Current state of International
Medical Graduates in Japan
Tatsuki Abe - ICME D1ICME meetingTable of contents
1. Backgrounda. Deﬁnition of IMG
b. Entry procedure into the japanese healthcare system
2. Current state ot international medical graduate in japan
3. The issues surrounding IMG - why it matters
4. Comparison between IMGs in other countries
5. Areas of discussion and research

Background: what is an IMG/FMG?
IMG: International Medical Graduate or FMG : Foreign Medical Graduate
are people who has graduated from a medical school outside of the country
where he or she intends to practice.
For e.g.
I have graduated from a university in Malaysia, and currently practicing inJapan. This makes me an IMG.
A physician who graduated from United Kingdom is practicing in Japan.
This person is also an IMG.
A physician who is originally Malaysian, went to a university in United
Kingdom, graduated, and practicing in United Kingdom = not an IMG.

Background: entry procedure into japanese
healthcare system

Graduate from foreign medical school
Medical license from respective country

Submission of documents to the Ministry of Health and Welfare of JapanSubsequent case-by-case consideration
Medical licensing exam permitted

Preliminary exam permitted

Japanese language and clinicalaptitude exam

Declined

Preliminary exam
厚生労働省 (2023, September). 令和５
年度医師国家試験予備試験の施行

1 year clinical posting

Japanese Medical Qualifying Exam
Residency in Japanese hospital

Current state of IMG in Japan
There has been a steady increase in the number of IMG entering the healthcaresystem.
A total of 102 IMGs passed the the most recent (2023) Medical Licencing Exam,which is about 1.1% of total(9432) number of doctors licensed in 2023*.
The above number of IMG includes mostly Japanese people who graduated from
East European countries like Hungary.

*[厚生労働省 (2023, September). 第117回医師国家試験の合格発表について]

Transition of Licensed IMG over the years bynationality
102979078

114 115 116 117

Why it matters

The issues surrounding IMG - why it matters
The issue of increasing number of IMG has varying effects on multiple aspects of healthcare and thepublic.
●●●

In terms of Japanese healthcare demand and supply, IMGs have (just like the other Japanesenationals who passed the Licensing exam) the freedom to apply and practice in any prefectureand hospitals that offers a place for junior residents in Japan. That being said, majority of IMGs
prefer to practice in the city - i.e. Tokyo, Osaka, Kanagawa prefecture etc. It could be said that thepresence of IMG does not contribute positively to the distribution of healthcare workers. (Since
the current policy does not differentiate IMG with local graduates)
There is a gradual increase in the number of foreign resident population in Japan. This would
lead to an increase in the amount of foreign people seeking healthcare - which calls for diversity
in the healthcare provider as well. The presence of IMG may help with the diversity that is neededby the increasing number of foreign residents in Japan
The presence of IMG is thought to positively inﬂuence the culture of medical education, as
diversity and interaction between multiple learning culture is thought to give diversity toComparison between othercountries and Japan

Comparison between other countries and Japan●In US / UK / Australia, there is a higher proportion of IMGs among the total healthcare
providers.
○ There are almost 325,000 IMG physicians practicing in the U.S., which accounts for around
25% of the physician workforce. The number of IMGs practicing in the U.S. has grown bynearly 18% since 2010. That figure is bigger than the 15% rise in U.S. medical graduates
over that same time period (According to a report released by the Association of American
Medical Colleges).

●In the above mentioned countries however, there are many more graduating students that areoriginally from foreign countries. This means that given a higher proportion of incoming IMGs,
there are also higher proportion of “foreign originated but local medical graduates”.
○A total of 3,656 medical students graduated from Australian medical schools in 2020, of which 3,066(83.9%) were domestic and 590 (16.1%) international students.

Comparison between other countries and Japan● The situation in Japan may be more similar to that of taiwan :○ The number of practicing IMGs in Taiwan increased from 834 (3.1% of●26,991 physicians) in 1998 to 1,733 (3.7% of 46,452) in 2017.
○ Their medical schools were distributed across 37 countries, withgraduates of schools in the Philippines (n = 550), Poland (n = 420), andMyanmar (n = 364) accounting for 77.0% of all practicing IMGs in 2017.
○ However, only 29, 0, and 253 physicians were themselves Filipinos,Polish, and Myanmarese, respectively.
Taiwan has a larger proportion of IMGs as compared to Japan - but the originof the IMGs are, like Japan, mostly local. Perhaps in terms of diversity in origin
of IMGs, Japan is slightly more diverse.

Comparison between other countries and Japan●In summary○ Japan has a growing but small number of IMGs compared toUS/UK/Australia○ Japan does not utilize IMGs in a way the above mentioned
countries does - in a sense that IMGs (by right) have the sameamount of freedom as the locally graduated doctors.
○ In the US/UK/Australia, IMGs tend to serve in less popular,
under-supplied areas due to high competition.
○ That being said, it is up to debate whether the doctors originatingfrom other countries in Japan would get the same treatment as
the “local” IMGs. (so in the end, “fair” might be an overstatement)

Areas of research surrounding
IMGsConclusion●●●So far, there is a shortage in the research in the state of IMG in Japan.
As the number of IMGs increase in Japan, and increasing number of foreign resident
population in Japan, there may be an increase in the need for assessment of the current stateof IMGs in Japan.
There is an ongoing issue of healthcare provider distribution in Japan. The role of IMG may beable to mitigate the distribution issue, though this may be a sensitive topic.
○ It is up for discussion if Japan will remain an attractive destination for international
medical graduates, if the destination of employment becomes limited.
○ On the other hand, it may help greatly if there is a match in demand and supply ofhealthcare workers, in terms of recognizing the need (cultural, language and others) of
the society and recognizing the skills that the IMGs can offer.

References
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厚生労働省 (2023, September). 令和５年度医師国家試験予備試験の施行
https://www.mhlw.go.jp/kouseiroudoushou/shikaku_shiken/ishi/yobi.html
厚生労働省 (2023, September). 第117回医師国家試験の合格発表について
https://www.mhlw.go.jp/stf/shingi2/0000197611_00006.html
厚生労働省（2023, September). 医療従事者の需給に関する検討会第31回医師需給分科会 海外医学部を卒業した医師の動向 令和1年11月27日
https://www.mhlw.go.jp/content/10801000/000571283.pdf
IHS Markit Ltd. The Complexities of Physician Supply and Demand:Projections From 2019 to 2034. Washington, DC: AAMC; 2021.