than enough to make up for the hectic pace.

“At stake in this job are my own skills,” said the would-be cancer surgeon. “And it is so evident that I am curing illnesses and wounds with my own hands.”

RARE CALL FOR BETTER WORK CONDITIONS

Gastroenterological surgeons not only carry out operations on stomach, liver, intestine and other cancers but also perform emergency surgeries on patients with appendicitis or with a hole in the intestines.

The general term “surgery” is often used to refer to gastroenterological surgery.

The shortage of gastroenterological surgeons is mainly because they are busy.

A government-led initiative for “work style reform” for medical practitioners led to the introduction, in April 2024, of regulations, under penalty, on overtime hours worked by hospital doctors.

A JSGS survey of its own members, which the medical society released in January, showed, however, that only less than 20 percent of the surgeons who responded said that they were working fewer hours than before the work-style reform was in place.

Some 10 percent of the respondents said they continued to work at least 100 hours overtime a month. That exceeds the 80-hours-a-month labor ministry standard for recognizing deaths as work-related.

The survey showed there were seldom any improvements in the working conditions. Some 74 percent of the respondents said their workload had not been reduced.

Amid these circumstances, there are increasingly fewer gastroenterological surgeons, and young ones in particular, even though the overall number of medical practitioners is growing.

Plastic and aesthetic surgeons are increasing in number. That makes gastroenterological surgery about the only “loser” among different branches of surgery.

The JSGS membership is aging. The medical society has estimated that, compared with the 2023 levels, the number of its members aged 65 or younger will drop 26 percent by 2033 and by 50 percent by 2043.

A sense of alarm was first raised by a JSGS survey taken in 2023. Only 14 percent of the 2,932 JSGS members who responded to it said that they would encourage their children to become gastroenterological surgeons.

“I felt as if I were being hit in the head when I looked at these results,” Naoki Hiki, a Kitasato University professor, told a news conference last July.

Hiki pointed out that doctors are shunning gastroenterological surgery because they are feeling that surgeons in that specialty are not properly appreciated for being so busy and carrying so heavy a responsibility.

The JSGS released a rare statement last year calling for understanding and support of the public for improvements in the working conditions of gastroenterological surgeons, which it said are essential for maintaining the current setup of medical consultation and treatment.

The working conditions, however, are not the only problem. It appears vital, given the growing number of female gastroenterological surgeons, to change workplace environments to be more friendly to all workers.

Hospitals will also have to devise measures to make the job more fulfilling for young surgeons.

A shortage of gastroenterological surgeons could result in significantly longer waiting time for cancer operations.

Starting in April, Hiroshima University is introducing a new monthly allowance of 100,000 yen ($671) for young surgeons. Similar measures, however, yet have few parallels elsewhere in Japan.

The health ministry is also calling attention to the fact that medical practitioners are distributed unevenly among clinical departments.

The ministry is set to open discussions, as early as this spring, toward the goal of improving the situation.

(This article was written by Kazuya Goto and Kazuhiro Fujitani.)