Department Hierarchy and Letters by the Younger Generation

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To the Editors,

Koga’s Letter ^(1)^, written by a Japanese resident physician in the United States, is significant. While complementing Saeki’s article ^(2)^, it emphasizes that Japan’s academic hierarchy may discourage younger physicians―particularly residents―from independently authoring Letters.

As Koga notes, “resident-only” Letters appear rare. I therefore examined how many were written by younger physicians at a Japanese medical university. As a retired obstetrics and gynecology (OBGYN) professor familiar with departmental hierarchies, I focused on OBGYN. On September 17, 2025, a PubMed search of the Japan Society of Obstetrics and Gynecology journal (“J Obstet Gynaecol Res” and letter) yielded 252 Letters (1999-2025). Excluding my own, 22 Letters originated from the same Japanese university department; professors’ names were absent in only two―both single-authored papers by writers in their forties and fifties. Notably, no Letters were authored by residents without a professor’s name.

Letters from abroad were not examined due to technical limitations, and the small sample cautions against firm conclusions. I do not claim that a professor coauthoring a resident’s Letter is inappropriate; a resident may write their own thoughts while a professor polishes them, which can be welcome. Nevertheless, the absence of independent “residents’ Letters” struck me.

Indeed, during my 18-year professorship, no residents in my department wrote Letters (opinion pieces). I assumed many residents focused on case reports or original articles, or were not motivated to express themselves independently. Although I dislike academic hierarchy and made this clear to my staff, I may have created an atmosphere where “the professor’s name should appear.”

I have suggested readers wish to hear residents’ perspectives in Letters―voices reflecting a uniquely younger sensitivity ^(3)^. Koga captured this perfectly: his keen, youthful perspective clearly identified the barriers preventing such contributions.

I have two humble requests. First, journals could consider a “Younger Voice” section, accepting only residents’ opinions, similar to “Patient Voice” or “Student Corner” in some journals. Second, professors should read Koga’s Letter: it may spark broader discussion among senior faculty―key figures in this issue.

Still, I respectfully disagree with Koga. Letter writing is not so easy ^(3), (4)^. While it may take less time than original research, composing a Letter based solely on one’s thoughts or convictions demands deep insight. A Letter’s quality is independent of the author’s age. Undoubtedly, Koga produced an excellent Letter. Seasoned physicians should encourage ambitious younger colleagues to write such Letters independently.

Article Information

Author Contributions

Study design, manuscript writing, editing, approval, and ICMJE authorship criteria met: Shigeki Matsubara.

Conflicts of Interest

None

Ethics Approval

Jichi Medical University does not require Institutional Review Board approval for this type of study. Preservation of patient anonymity and informed consent for reporting are not applicable.

Patient Anonymity

Not applicable.

Informed Consent

Not applicable.

Data Availability Statement

Data sharing is not applicable to this article, as no new data were created or analyzed in this study.