TOKYO - Japan's Finance Ministry in April urged a cutback in medical school enrollment in a subcommittee of the Fiscal System Council, arguing that in a country facing population decline, the supply and demand of physicians will balance from 2029 to 2032 and then turn into an oversupply. The government is coordinating policy to reduce enrollment.
I cannot support that approach after studying the issue of physician shortages for more than two decades because the debate is not rational.
The benchmark for estimating how many doctors are needed should not be population size but medical demand, and one key indicator is aging. Japan's population aged 75 and older will rise sharply until around 2030. It is assumed that if the elderly population grows, medical demand will increase, making it hard to believe that supply and demand will balance in the same period.
Advances in medical technologies also raise demand for physicians, with pediatrics a typical example. As fields such as neonatal care, pediatric cardiology and pediatric neurology have become more specialized, each doctor covers a narrower scope.
Over the past 25 years, the population under 15 fell by 26 percent while the number of pediatricians rose by 27 percent. Yet shortages remain acute. A report by the Japan Pediatric Society says 21 percent of regional pediatric centers, which aim to staff at least nine pediatricians, are run by four or fewer full-time doctors.
In recent years, the number of female physicians has increased and the reform measures for doctors' work-life balance took effect in 2024. I cannot help pointing out that the number of doctors needed is underestimated in the projections underlying the ministry's proposal.
Physician training output in Japan is extremely low to begin with. According to the OECD's Health Statistics 2025, Japan has 7.5 medical school graduates per 100,000 people, the fourth-lowest among 36 member countries for which data is available, even as its aging rate, or the share of people 65 and older, stands at a world-leading 29 percent.
Italy and Portugal have 16.6 and 17.4 medical school graduates per 100,000 people, respectively. Both are expected to see future population declines, yet Italy is moving to increase the number of medical students.
This is not a situation limited to Europe. South Korea plans to expand medical school enrollment despite a total fertility rate of just 0.8 in 2025 and an expected population decline faster than Japan's, out of concern over aging and physician shortages, an approach that contrasts with Japan's.
To my knowledge, no country is currently debating cutting back medical school enrollment, making Japan's response abnormal.
In fact, the government has repeatedly misestimated the number of physicians. Since the 1980s, the old Health and Welfare Ministry repeatedly claimed that an era of physician oversupply would come. In 1986, the ministry proposed reducing medical school enrollment, which was gradually reduced from the late 1980s.
In the mid-2000s, cases in which pregnant women struggled to find emergency care became a social problem and the medical system's collapse became a national concern. But the current Ministry of Health, Labor and Welfare's supply-demand projection in 2006 still forecast that Japan would meet the number of doctors needed in the 2020s amid population decline, an estimate that proved clearly inappropriate in light of today's reality.
In 2007, health minister Yoichi Masuzoe led a shift to expanding medical school enrollment. Without that step, today's physician shortage would have been even more severe.
In discussing a cutback in medical school enrollment, Japan should squarely face history, and global trends and politicians should make decisions from the public's perspective. A shortage of doctors would directly affect people's lives, while an oversupply would trouble doctors themselves, making the conclusion of this debate clear.
(Masahiro Kami, born in 1968, is an internist and president of the Medical Governance Research Institute. He graduated from the University of Tokyo in 1993.
