In 2018 it was revealed that Tokyo Medical University had deliberately altered entrance exam scores for over a decade to restrict the number of female students and ensure more men became doctors. It quickly became clear that they weren’t the only ones to do this. At least nine Japanese medical schools manipulated admissions, and the practice is thought to be prevalent in medical universities across Japan (see "Tokyo Medical University discriminated against female applicants by lowering entrance exam scores: sources")

Many of the women who had prepared their entire lives for a career helping people would not go on to practice medicine.

systemic discrimination with intent

The Yomiuri Shimbun newspaper quoted an unknown source at the university who attempted to explain the rationale for the discrimination, saying "many female students who graduate end up leaving the actual medical practice to give birth and raise children."

Tetsuo Yukioka, the school’s managing director, said at a news conference, “We sincerely apologise for the serious wrongdoing involving entrance exams that has caused concern and trouble for many people and betrayed the public’s trust,” denying any previous knowledge of the score manipulation and claiming he was never involved, “I suspect that there was a lack of sensitivity to the rules of modern society, in which women should not be treated differently because of their gender.”

The university later admitted that they had falsified test scores, both defrauding women, intentionally lowering their test scores and while raising the test scores of men whose families had made large donations to the school. An internal investigation found that this had been a practice since 2006.

Consequences? What consequences?

In January 2019, the education ministry said it would not provide financial subsidies to Tokyo Medical University for the current and subsequent fiscal year as a consequence. The university did not receive so much as a slap on the wrist. The penalties for over 12 years of destroying careers was little more than a wag of a finger.

But nothing, absolutely nothing could have prepared me for what happened this week, three years after the discovery of falsified tests and bribes. According to the Mainichi Shinbun, Tokyo Medical University has agreed to pay the Consumers Organization of Japan (COJ) an agreed-upon ¥57 million yen in the lawsuit settlement over the university's rigging of entrance exams. 57 million sounds like a big number, but it’s not. That’s equivalent to $520,000 US dollars.

Adding insult to injury

According to the terms of the settlement, 558 female applicants who had their test scores deliberately lowered in order to intentionally reduce the number of women admitted into medical school and increase the number of men admitted, will receive between 40,000 yen (about $360) and 220,000 yen (about $2,000) each, depending on the number of times they took the exams.

$360. Think about that for a minute. Let it sink in.

This isn’t a driver’s license exam.

This is entrance into medical school, something most people spend their entire youth preparing for starting from when they’re in Japanese yochien (preschool) and asked to tell an audience of everyone’s parents what they want to be when they grow up. This is thousands upon thousands of hours, and years preparing for a grueling entrance examination - during the prime of one’s life - time not spent on all of the other opportunities.

What is Tokyo Medical University saying with this settlement? “Here’s $360. Now go away.”

This bothered me beyond words. It bothered me because it’s discrimination. It bothered me because it was an opportunity for the leadership of the Japan to demonstrate to all the women of Japan what “Empowering Women” as a national priority is real, and what happens when a Japanese institution steps on and completely desecrates the national agenda and destroys dreams, careers and even future families. The opportunity was missed. And it bothered me because, to top it all off, the settlement is inconceivably offensive.

What Tokyo Medical University derailed wasn’t just the test scores for 558 women. What Tokyo Medical University derailed were their careers as Doctors. Well-compensated Doctors.

There is a simple business school formula for answering the question of what that career would have been worth: It’s called Net Present Value (NPV). NPV is the value of future cash earned in today’s dollars, less the cost of the investment. To measure the pure financial value of an MD from the “prestigious” Tokyo Medical University, just take the fully burdened cost of attending, including tuition, books, time value that could have earned a salary in the working world instead of attending six years in medical school, and then apply the discounted cash flows expected from a future career as a Medical Doctor from one of the most prestigious medical schools in Japan.

I won’t run the calculations here because you can do it at this web site. I made some assumptions, like $200,000 for medical school. And I used the publicly available data that shows what junior and senior doctors from Tokyo Medical University make, and I used the difference between this and a regular salary doing IT or some other “middle class” job. It turns out the NPV of a medical degree from Tokyo Medical University is approximately $5 million dollars (or ¥550 million yen).

And all they received was $360 for each falsified test score.

What can we learn from this?

It’s clear that Japan has a very long way to go when it comes to gender discrimination. It’s difficult to say that it’s even a priority based on how this egregious offense simply slipped through the news without prompting any major backlash. By comparison, just look at the volume and intensity of investigation, prosecution and news related to the United States related to the University of Southern California (USC) college admissions scandal. It makes one wonder if what Tokyo Medical University did had happened in the US, would the male graduates whose tests were falsified have their medical degrees invalidated?

Another by product of this scandal is destruction of trust. Tokyo Medical University can’t just apologize to make this right (which they never did) and even if they had apologized, it’s not enough to regain trust. Tokyo Medical University no longer has credibility, and they certainly have any integrity. How do you feel about being operated on by a doctor who graduated from a medical university where its unknown if they were even qualified to attend? On what merits were they accepted, other than having a penis? It took having previously failed the entrance exam four times to not have their exam scores fraudulently inflated.

How do we prevent it from happening again? How do we stop it from happening at all the other universities it may be happening at right now? These are important questions. Will this impact the livelihoods of doctors who graduated from Tokyo Medical University? Will this stand for Japanese women as a line crossed?