2019 年 66 巻 4 号 p. 359-368
The Japan Endocrine Society (JES) has the largest ratio of female membership among societies associated with Internal Medicine in Japan; half of female members are in their 20s or 30s at present. In 2009, JES organized the “JES-We-Can” committee to promote women’s career development. To evaluate the effectiveness of JES-We-Can, we investigated the gender balance of various activities at JES in fiscal 2009 and 2017. Significant gender-differences were not observed in the acquisition rate of board-certified endocrinologists (BCEs) aged <40 y in 2009 and 2017. However, the acquisition rate of BCEs among women aged ≥40 y was significantly lower than men in 2009. In 2017, the gender-difference among BCEs in this group (currently aged ≥50 y) has considerably improved, but is not resolved. The acquisition rate of certificated endocrine educators (CEEs) among women was still significantly lower than men at all ages in 2017. Since the ratio of women oral speakers or poster presenters at annual academic meetings have grown to equal or surpass the membership ratio, female members make efficient contributions to JES. The numbers of women chairpersons, symposiasts, lecturers and invited speakers have increased, but remain limited. JES-We-Can was found to be effective in reducing the gender gap in academic activities at JES, but JES-We-Can should support women more intensely to raise the rate of CEEs among all ages and BCEs currently over 50 y, and to promote more women into higher positions in JES in the future. These actions are expected to introduce new and diverse perspectives into academia.
ACCORDING TO THE LATEST DATA released by Japanese government statistics, the percentage of women medical doctors (MDs) in Japan is 21.1%, which is the lowest among the Organization for Economic Co-operation and Development (OECD) countries as of 2013 [1, 2]. However, the ratio of women MDs in their 20s reached 34.6% in 2016, which was the highest among all age groups [3]. Similar to other occupations, an “M-shaped curve” has been observed among women MDs, as demonstrated by the low employment rate during maternity and childcare leave [4]. According to a survey by the Ministry of Health, Labour and Welfare, the employment rate among women decreases to its lowest point (73%) at the 11th year after registration (estimated age of 37 y), compared with 89.9% among men in the same age cohort. Although the employment rate increases to over 80% among women in their 50s, it is still lower than that among men of the same age. This issue needs to be addressed by promoting changes in health policies, the working environment, and established notions about women and childcare, among others.
Since around 2006, various federal budgets, including grants and incentives from the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labour and Welfare in Japan, have been established to promote activities for women doctors’ career development and prevent job abandonment in universities, prefectural governments, academic societies, and the Japan Medical Association and affiliated associations.
As of fiscal 2009, the average female membership ratio in the Japan Endocrine Society (JES) was 25.0% for all age groups (Table 1), with women in their 20s and 30s accounting for 46.2% and 42.7%, respectively (Fig. 1). In fiscal 2009, the acquisition rate of board-certificated endocrinologists (BCEs) was 38.9% in men but only 23.3% in women (Table 2). Therefore, in April 2009, the JES organized a committee composed of 19 women and three men to promote career development among women endocrinologists, including brushups for those returning from childcare leave. This committee was subsequently renamed the “Japan Endocrine Society Women Endocrinologists Association (JES-We-Can)”, and soon initiated official activities for both genders to support women members. Several working groups were launched within JES-We-Can, one of which involved tracking the number of chairwomen and women speakers to evaluate the appointment of women at annual academic meetings of the JES. Since 2009, JES-We-Can has periodically announced about annual changes in the number of women chairpersons and speakers at JES academic meetings on JES News or JES-We-Can special sessions at their annual congress.
| Fiscal 2009 | Fiscal 2017 | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Total | Men | Women | Total | Men | Women | |||||
| n | n | (%) | n | (%) | n | n | (%) | n | (%) | |
| Member | *7,075 | 5,307 | 75.0 | 1,767 | 25.0 | 8,155 | 5,620 | 68.9 | 2,535 | 31.1 |
| <40 y | 2,228 | 1,265 | 56.8 | 963 | 43.2 | 2,631 | 1,373 | 52.2 | 1,258 | 47.8 |
| ≥40 y | 4,640 | 3,839 | 82.7 | 801 | 17.3 | 5,428 | 4,153 | 76.5 | 1,275 | 23.5 |
| Age undisclosed | 206 | 203 | 98.5 | 3 | 1.5 | 96 | 94 | 97.9 | 2 | 2.1 |
| Councilor | 1,118 | 1,039 | 92.9 | 79 | 7.1 | 1,103 | 975 | 88.4 | 128 | 11.6 |
| Board member | 24 | 23 | 95.8 | 1 | 4.2 | 34 | 31 | 91.2 | 3 | 8.8 |
| Medical doctor (MD) | 5,556 | 3,991 | 71.8 | 1,565 | 28.2 | 7,101 | 4,738 | 66.7 | 2,363 | 33.3 |
| <40 y | 2,029 | 1,136 | 56.0 | 893 | 44 | 2,505 | 1,304 | 52.1 | 1,201 | 47.9 |
| ≥40 y | 3,527 | 2,855 | 80.9 | 672 | 19.1 | 4,596 | 3,434 | 74.7 | 1,162 | 25.3 |
| Board-certified endocrinologist (BCE) | 1,916 | 1,552 | 81.0 | 364 | 19.0 | 2,614 | 1,923 | 73.6 | 691 | 26.4 |
| <40 y | 308 | 177 | 57.5 | 131 | 42.5 | 494 | 279 | 56.5 | 215 | 43.5 |
| ≥40 y | 1,608 | 1,375 | 85.5 | 233 | 14.5 | 2,120 | 1,644 | 77.5 | 476 | 22.5 |
| Certified endocrines educator (CEE) | 855 | 760 | 88.9 | 95 | 11.1 | 1,207 | 992 | 82.2 | 215 | 17.8 |
| <40 y | 19 | 14 | 73.7 | 5 | 26.3 | 69 | 49 | 71.0 | 20 | 29.0 |
| ≥40 y | 836 | 746 | 89.2 | 90 | 10.8 | 1,138 | 943 | 82.9 | 195 | 17.1 |
The value of total members in fiscal 2009 with * include a member with undisclosed gender. Each value is the percentage of men or women in total.
Gender balance for each generation among Japan Endocrine Society (JES) members in fiscal 2009 and fiscal 2017
The percentage of men (light blue bar in fiscal 2009, sky blue bar in fiscal 2017) and women (light pink bar in fiscal 2009, magenta bar in fiscal 2017) are plotted. The data are compared between fiscal 2009, at the time JES-We-Can was founded, and fiscal 2017. The number above the bar graph shows the percentage of women among total members for each age group. Black and red characters show the women’s percentages in fiscal 2009 and fiscal 2017, respectively.
| Fiscal 2009 | Fiscal 2017 | |||||
|---|---|---|---|---|---|---|
| Total | Men | Women | Total | Men | Women | |
| % | % | % | % | % | % | |
| Councilor | 15.8 | 19.6 | 4.5* | 13.5 | 17.3 | 5.0* |
| Board member | 0.34 | 0.43 | 0.06* | 0.42 | 0.55 | 0.12* |
| Board-certified endocrinologist (BCE) | 34.5 | 38.9 | 23.3* | 36.8 | 40.6 | 29.2* |
| <40 y | 15.2 | 15.6 | 14.7 | 17.9 | 21.4 | 17.9‡ |
| ≥40 y | 45.6 | 48.2 | 34.7* | 46.1 | 47.9 | 41.0† |
| Certified endocrine educator (CEE) | 15.4 | 19.0 | 6.1* | 17.0 | 20.9 | 9.1* |
| <40 y | 0.9 | 1.2 | 0.6 | 1.7 | 3.8 | 1.7* |
| ≥40 y | 23.7 | 26.1 | 13.4* | 24.7 | 27.5 | 16.8* |
Acquisition rates were calculated by dividing the number of holders by the number of candidates for each qualification in each group using the values in Table 1.
*: p < 0 .01, †: p < 0.05, ‡: 0.05 < p < 0.10
Currently, JES-We-Can consists of 54 female and four male JES members from each region of the country. Since 2009, JES-We-Can has been conducting a special session successfully promoted by women members that invites women candidates to participate in the annual congress of the JES as chairpersons, speakers, and lecturers. In addition, since 2016, JES-We-Can has friendship-exchange with the “Women in Endocrinology” group of the US Endocrine Society.
Since the activities of JES-We-Can precede those of other academic medical societies in Japan, we analyzed the effectiveness of these activities over the 10-y period since they began targeting women academics in 2009. In the present study, we investigated the degree of change in gender equality and organization culture in the JES by analyzing the gender balance of members, councilors, board members, MDs, BCEs, certified endocrine educators (CEEs), and chairpersons or speakers at annual academic meetings (the JES’s Annual Congress and Clinical Updates on Endocrinology & Metabolism) from 2006 to 2018 (fiscal 2017).
We retrospectively counted the number of women JES members in each age group from 20–89 y. The gender balances of members, councilors, and board members were then calculated by dividing the number of women by the number of members. The gender balances of MDs, BCEs, and CEEs were calculated by dividing the number of women physicians by the total number of physicians. Similarly, the ratios of chairpersons, lecturers, invited speakers, symposiasts, oral presenters, and poster presenters at two major annual academic meetings of the JES (the JES’s Annual Congress and Clinical Updates on Endocrinology & Metabolism) in the last 12 y were calculated. To assess the influence of JES-We-Can since its establishment in 2009, we examined the gender balance data of these two major JES annual academic meetings each year from 2006 to 2017. The JES-We-Can executive committee implemented this survey with the approval of the board of directors.
The numbers of qualified persons (members, councilors, board members, MDs, BCEs, and CEEs) were counted based on the Japanese academic fiscal year (from April until March of the next year). For example, data from fiscal 2017 meant that the data were aggregated until the end of March 2018.
The chi-square test was used to compare the prevalence of councilors, board members, BCEs, and CEEs in men and women for candidates (members for councilors and board members, in contrast to MDs for BCEs and CEEs) in each age group in fiscal 2009 and fiscal 2017, and p < 0.05 was considered to indicate statistical significance.
Terminology from the articles of an association is the following as 1)~6).
1) Member: a person with knowledge and experience regarding endocrinology and metabolism who agrees with purpose of the Japan Endocrine Society, participates in the Japan Endocrine Society, was recommended by a councilor, and paid the annual fee of 12,000 yen.
2) Councilor: a member with more than 10 (clinician) or 7 (basic scientist) years of experience who has given a presentation at the JES or related scientific meetings more than five times, has more than 10 publications in endocrine-related journals, pledged to cooperate in volunteer activities according to the mission of the board of directors, was recommended by another councilor, and who has been approved by the board of directors.
3) Board member (directors and auditors): the board of directors consists of 20–25 directors and one to two auditors selected by the voting members and approved by the general assembly. The board of directors selects the president, and the president nominates the vice-president.
4) Board-certified endocrinologist: medically licensed clinician who has appropriate special training satisfying the JES requirements and has passed the examination for specialists conducted by the JES.
5) Certified endocrine educator: medically licensed clinician and board-certified endocrinologist who has been a JES member for more than 10 years and has appropriate achievements satisfying the JES requirements, including a certain number of publications or presentations at the Annual Congress of the JES.
6) Annual academic meetings: attendance at the Annual Congress of the JES, which is commonly held in spring, and the JES Clinical Update on Endocrinology & Metabolism, which is commonly held in autumn.
The percentage of women JES members increased from 25.0% in 2009 to 31.1% in 2017 (Table 1). The percentage of women members in their 20s was 50.8%, exceeding the percentage of men in fiscal 2017. Although the percentage of women in their 40s was 25.5% in fiscal 2009, it increased substantially to 35.8% in fiscal 2017, as the women in their 30s in fiscal 2009 were in their 40s in fiscal 2017 (Fig. 1).
The gender balance between members, councilors, board members, MDs, BCEs, and CEEs in fiscal 2009, the year JES-We-Can was founded, and that in fiscal 2017, are shown in Table 1.
The percentage of both women councilors and CEEs have been increasing continuously, from 7.1% and 11.1% in fiscal 2009, to 11.6% and 17.8% in fiscal 2017, respectively. Particularly, the percentage of women BCEs aged ≥40 y has increased substantially, from 14.5% in 2009 to 22.5% in fiscal 2017; however, as mentioned above, this is mostly the result of the transition from the 30s to the 40s age group.
In regard to board members, the JES welcomed its first woman in fiscal 2009. As of 2017, this has increased to three; however, the JES has still never had a woman president or vice president.
Acquisition rates of each qualification among JES members compared by gender and age (Table 2)The acquisition rates of councilors, board members, BCEs, and CEEs compared by gender and age are shown in Table 2. The results showed that the acquisition rates among councilors and board members in fiscal 2009 and fiscal 2017 were significantly male dominant. The acquisition rates of BCEs and CEEs were significantly higher among men than among women for all age groups. Those for the ≥40 y age group were significantly higher in men compared with the male–female ratio among MDs in both fiscal 2009 and fiscal 2017. However, no significant difference was found between men and women in the acquisition rate of BCEs <40 y in fiscal 2009 or fiscal 2017. The acquisition rate of CEEs <40 y was not significantly different between men and women in 2009, however, it was significantly higher among men than among women in fiscal 2017.
Acquisition rates of BCEs and CEEs compared by gender and age group in fiscal 2009 and 2017 (Fig. 2)To analyze the data in more detail, the acquisition rates of BCEs and CEEs were compared by gender for each age group in 2009 and 2017. As shown in Fig. 2, no gender difference was found in the BCE acquisition rates for those aged <40 y in 2009 or those aged <50 y in 2017. However, a significant difference in the CEE acquisition rate was observed between men and women aged >40 y in both fiscal 2009 and fiscal 2017.
Acquisition rates of board-certificated endocrinologists (BCEs) and certified endocrine educators (CEEs) compared by gender and age group in fiscal 2009 and 2017
The acquisition rates of BCEs or CEEs were calculated by dividing the number of holders by the number of medical doctors (MDs) for each age group.
The changes in the number of women chairpersons, speakers and poster presenters at JES academic meetings are shown in Table 3A. The numbers of women chairpersons, symposiasts, oral speakers, and poster presenters have gradually increased, but the numbers of women lecturers and invited speakers have remained extremely low. However, the percentages of women oral speakers and poster presenters have consistently exceeded that of female membership in the JES. The annual changes in the numbers of women chairpersons, symposiasts, oral speakers, and poster presenters at JES academic meetings are shown in Fig. 3. Especially, the numbers of women chairpersons and symposiasts have increased substantially since 2015.
| 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | W/T | (%) | |
| Chairperson | 15/255 | 5.9 | 13/259 | 5 | 21/269 | 7.8 | 14/281 | 5 | 5/78 | 6.4 | 19/255 | 7.5 | 18/247 | 7.3 | 20/282 | 7.1 | 22/297 | 7.4 | 89/329 | 27.1 | 54/265 | 20.4 | 55/296 | 18.6 |
| Lecturer | 0/13 | 0 | 0/12 | 0 | 0/11 | 0 | 2/26 | 7.7 | 0/6 | 0 | 0/29 | 0 | 2/27 | 7.4 | 1/19 | 5.2 | 2/24 | 8.3 | 1/27 | 3.7 | 1/16 | 6.3 | 2/20 | 10.0 |
| Invited speaker | 8/49 | 16.3 | 7/65 | 10.8 | 5/53 | 9.4 | 9/50 | 18 | 2/19 | 10.5 | 17/74 | 23 | 8/51 | 15.7 | 10/42 | 23.8 | 8/51 | 15.7 | NA | NA | NA | NA | 5/31 | 16.1 |
| Symposiast | 8/64 | 12.5 | 4/46 | 8.7 | 1/32 | 3.1 | 8/99 | 8.1 | NA | NA | 3/91 | 3.3 | 11/83 | 13.3 | 9/84 | 10.7 | 11/95 | 11.6 | 24/111 | 21.6 | 21/82 | 25.6 | 12/90 | 13.3 |
| Oral speaker | 41/163 | 25.1 | 63/204 | 30.9 | 63/198 | 31.8 | 40/163 | 24.5 | NA | NA | 59/201 | 29.3 | 54/187 | 28.8 | 58/205 | 28.2 | 74/272 | 27.2 | 94/255 | 36.9 | 34/126 | 27 | 33/108 | 30.6 |
| Poster presenter | 117/451 | 25.9 | 145/467 | 31 | 117/434 | 26.9 | 182/537 | 33.8 | 139/413 | 33.7 | 162/541 | 29.9 | 197/606 | 32.5 | 154/525 | 29.3 | 204/550 | 37.1 | 191/568 | 33.6 | 203/571 | 35.6 | 218/661 | 33.0 |
W: number of women, T: number of total (men and women), NA: not applicable (symposium and oral presentation were not conducted in 2010).
| 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| W | M | W | M | W | M | W | M | W | M | W | M | W | M | W | M | W | M | W | M | W | M | W | M | |
| Chairperson (CP) | 15 | 240 | 13 | 246 | 21 | 248 | 14 | 267 | NA | NA | 19 | 236 | 18 | 229 | 20 | 262 | 22 | 275 | 89 | 240 | 54 | 211 | 55 | 241 |
| Oral speaker (OS) | 41 | 122 | 63 | 141 | 63 | 135 | 40 | 123 | NA | NA | 59 | 142 | 54 | 133 | 58 | 147 | 74 | 198 | 94 | 161 | 34 | 92 | 33 | 75 |
| CP vs. OS | p < 0.01 | p < 0.01 | p < 0.01 | p < 0.01 | NA | p < 0.01 | p < 0.01 | p < 0.01 | p < 0.01 | p < 0.5 | NS | p < 0.5 | ||||||||||||
| Poster presenter (PP) | 117 | 334 | 145 | 322 | 117 | 317 | 182 | 355 | 139 | 274 | 162 | 379 | 197 | 409 | 154 | 371 | 204 | 346 | 191 | 377 | 203 | 368 | 218 | 443 |
| CP vs. PP | p < 0.01 | p < 0.01 | p < 0.01 | p < 0.01 | NA | p < 0.01 | p < 0.01 | p < 0.01 | p < 0.01 | p < 0.5 | p < 0.1 | p < 0.1 | ||||||||||||
W: number of women, M: number of men, NA: not applicable (no oral presentations were given in 2010), NS: not significant. The chi-square test was used to compare the ratio of chairpersons to presenters between men and women.
Annual changes in the percentage of women chairpersons, symposiasts, oral speakers, and poster presenters at the Annual Congress of the JES
Data regarding chairpersons, symposiasts, oral speakers, and poster presenters were extracted from Table 3A.
The chi-square test was used to compare men and women in terms of the number of chairpersons and presenters. The proportion of chairpersons to presenters was significantly higher in men than in women until 2014; however, since 2015, this difference has no longer been significant (Table 3B).
Female participation in the Japanese Societies of Internal Medicine and Subspecialties in 2016 (Table 4)
| Inter Med | Endo | Diab | Aller | Neph | Neuro | Hema | Respir | Geriat | Rheum | Infect | Gast | Circu | Hepat | Average of 14 societies | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Women physician (WMD) | n | 23,708 | 2,283 | 4,449 | 2,854 | 2,501 | 1,876 | 1,478 | 2,420 | 817 | 1,454 | 1,368 | 4,596 | 3,045 | 1,500 | |
| W/T % | 22 | 33 | 28 | 27 | 25 | 23 | 23 | 19 | 16 | 15 | 15 | 14 | 13 | 12 | 20.4% | |
| Women board-certificated physician (WBCP) | n | 5,292 | 574 | 1,592 | 884 | 1,008 | 1,200 | 779 | 1,057 | 190 | 627 | 154 | 2,502 | 1,432 | 603 | |
| W/T % | 20 | 24 | 29 | 23 | 22 | 22 | 20 | 17 | 13 | 13 | 11 | 12 | 11 | 10 | 17.6% | |
| Women chairperson (WCP) | n | 10 | 54 | 115 | 9 | 23 | 12 | 21 | 57 | 13 | 21 | 13 | 11 | 64 | 11 | |
| W/T % | 8 | 20 | 18 | 8 | 12 | 10 | 6 | 9 | 10 | 11 | 6 | 4 | 13 | 7 | 10.1% | |
| WBCP/WMD index | 0.90 | 0.72 | 1.03 | 0.85 | 0.88 | 0.96 | 0.96 | 0.89 | 0.81 | 0.87 | 0.73 | 0.86 | 0.85 | 0.83 | 0.81 | |
| WCP/WMD index | 0.36 | 0.60 | 0.64 | 0.29 | 0.48 | 0.43 | 0.26 | 0.47 | 0.62 | 0.73 | 0.40 | 0.27 | 1.00 | 0.58 | 0.51 |
Inter Med: The Japanese Society of Internal Medicine, Endo: The Japan Endocrine Society, Diab; The Japan Diabetes Society, Aller: Japanese Society of Allergology, Neph: Japanese Society of Nephrology, Neuro: Japanese Society of Neurology, Hema: Japanese Society of Hematology, Respir: The Japanese Respiratory Society, Geriat: The Japan Geriatrics Society, Rheum: Japan College of Rheumatology, Infect: The Japanese Association for Infectious Diseases, Gast: The Japanese Society of Gastroenterology, Circu: The Japanese Circulation Society, Hepat: The Japan Society of Hepatology.
This table was modified from Tables 2 and 3 in Ref. 5; Nagoshi S et al. (2018) Nihon Naika Gakkai Zasshi (The Journal of the Japanese Society of Internal Medicine) 107: 1-6.
The bold values in shaded area are our original additions and the societies are sorted from highest to lowest female membership ratio by us.
First, as a characteristic feature, the JES had the highest ratio of women physicians (WMDs) among the Japanese Society of Internal Medicine and its 13 associated societies in 2016. The ratio of WMD in the JES (33%) is much higher than the average (20.4%) of the 14 medical associations related to internal medicine.
Second, the JES has the lowest ratio of women board-certificated physicians (WBCPs) when compared with that in our original index (ratio of WBCP/ratio of WMD in each society). Board-certificated physicians corresponds to BCE in the JES.
Third, the JES has a slightly higher ratio of women chairpersons (WCPs) than female ratio of physicians (WCP/WMD index 0.60) compared with the average (WCP/WMD index 0.51) of the 14 medical associations related to internal medicine. Although the ratio of WCP in the JES is the highest (20%) among the 14 related internal medicine societies (average 10.1%), this may be reflected the JES also has the highest female membership ratio.
By contrast, the Japanese Circulation Society has the lowest ratio of WMD, but has already achieved gender equality in terms of chairpersons because of a 1:1 female ratio; WCP/WMD index 1.0.
In the present study, the following major features of the JES were identified: 1) the ratio of female members is the largest among the 14 related internal medicine societies and Subspecialties in Japan; 2) almost half of women members consist of those in their 20s and 30s; 3) no significant differences were observed between men and women in the acquisition rate of BCEs aged <40 y in fiscal 2009 or 2017; 4) a significant difference in the BCE acquisition rate in fiscal 2009 was found between those aged ≥40 y and <40 y, and the number of women MDs aged 50 y or more is the major cause the decreased acquisition rate of women BCEs in the JES; 5) the JES has the lowest ratio of women specialists (which correspond to BCEs) to members among the 14 medical associations related to internal medicine; 6) the CEE acquisition rate was significantly lower in women than in men, except for MDs aged <40 y in fiscal 2009; 7) the numbers of women chairpersons, symposiasts, oral speakers, and poster presenters have tended to gradually increase year after year; 8) Since the ratio of women oral speakers or poster presenters at annual academic meetings has increased to a level almost equal or more to that of the membership ratio, respectively, female members make an efficient contribution to JES; 9) the JES has a relatively higher ratio of women chairpersons than the 14 medical associations related to internal medicine in Japan after adjusting for the ratio of women MDs; and 10) although the acquisition rate of CEEs and the ratio of women councilors and board members have increased, gender disparity is still observed in higher positions. In addition, the numbers of women lecturers and invited speakers at annual academic meetings remain limited.
Based on these results, the JES must undertake initiatives for career development projects for women for the following two main reasons. First, career development for women is expected to play an important role in the overall development of the JES because women in their 20s have already become the majority gender. Second, as the Japanese medical association with the highest female ratio, the JES has the mission of demonstrating a model of diversity. Actually, the JES started earlier than other academic societies in Japan in terms of undertaking activities to decrease the gender gap as JES-We-Can in 2009. As JES-We-Can is in its 10th year, the present study was conducted to evaluate the effectiveness of its activities targeting female academics in Japan.
We discussed the annual changes by gender in two age groups (<40 y and ≥40 y) in Tables 1 and 2 because the ratio of female members aged ≥40 y changed substantially in 2009. In fiscal 2009, a gender difference was found in the BCE acquisition rate for those aged ≥40 y, but not for those aged <40 y. This substantial difference between generations in 2009 was the result of whether the BCE career path system had been introduced at the start of clinical training. The important point here is that after the establishment of the career path system for BCEs from the beginning of clinical training, there was no capacity difference or performance gap between men and women. This result suggests the need to discuss the BCE and CEE acquisition rates among those aged ≥40 y in 2009 or ≥50 y at present. Based on this finding, the gender gap among BCEs aged ≥40 y in 2009 might not have depended on a performance gap, but rather on an opportunity gap. This could be because this generation did not have sufficient opportunities for access to designated training hospitals. However, if this were the case, it should also be the same situation for men JES MDs as well as WMDs in other academic societies related to internal medicine in Japan. Furthermore, data for all age groups revealed that the JES had the lowest ratio of women specialists to members among the 14 medical associations related to internal medicine in Japan (Table 4) [5]. It is suspected that the lower numbers of women JES members aged ≥40 y in 2009 (those around 50 y of age or more at present) represents the major cause of the decreased acquisition rate of women board-certificated physicians in the JES. The situation regarding the acquisition of specialists, especially women in older generations, and support to overcome barriers to board certification needs to be investigated in a future study regarding JES-We-Can.
In addition, a gender gap was observed in the CEE acquisition rate among endocrinologists aged ≥40 y in fiscal 2009, and this extended to those aged <40 y in 2017. A BCE qualification is a necessary license for performing routine clinical practice as an endocrinologist. CEEs are further required to satisfy all JES requirements, including having over 10 years of clinical experience and having made more than five presentations or publications about endocrinology practice every 5 years. Possible reasons for the women’s lower CEE acquisition rate include the fact that women may not be as interested as men in acquiring leadership qualifications [6], may not be as able to afford it, or may not qualify as easily. The situation regarding the acquisition of women CEEs and the provision of support to overcome barriers to board certification also needs to be investigated in a future study. Based on the recent increase in the female ratio, this issue could lead to a lack of CEEs at the JES in near future; therefore, this is an urgent issue for JES-We-Can.
As mentioned above, after the establishment of JES-We-Can in 2009, the proportion of women chairpersons in the JES increased steadily, and this was also the result of a boost in the promotion of women members of the JES. It also can be said that JES-We-Can’s activities began to bear fruit, particularly, in terms of making annual announcements of changes in the numbers of female participants and encouraging awareness among the board and other members about the importance of career development for women in the JES in the future. Indeed, the JES has the largest proportion of women chairpersons among the 14 medical associations related to internal medicine in Japan (Table 4). By contrast, the ratio of women chairpersons to members in the JES is 0.6, which is slightly above the average of 0.51 in the 14 medical associations related to internal medicine; only the Japanese Circulation Society shows a similar ratio between women chairpersons and members. However, the JES is characterized by a rapid increase of members aged <40 y. Considering the age that people are typically appointed as chairpersons, we reanalyzed the data limited to JES members aged ≥40 y. As a result, the ratio of women chairpersons was 20%, which is close to that of total members (23%). Therefore, the JES currently appears to be approaching their goal, but in near future, the goal regarding the ratio of women chairpersons should be updated annually according to the increasing ratio of younger female members. Accordingly, men and women physicians will need to improve their skills as endocrinologists.
Although the percentage of women BCEs has increased, issues relating to work–life balance among women physicians still need to be addressed. The ratio of females in the Japanese workforce by age group, especially among those aged 30–44 y, is still low compared with Western countries [1]. The so-called “M-curve phenomenon,” which has been characteristic of various occupational categories in Japan, is also observed in medical fields [2]. Within the OECD countries, the “M-shaped curve,” which is poorly regarded in highly professional groups such as licensed MDs, is observed only in Japan and South Korea. According to a gender gap index statement published by the World Economic Forum in 2017, Japan ranked 114th overall among 144 countries, which is lower than its rank in previous years (111th in 2016 and 101st in 2015). This suggests that the cultural background in Japan, which involves hesitation and modesty among women, may act to prevent change in the workplace environment. Therefore, JES-We-Can must continue its activities in consideration of this cultural background.
Needless to say, maintaining an appropriate gender balance is not the only diversity concern in the workplace. Issues surrounding the appropriate balance of race, age, education/career background, and individuals with disabilities or special needs also need to be considered. A previous study noted that “making women active members of the scientific workforce means rethinking the work–life balance” [7]. Supporting activities for women physicians may have a strong impact on work–life balances for both men and women in medical institutes and academic settings.
In the US, approximately 70% of current endocrinology fellows are women, which suggests a shortage of endocrinologists overall. Pelley et al. [8] reported findings occupational gender segregation, a gender pay gap, an underrepresentation of women in academic leadership positions, and gender biases in patient satisfaction. Since there are an increasing number of patients with endocrine disorders, the authors emphasized the importance of advocating support for women endocrinologists and projected the transition to a “female-predominant” medical specialty in the endocrinology field. They also pointed out that strengthening the support offered to physicians in the workplace can only serve to attract talented physicians, which will be key in meeting the needs of the increasing number of patients with endocrine disorders. The numbers of patients with endocrine diseases induced by chemotherapy, immune-modulating therapy, and aging has increased continuously not only in the US, but also in Japan, as these are both rapidly aging societies. A support system for women physicians and researchers may improve the quality of medical care for patients through improving the work–life balance for men physicians and researchers.
In U.K., there is a movement of “NHS Women on Boards: 50:50 by 2020” at National Health Service (NHS) Employers. They state the reason as that women on boards bring new skills and new ways of thinking, they enhance governance, work more collaboratively and ask different questions. It is a strategic priority for the makeup of boards to more closely reflect the population they serve. Further, they point out that the success of women in different areas of society is interconnected, the success of women in one strata can reinforce success of women in another, creating a virtuous cycle [9].
In addition, the importance of same-sex role models has been pointed out, especially for younger women physicians and medical students, to develop their confidence and self-consciousness as women doctors [10]. Therefore, the activities and progress of JES-We-Can over the past 10 y have been meaningful. The ultimate goal of JES-We-Can is not only to resolve the gender gap in JES, but also to help both men and women physicians in Japan and around the world work with confidence and develop their abilities to the fullest.
In summary, although the activities of JES-We-Can were found to be effective for women in the JES, future challenges remain. More female participants are needed in higher positions in academic societies and to play more important roles in annual academic meetings; this could be expected to introduce new and diverse perspectives into the academic world. We believe that such diversity will strengthen the JES as an academic society and lead to further development.
First, we would like to express our appreciation to Emeritus Professor Masatomo Mori, who decided to establish JES-We-Can as the president of JES in 2009. We deeply thank all successive members of JES-We-Can for their cooperation. We would also like to express our special appreciation to the previous JES-We-Can chairpersons; Emeritus Profs. Kazue Takano and Naomi Hizuka, an important initial member; Visiting Prof. Kumiko Tsuboi and the board director in charge of JES-We-Can; Dr. Akira Shimazu, for their warm guidance and support since the beginning. We deeply appreciate the kind cooperation of Prof. Sumiko Nagoshi. Finally, we express our deep appreciation to the secretariats of JES for providing aggregated data and the current President of JES, Prof. Hiroshi Itoh, who has understood and positively supported our activities.
None of the authors have any potential conflicts of interest associated with this research. M.K. contributed to the study design, data collection, data analysis, data interpretation, and writing in English, takes responsibility for the accuracy of the data analysis and the literature search, and had full access to all the data in the study and takes responsibility for its integrity. K.S. and M.F. contributed to the data collection regarding speakers and chairpersons at annual academic meetings. M.Y. contributed to the data interpretation and partial drafting of the manuscript in English, and takes responsibility for the validity of the statistical analysis. S.H.M. is the guarantor of this work and, as such, had full access to all the data, analyses, and interpretation. Parts of this study were previously presented at the Annual Congress of the JES in Kyoto, Japan, held on 21–23 April, 2016.
