How Russian doctors can get licensed in Japan: navigating an exam with a 10% success rate

The allure of Japan

For practicing physicians, Japan offers the chance to work within one of the world’s most advanced healthcare systems. The country faces systemic staff shortages in specific fields, particularly in rural areas and surgical specialties like general surgery, neurosurgery, obstetrics/gynecology, and emergency medicine.

Key challenges on the path to licensure

Bureaucratic hurdles: The process of getting a foreign medical degree recognized by the Ministry of Health, Labour and Welfare (MHLW) is notoriously long (document review alone can take up to two years), opaque, and unpredictable.
Grueling examinations: You must pass several exceptionally difficult exams in Japanese. The toughest is the preliminary examination (Ishi Kokka Shiken Yobi Shiken), which has an extremely low first-pass rate—only about 10% of candidates clear all stages without retakes.
Financial strain: A significant financial safety net is required to cover living expenses for 3-5 years, as you will have no stable income from medical practice during the licensing process.
Starting from scratch: Even experienced physicians must begin their careers from the entry level: a two-year residency program (Kenshūi) alongside recent Japanese medical school graduates.

The roadmap to medical licensure

Obtaining a full medical license in Japan (Ishi Kokka Shiken) is a multi-step quest.

Document submission to the MHLW (書類審査, Shorui Shinsa) The MHLW will scrutinize your diploma and curriculum to determine if they are equivalent to Japanese standards. This review almost invariably results in the candidate being required to take qualifying exams.
The MHLW’s decision Based on their review, you will be assigned to one of two pathways:

Direct pathway: If your education is deemed fully equivalent to Japan’s standards.
Preliminary pathway: If significant discrepancies are found (the most likely scenario for a diploma from Russia).

Examinations

Direct pathway: You must pass a clinical skills exam in Japanese (Nihongo Shinryō Nōryoku Chōsa).
Preliminary pathway: You must pass the preliminary licensing exam (Ishi Kokka Shiken Yobi Shiken).

Clinical training (preliminary pathway only) Candidates on this path must complete one year of mandatory clinical training (Jitchi Shūren) at a designated Japanese hospital.
The national medical examination (all candidates) Finally, all candidates must successfully pass the main National Medical Examination (Ishi Kokka Shiken).

Recognition of medical specialization

This is a separate process that begins after you have obtained your general medical license and completed the two-year residency. Specialty recognition is handled by specific medical associations, not the MHLW. In practice, having a foreign residency directly accredited is nearly impossible. The most realistic approach is to complete a Japanese specialization program (Kōki Kenshū, 後期研修) from the beginning.

MHLW application checklist

Completed application form
Diploma of Higher Medical Education
Academic transcript (Curriculum) with a full list of subjects and hours
A valid medical license from your home country
Japanese Language Proficiency Test (JLPT) N1 certificate (mandatory for anyone not educated in the Japanese school system)
Resume (Curriculum Vitae)
Copy of your passport

Requirements: All documents must be translated into Japanese by a certified translator. Applications must be submitted in person or by mail in Tokyo.

The main examinations

Language proficiency assessment (Nihongo Shinryō Nōryoku Chōsa)
Format: A practical OSCE-style exam with 3-5 stations featuring simulated patients. It assesses five core competencies: listening, speaking, writing (medical records), reading (medical terminology), and conducting a physical examination in Japanese.
Passing criteria: The cost varies. To pass, a candidate must score over 60% and avoid receiving a «0» in any single category, an immediate failure given for any action deemed dangerous to the patient.

Preliminary licensing exam (Ishi Kokka Shiken Yobi Shiken)
Format: A series of written and practical tests covering both fundamental and clinical sciences. It is considered extremely challenging.
Failure rate: Very high. According to unofficial data, only about 10% of candidates manage to pass all stages on their first attempt.

Integrating into the Japanese medical system

Job search tools: A key strategic tool is the clinical observership (similar to a medical rotation for observation). Many university hospitals, like the University of Tokyo Hospital or Tsukuba University Hospital, offer these programs for foreign doctors. This is the best way to get acquainted with the system, build a professional network, and find a potential hospital for your mandatory training or residency.

Labor market: The highest demand for physicians is in rural prefectures and in specialties such as surgery, neurosurgery, obstetrics and gynecology, and emergency medicine.

Career path and long-term strategy

Clinical career hierarchy

Kenshūi (研修医) — Resident (2-year mandatory program)
Senkōi (専攻医) / Iin (医員) — Specialist-in-training / Staff Physician (similar to a Fellow)
Shidōi (指導医) — Supervising Physician (similar to an Attending Physician)
University hospital ranks: Jōkyō (助教) – Assistant Professor, Kōshi (講師) – Lecturer, Jun-kyōju (准教授) – Associate Professor, Kyōju (教授) – Professor.

Finances

Position / Age Range	Average Annual Gross Salary	Estimated Net Salary (After Taxes)
Resident (20-29)	¥8,180,000	~ ¥6,000,000
Junior Doctor (30-39)	¥11,870,000	~ ¥8,200,000
Experienced Doctor (40-49)	¥15,460,000	~ ¥10,200,000
Senior Doctor (50-59)	¥17,470,000	~ ¥11,300,000

Alternative careers («plan B»)

If clinical practice isn’t the right fit, a medical license opens doors to careers in the pharmaceutical and MedTech industries.

Industry leaders: Japan is home to the headquarters and major offices of global giants like Takeda, Astellas Pharma, and Daiichi Sankyo.

Roles and salaries:

Medical Science Liaison (MSL): A role requiring deep medical expertise to engage with key opinion leaders. Mid-to-senior level salaries at Japanese pharma companies can range from ¥7,000,000 to ¥15,000,000 or more.
Medical Advisor: Provides medical consultation to internal departments like marketing and sales. The salary range is comparable to that of an MSL.

Final verdict

Summary of pros and cons

Pros: Access to high-level medicine and technology, excellent compensation, a fast track to permanent residency after licensure, and a high quality of life in a safe country.
Cons: An extremely high language barrier, a complex and opaque licensing process, the necessity of restarting one’s career from scratch, and potential cultural isolation.

Verdict: Pursuing a medical career in Japan is not merely an immigration plan; it is a project of complete professional and cultural assimilation. This path is only suitable for the most motivated, disciplined, and linguistically gifted individuals for whom living and working in Japan is the ultimate goal, not just a means to an end.

Common mistakes to avoid

Underestimating the language barrier JLPT N1 is not enough. You need fluency that surpasses that of an average native speaker, including an understanding of regional dialects and the cultural nuances of patient communication.
The illusion of an easy final exam The high pass rate for the Ishi Kokka Shiken (around 90%) applies to Japanese graduates. For foreign candidates taking the preliminary exam, the actual success rate is significantly lower.
Underestimating MHLW bureaucracy The document review process can drag on for years without clear communication. Meticulous preparation of every single document is essential.
Neglecting to network Professional connections are immensely important in Japan. Using observership programs to build relationships is a critical step for success.

Visual roadmap

For a physician with a diploma:
Russian diploma → Pass JLPT N1 → Submit Documents to MHLW → (Preliminary Pathway) → Pass Yobi Shiken → 1-Year Clinical Training → Pass Ishi Kokka Shiken → Obtain License → 2-Year Residency → Specialization

Егор Кугно