A Questionnaire Study of Leadership in General Medicine: General Physicians in Japan are Facing Challenges in Education and Research [Response to Letter]

Dear editor

We extend our gratitude to Zhang et al for their insightful comments. Leadership is an essential skill for general physicians engaged in clinical practice, education, and research, and it is important to establish an educational framework for its development.

As Zhang et al noted, leadership requirements vary by environment; thus, detailed information on respondents’ backgrounds is essential for interpreting results.¹ Our survey categorized experience levels based on typical career progression in Japan.² Physicians generally undergo clinical resident training in the first two years post-graduation,^3,4 specialty training in years three to five,^3,4 and subspecialty training in years six to ten, with leadership roles, such as instructors or managers, typically emerging from the eleventh year onwards. Our study did not assess specific job responsibilities or research involvement.² Among respondents, 74.9% were supervisors or department chairpersons with more than six years of experience (6–10 years: 22 physicians, ≥11 years: 192 physicians). In addition, 78.5% of those supervisors or chairpersons worked in hospitals with more than 200 beds, including very large hospitals with over 500 beds. These physicians likely mentor junior colleagues and engage in research. Additionally, 20.2% of respondents who selected “other” for their position had 6–10 years of experience, indicating they are mid-career physicians with specialist qualifications expected to demonstrate leadership. Findings suggest that in this cohort—comprising many general physicians in leadership positions—democratic leadership is recognized as necessary for clinical practice, while transformational leadership is deemed essential for education and research.²

As Zhang et al emphasized, leadership is crucial for physicians, necessitating structured leadership education and further research.¹ In our survey, 57% of general practitioners expressed interest in leadership training,² highlighting its relevance. Our findings suggest that general physicians must develop a broad spectrum of leadership skills, particularly in research and education.² Furthermore, effective leadership requires adapting styles to specific environments and supervisory responsibilities. However, these insights remain empirical, and further research is needed to determine whether leadership approaches should evolve with experience.¹ Before applying leadership strategies, learners must first recognize different leadership types and their practical implications. Since individual traits shape leadership strengths and weaknesses, personalized leadership education may be beneficial. Previous research has examined the effects of different leadership types on outcomes such as patient satisfaction,⁵ turnover rates,^5,6 and physician performance.⁷ Future studies employing rigorous methodologies, clearly defined target populations, and well-specified outcomes are essential to build a stronger evidence base.