In the last piece, I introduced a situation that happened at a private medical school: A splendid person considered application for the chair position but didn’t run for the selection race, because after investigation, he found that the race was definitely advantageous for the graduates of that private college, and his competitor was one.
I wrote that such stories are ubiquitous in Japan and presented one possible reason why this occurs. That is, if the medical college places higher priority on candidates’ ability than on alumni-based “nepotism,” current members working in the department are discouraged from staying at the workplace and encouraged to leave, because the ability-based selection system destroys their expectations of being promoted to high positions in the future. This makes it difficult for the department to maintain their practice. So, hiring from within is advantageous to get the ball rolling, at least on a short-term basis.
Viewed from the standpoint of surgical practice, this “nepotism” has another advantage. Surgical operation requires teamwork. Surgery isn’t something that can be done only by a single surgeon. However skillful the operator may be, good results cannot be achieved without willing and considerate assistance by other surgeons. Cooperation of anesthesiologists and nurses is indispensable, too. Invitation of a department chair from outside requires a reset of the teamwork, and the reset might end in failure. Even if it goes well, reorganization of the team takes some time. Promotion of an existing member avoids the risk of failed teamwork, and saves the cost of reorganization. This is the second advantage of the “nepotism”-based recruitment system.
For private medical colleges, “nepotism”-based recruitment is advantageous to attract students. So far, private medical colleges have managed to stay popular, despite their notoriously high study fees. However, their popularity has peaked and will perhaps go down, because the prospective development of artificial intelligence will replace many of physicians’ jobs, and the decrease in the country’s population will reduce their job opportunities. Faced with such gloomy prospects in the near future, private medical colleges still need to solicit students. Offering academic positions is a useful tool to achieve this purpose. Reserving tenure positions only for their graduates is encouraging for the students who plan to be on academic tracks in the future. This is the third reason of a hiring-from-within system.
As stated above, this type of system is advantageous to preserving the status quo, without taking the risks of drastically changing the situation, which is a positive aspect of the system. The negative side is that it simply keeps the status quo and provides little prospect of improvement. Taking the balance of the positive and negative sides, most private medical colleges decide to employ the nepotism-based recruitment system, because it seems most advantageous for them to survive.
However, the prevalence of this system will lower the academic level of the country. An advantage for each specific organization isn’t necessarily equal to an advantage for the society it belongs to. Suppose a company makes a certain product, a ship, for instance. The company needs steel to make ships. Suppose a certain country offers to provide steel at a lower price than usual. However, the country that is going to provide the steel politically is in conflict with the company’s country: enriching the seller country is disadvantageous for the company’s own country. For another instance, if people always buy foreign products because they are cheaper than domestic products, the industries of the people’s country will perish in the long run. Tariffs exist to avoid this.
The “nepotism”-based recruitment system is－so to say－ a very strong tariff. Total exclusion of foreign products―however splendid they might be―is surely very effective in raising domestic industries. However, denial of international competition is disadvantageous for the development of industry at a global level.
Even worse, the exclusion of non-local graduates by Japanese private medical colleges isn’t even equivalent to national tariffs; it is rather a domestic tariff between prefectures or cities. Boycotting the people from other cities might protect the workforce of a city. However, merely temporarily. If most Japanese medical colleges shut out talents from other places and isolate themselves, the academic standard of Japan drops. That’s what’s happening now. Japan’s academic performance is plummeting. Many people attribute this to the lack of research funds. However, I believe the denial of competition is another and greater factor in this decline.
