Concerning the gender gap, Japan is ranked the lowest among developed countries, at 121 of 156 countries in 2021.1 This is clearly linked to fewer women working in their 30s or 40s, in sharp contrast with other Organisation for Economic Co-operation and Development (OECD) member countries.2 However, approximately 30% of medical students are female, therefore a greater number of female doctors will be expected, although still fewer than the overall statistic of women being 46.5% of medical practitioners in OECD member countries.3

Nowadays, we are aware that the past one-size-fits-all career no longer fits into the medical setting. The Japanese economy and society have evolved through a culture of long working hours, which was also the case in the medical field. Moreover, we have tended to believe that long working hours are required to become fully qualified doctors; however, reform of work practices has been promoted in Japanese society, including in medicine.4 Seeing patients as a group, medical assistants and even artificial intelligence will facilitate work sharing and optimization of professional tasks for medical doctors.

Diversity and inclusion will soon be essential concepts for all medical professionals. Enabling both men and women doctors to access part-time medical positions allows better sharing of professional, domestic and childcare responsibilities.5 Furthermore, limiting access to part-time roles to women may affect the career development of female doctors and interfere with work–life balance for both men and women. Therefore, systems to support parents of young children with breastfeeding and childcare should be revised to enable both men and women to continue to work. Simultaneously, unconscious gender bias should be redressed to make a better working environment for all.

The Japanese Respiratory Society (JRS)6 provides consultation services, e-learning materials and sessions on gender equality at their conference. Increasing the rate of women chairing sessions was strongly recommended in past conferences. The Committee of Gender Equality in JRS was established in 2016 and conveyed recommendations on taking parental leave after childbirth for both female and male doctors. Among the active JRS committee members in medical schools and hospitals, approximately half are women.

The requirements for board certification are important considerations for many trainees. Trainee respiratory physicians are now permitted to pause or extend their training periods, or work part-time to meet caregiving responsibilities, which fosters diversity and maturity in future supervisors and the educational environment.

We now introduce three leading female professors, who each exemplify what women can achieve in respiratory medicine in Japan. Dr Tomoko Betsuyaku was the first female clinical professor in the medical department of Keio University. She graduated from Hokkaido University and joined the Department of Respiratory Medicine at Hokkaido University. She was interested in the molecular pathogenesis of chronic obstructive pulmonary disease, especially matrix metalloproteinases, and began her research on bronchoalveolar fluid in smokers with and without emphysema. New exciting articles always kept Dr Betsuyaku in discussions with her mentors or colleagues. It did not take long for her to make her mark as one of the brightest researchers in respiratory medicine in Japan. Studying abroad in St Louis, USA, fostered her international perspective. Meanwhile, it was not easy even for Dr Betsuyaku, such an energetic and gifted woman, to balance work and life as a leading researcher, mother and busy faculty member. However, she has overcome many challenges and with the combined help of her husband, mother and colleagues she maintained communication with her mentors and friends at home and abroad. Moreover, Dr Betsuyaku launched a committee for gender equality, conducted the hospital's survey on steps to improve gender equality and has been involved in preparing childcare for sick children of staff at Hokkaido University Hospital. Her presence in leading positions has contributed to empowering women in respiratory medicine in Japan.

We are delighted to present the following messages from Professor Hisako Matsumoto and Professor Mitsuko Kondo.

Dr Hisako Matsumoto, Department of Respiratory Medicine & Allergology, Kindai University Faculty of Medicine.

Except for her initial residency at Kobe City General Hospital and studying abroad at Sydney University, Dr Matsumoto spent her career at Kyoto University until she moved to Kindai University this spring. She works with patients with severe asthma, addressing various aspects such as chronic cough, airway remodelling, endo-phenotyping using type 2 biomarkers (including periostin) and comorbidities including bronchiectasis. With sincere gratitude to her mentors and colleagues, she is inspired by her favourite message of Sir William Osler: ‘The value of experience is not in seeing much, but in seeing wisely’.

Dr Mitsuko Kondo, Department of Respiratory Medicine, Tokyo Women's Medical University.

Since graduation from Niigata University in 1980, she has worked at Tokyo Women's Medical University. At that time, patients with diffuse panbronchiolitis and asthma suffered from asphyxia due to hypersecretion; therefore, the management of airway secretion clearance became a strong focus for her research. After studying abroad at the University of California, San Francisco, in 1988–1990, she continued to work on the development of air–liquid interface culture, airway epithelial ion transport, goblet cell metaplasia and mucociliary clearance. Dr Kondo is sincerely grateful for support from many excellent leaders and colleagues, her family and the environment of Tokyo Women's Medical University, where many female doctors actively work. Through her life's journey as a researcher, she learned that translational research may in time result in changes in clinical practice, that unexpected results can bring about new discoveries and that simple and reproducible laboratory methods become widespread. She is convinced that female doctors, who bring with them diverse life experience, are indispensable for the development of respiratory medicine.

Diversity in leading women and men will hopefully motivate us and bring about a paradigm shift both in clinical and research fields of respiratory medicine.

The authors thank Dr Hisako Matsumoto and Dr Mitsuko Kondo for their valuable messages for this letter and Dr Tomoko Betsuyaku for all her contributions to respiratory medicine in Japan.