【Tokyo, Japan】Tokyo: Fewer Doctors in Hospitals as Young Graduates Choose Aesthetic Clinics

Many Japanese medical residents prefer to move directly into private aesthetic medicine, which is more lucrative and less risky. This phenomenon, known as “chokubi,” reflects the difficulties and underinvestment in the public healthcare system, which risks reaching the staffing shortages seen in South Korea.
Japan
23 April 2026

To obtain a medical license in Japan, one must often pursue a very long and demanding career in public hospitals. As a result, an increasing number of new graduates prefer to invest the early part of their studies in the private sector, moving directly to aesthetic clinics after the mandatory two-year internship. This phenomenon is known by the Japanese term “Chokubi,” which literally means “direct access to aesthetics.”
These clinics are private facilities, not regulated like the public healthcare system, specializing in non-surgical or minimally invasive treatments – such as Botox, fillers, lasers, and peels – which are in high demand in Japan, where the demand for aesthetic procedures is growing strongly. Along with South Korea, the Land of the Rising Sun ranks among the top in the world for this type of procedure, with the population, especially younger generations, paying attention to ensuring results are natural and minimally invasive.
According to some estimates, out of approximately 9,000 new professionals entering the healthcare system each year, over 300 young doctors choose the path of aesthetic clinics. This loss appears contained, but over time it risks emptying fundamental specializations such as surgery, emergency medicine, pediatrics, and internal medicine: sectors that are less lucrative and increasingly unattractive due to the intense pressures doctors face.

At the root of this migration are economic and cultural motivations. Young Japanese professionals rely on two criteria to make the best choice for their future: cos-pa (cost-benefit ratio) and tai-pa (time efficiency). The traditional hospital path, with grueling shifts, high legal responsibilities, and limited salaries, offers poor returns using both criteria. In contrast, aesthetic medicine guarantees incomes that can be double those of a hospital doctor, regular hours, and significantly lower legal risks.
The problem, the analysis emphasizes, is structural because the Japanese healthcare system is based on a national public insurance, which imposes fees that limit earnings from essential medical services, while the aesthetic sector, regulated by the private market, allows for much higher profits. In this context, the choice of young doctors appears less as an ethical renunciation and more as a response to the distorted incentives of the welfare system.
The same dynamic has already emerged in South Korea, where the flight from essential specializations contributed to a healthcare crisis culminating in 2024 with large-scale strikes. There too, many doctors have moved towards so-called “GP-Skin,” aesthetic medicine, attracted by better economic and working conditions.

In Japan, the phenomenon raises questions about the use of public resources. Medical training is heavily subsidized by the state, but when graduates move into the private sector, the return on public investment is lost. Furthermore, the shortage of doctors in hospital facilities risks compromising the transmission of skills between generations, weakening the system’s ability to guarantee complex care in the long term.
To address this trend, reforms are needed to reduce inequalities between the public and private sectors: from increasing compensation for the most important specializations to reducing legal risks, and to greater regulation of the aesthetic sector. Among the proposals is the introduction of a mandatory minimum period of service in hospital specializations before being able to access private practice, in addition to possible resource redistribution mechanisms.