If academic medicine depends on
personal sacrifice to function,

how sustainable is it
in the long run?

When incentives do not match expectations,
academic medicine relies on goodwill.

Over time, that model selects
not for excellence,
but for endurance.

In many other systems,
academic medicine comes with
either protected time, higher pay,
or both.

In Japan, it often comes with
added responsibility — without either.

In Japan,
academic physicians are expected to
deliver clinical care, research, education,
and administration —

often with little financial distinction
from non-academic clinical roles.