Professor Ikeda justly brings to light the immense contributions of Michinosuke Amano, M.D. (1916–; Professor Emeritus, Department of Anesthesiology, Keio University, Tokyo, Japan) and the little known Government Account for Relief in Occupied Area program to the progress of anesthesiology in Japan.1Because of the efforts of pioneers such as Dr. Amano and Hideo Yamamura, M.D. (1920–; Professor, Department of Anesthesiology, University of Tokyo, Tokyo, Japan), Japanese academic anesthesiology has attained remarkable levels as witnessed by the numerous scientific publications originating from these institutions. The state of clinical anesthesiology in Japan, however, is not as rosy. The specialty suffers from a chronic workforce shortage. The majority of practitioners are salaried hospital employees, forced to work long hours for relatively poor compensation—a clear reason the specialty has trouble attracting personnel. One of the fundamental problems is the inability of anesthesiologists to directly bill the social health insurance system for their services and become independent private practitioners. The Japanese Society of Anesthesiologists; academic centers; the Ministry of Health, Labor and Welfare; and other interested organizations, while acknowledging this problem, have thus far been unwilling or unable to implement the necessary changes. For unclear reasons, what would usually be considered significant bargaining power has not been used to improve the predicament of clinical anesthesiologists. The result is what can only be described as a crisis, with no relief in sight. Calls are mounting from the surgical (and even within the anesthesia) community for introduction of alternative anesthesia providers—a move that will further devalue the specialty. It is unclear what it will take to force change, because repeated reports of mishaps during surgeon-administered anesthesia are apparently not reason enough.

In Japan, although academic anesthesia flourishes, things have not changed much in the operating room since 1955, being “understaffed, and (with many) anesthetics . . . still given by junior surgeons.”1Someone must step up to the plate soon, at the very least to honor the efforts of Dr. Amano and the pioneers, if not for the patients.

Nakagaki Clinic, Nagoya, Japan.

Ikeda S: Government Account for Relief in Occupied Area: A Japanese physician's journey to a new medical specialty. Anesthesiology 2005; 103:1089–94