One year has passed since the new Board of Directors of the Japanese Society of Pediatric Surgeons (JSPS) was inaugurated in June 2025 and I was entrusted with the responsibility of serving as President. It has been a year marked by both significant challenges and meaningful progress, during which our Society has continued to pursue its mission of advancing pediatric surgery while responding to rapid changes in healthcare and society.

Pediatric surgery in Japan is entering a period of profound transformation. The implementation of physician work-style reform, the continuing decline in the national birth rate, regional disparities in healthcare resources, and the increasing need for international collaboration are reshaping the environment in which pediatric surgeons practice, teach, and conduct research. These challenges require us not only to adapt, but also to redefine how our Society can best support pediatric surgeons and safeguard the future of our specialty.

One of the most significant developments has been Japan’s physician work-style reform, introduced in 2024, which established legal limits on physicians’ overtime working hours. While this reform represents an important step toward improving physicians’ well-being, a nationwide survey conducted by the JSPS Committee on Work-Life Balance revealed that pediatric surgery faces unique challenges in implementing these changes. Compared with many other medical specialties, opportunities for task shifting and task sharing remain limited because of the highly specialized nature of pediatric surgical care. Furthermore, outside major university hospitals and dedicated children’s hospitals, pediatric surgical services are often provided by only a small number of surgeons, making it difficult to secure adequate rest periods and alternative staffing arrangements. These findings indicate that substantial efforts are still required before the goals of work-style reform can be fully realized in pediatric surgery.

At the same time, encouraging developments have emerged through Japan’s 2026 revision of the national health insurance reimbursement system. Pediatric surgery has been officially recognized as one of several specialties facing a nationwide shortage of young physicians, together with gastrointestinal surgery, cardiovascular surgery, and cardiology. As a result, new reimbursement measures have been introduced to help support these essential specialties, representing an important step toward improving the working environment and long-term sustainability of pediatric surgical practice.

Nevertheless, demographic change remains our greatest long-term challenge. According to the provisional Vital Statistics released by the Ministry of Health, Labour and Welfare in June 2026, both the annual number of births and Japan’s total fertility rate reached record lows for the tenth consecutive year despite ongoing national efforts to address population decline. For pediatric surgery, this issue extends far beyond a reduction in patient numbers. It directly affects the sustainability of pediatric healthcare systems, the maintenance of regional surgical services, and, most importantly, the education and recruitment of the next generation of pediatric surgeons.

Against this background, our Society has continued to move forward with determination. Over the past year, we have advanced a number of strategic initiatives designed not only to address current challenges but also to strengthen the foundations of pediatric surgery for future generations. In the following report, I would like to summarize our principal activities during the past year, outline the projects currently underway, and share our vision for the continued development of the Japanese Society of Pediatric Surgeons.

1. Reforming the Training System for Pediatric Surgeons and Surgical Trainers

Ensuring high-quality education for future pediatric surgeons remains one of the Society’s highest priorities. As demographic changes continue to reshape Japan’s healthcare landscape, we must also reconsider how we educate specialists and support future surgical leaders across all regions of the country.

To address regional disparities in training opportunities, the JSPS is currently developing a new national matching system for pediatric surgical training. While a similar system existed approximately thirty years ago, its primary objective at that time was to provide additional training opportunities for residents working in institutions with limited surgical case volumes. The new matching system has a broader and more forward-looking vision. It aims to provide structured training opportunities for young surgeons who are committed to practicing pediatric surgery in their home regions, enabling them to acquire the experience required for specialist and trainer certification while strengthening regional pediatric surgical services throughout Japan.

Under the leadership of the Committee on Institutional Accreditation, we have begun this initiative by conducting a nationwide survey of accredited training institutions to evaluate their educational capacity and the conditions under which they can accept trainees. This will be followed by a survey of young pediatric surgeons to better understand their educational needs and career aspirations. Based on these findings, the Society will establish a comprehensive framework for the new matching system.

Current analyses of nationwide surgical case volumes indicate that Japan continues to maintain an adequate overall environment for specialist training. However, they also reveal considerable regional variation. In some areas, particularly those experiencing more rapid population decline, maintaining sufficient operative experience to satisfy the current requirements for trainer certification is becoming increasingly difficult.

Recognizing these realities, the Committee on Specialist Certification is reviewing the existing criteria for trainer accreditation. Rather than relying solely on experience with a fixed list of mandatory procedures, the Committee is considering a more flexible competency-based evaluation system that incorporates a weighted point structure according to the complexity of surgical procedures. We believe this approach will better reflect contemporary clinical practice while maintaining the high educational standards expected of pediatric surgical trainers.

Through these initiatives, the Society seeks not only to preserve the quality of specialist education but also to ensure equitable access to advanced pediatric surgical training throughout Japan, thereby supporting both regional healthcare and the long-term sustainability of our profession.

2. Reimagining Our Scientific Meetings for a Changing Era

Scientific meetings have long served as the cornerstone of academic exchange, professional development, and collaboration within our Society. However, the environment surrounding academic conferences has changed considerably in recent years.

In addition to the implementation of physician work-style reform, rising travel and accommodation costs have placed increasing time and financial burdens on our members, particularly early-career pediatric surgeons. At the same time, organizing scientific meetings has become increasingly challenging. Despite enhanced financial support from the Society, securing industry sponsorship, educational grants, and exhibition opportunities has become progressively more difficult, placing greater responsibility on meeting presidents and local organizing committees.

Recognizing these changes, the Committee on Future Planning has continued its comprehensive review of the optimal structure of our academic meetings. Following extensive discussion, the Society has reached a broad consensus on a new direction beginning in 2029.

Our current Autumn Symposium, including joint meetings with the Pediatric Surgery Joint Meeting (PSJM), is planned to transition to a Spring Symposium held in conjunction with the Annual Congress of the Japan Surgical Society. At the same time, the Annual Meeting of the Japanese Society of Pediatric Surgeons will continue as an independent scientific congress and will be scheduled for late October.

This new framework seeks to preserve the unique identity and academic excellence of our Annual Meeting while reducing the burden on members, encouraging greater interaction with surgeons from related specialties, promoting participation by young pediatric surgeons in the national surgical community, and improving the overall efficiency and sustainability of meeting organization.

Implementing this transition will require amendments to the Society’s Articles of Incorporation as well as adjustments to our fiscal year and administrative regulations. These changes will be carefully planned to ensure a smooth and transparent transition.

As our Society evolves, we remain committed to preserving the scientific independence and traditions of pediatric surgery while adapting to the changing needs of our members and the broader healthcare environment.

3. Investing in the Next Generation Through Research

Research is one of the fundamental pillars supporting the future of pediatric surgery. Scientific discovery not only advances patient care but also inspires young surgeons to pursue academic careers and become future leaders of our specialty.

With this philosophy in mind, the Society has established a competitive research grant program specifically designed for early-career pediatric surgeons. Under the leadership of the Committee on Academic Affairs and Advanced Medical Technologies, applications were carefully reviewed, and three research proposals were selected for funding during the 2025 academic year.

Although the financial support provided through this program is modest, we hope that it will serve as an important catalyst for young investigators, enabling them to initiate new research projects, generate preliminary data, and develop sustainable academic careers.

Supporting young researchers is an investment in the future of pediatric surgery. The Society will continue to expand opportunities that encourage innovation, scientific curiosity, and academic excellence among the next generation of pediatric surgeons.

4. Expanding International Collaboration and Global Communication

The COVID-19 pandemic reminded us that medicine is fundamentally global. Scientific knowledge, emerging technologies, and healthcare challenges transcend national borders, making international collaboration more important than ever before.

For Japanese pediatric surgery, maintaining an active presence within the global community is essential. We must ensure that our achievements are shared internationally while continuing to learn from colleagues throughout the world. Avoiding scientific isolation is critical for the continued advancement of our specialty.

To support this vision, the Society will launch an International Travel Grant Program for young pediatric surgeons beginning this year. This initiative will provide financial assistance for members presenting their research at international scientific meetings or publishing their work in international journals. By reducing financial barriers, we hope to encourage more young surgeons to engage confidently with the global pediatric surgical community.

The Society is also committed to strengthening partnerships with international organizations, including the World Federation of Associations of Pediatric Surgeons (WOFAPS), the Asian Association of Pediatric Surgeons (AAPS), and many other regional and national pediatric surgical societies. As an important first step, we successfully organized the inaugural AAPS–JSPS Webinar in February 2026. We intend to continue these educational webinars on a regular basis, creating valuable opportunities for scientific exchange, collaborative learning, and international networking, particularly for younger members.

Communication is equally important. In June 2026, the Society launched its official social media presence on X (formerly Twitter), providing timely updates on Society activities while promoting pediatric surgery to medical students, residents, and young physicians considering careers in our specialty. During the current fiscal year, we are also undertaking a comprehensive renewal of the Society’s official website to improve accessibility, usability, and the dissemination of information both within Japan and internationally.

International collaboration and effective communication are no longer optional—they are integral to the future of our Society. By creating opportunities for young pediatric surgeons to engage with colleagues around the world, we aim not only to strengthen their professional development but also to enhance the international visibility and influence of Japanese pediatric surgery.

5. Empowering the Next Generation: The U45 Initiative

The future of any professional society depends on the enthusiasm, creativity, and leadership of its younger members. Recognizing this, the Japanese Society of Pediatric Surgeons established the U45 Working Group in 2022 as an advisory body to the Committee on Future Planning.

Over the past three years, the U45 Working Group has demonstrated remarkable initiative by actively engaging young pediatric surgeons, encouraging discussion on issues relevant to early-career professionals, and proposing innovative ideas for the future of our specialty.

In recognition of these achievements, the Society has formally incorporated the U45 Working Group into its organizational structure. With clearly defined regulations and responsibilities, the group will now serve as an official committee of the Society, providing a structured platform through which the perspectives of younger members can be reflected in Society governance.

Beyond representing the voices of young pediatric surgeons, the U45 initiative will promote professional networking, leadership development, and collaborative activities among the next generation. We hope that this group will become an important driving force in shaping the future direction of pediatric surgery in Japan.

6. Advancing Digital Transformation and Organizational Efficiency

As our Society continues to grow, efficient governance has become increasingly important. Digital transformation is not simply a matter of improving administrative processes; it is essential for building a more responsive, transparent, and sustainable professional organization.

This year, we successfully introduced a fully electronic system for Conflict of Interest (COI) disclosure for Society officers and committee members. In addition to streamlining administrative procedures, this initiative has reduced paper consumption, mailing costs, and the overall administrative burden associated with annual reporting.

We have also expanded the use of electronic decision-making within the Board of Directors. Routine matters that do not require extensive discussion are now handled through electronic resolutions, allowing face-to-face Board meetings to focus on strategic issues, long-term planning, and matters of significant importance to the Society.

These initiatives represent only the beginning of our broader digital transformation strategy. By embracing digital technologies, we aim to maximize the efficient use of our financial and human resources while strengthening the quality, transparency, and agility of Society governance.

7. Strengthening Our Voice Through Policy Advocacy and Collaboration

A professional society has responsibilities that extend beyond education, research, and clinical practice. It also has a responsibility to advocate for healthcare policies that improve patient care and support the professionals who deliver it.

Although recent revisions to Japan’s national health insurance reimbursement system have provided important recognition of pediatric surgery as a workforce-shortage specialty, many of the broader challenges facing pediatric healthcare remain unresolved. Issues such as regional disparities in healthcare delivery, workforce sustainability, and the long-term impact of Japan’s declining birth rate require continued engagement with policymakers.

To strengthen the Society’s capacity for policy advocacy, we established an ad hoc Liaison Committee for the Children and Families Agency and created an online platform through which members can submit policy proposals and suggestions. These initiatives have enabled the Society to better understand the concerns of its members while fostering constructive dialogue with government agencies.

Our discussions with representatives of the Children and Families Agency also highlighted an important reality: although the Agency plays a central role in child welfare and family support, many healthcare policies, including reimbursement and medical workforce planning, ultimately fall within the jurisdiction of the Ministry of Health, Labour and Welfare.

This experience has reinforced our belief that meaningful policy change requires sustained and strategic engagement. It is not achieved through isolated requests but through continuous dialogue with government officials, legislators, and other stakeholders. As a professional society, we must continue to communicate the unique challenges facing pediatric healthcare and advocate for policies that ensure every child has access to high-quality surgical care.

Looking ahead, we hope to strengthen collaboration not only with governmental organizations but also with related academic societies, healthcare professionals, and patient advocacy groups. By speaking with a united voice, we can more effectively contribute to the development of healthcare policies that benefit children throughout Japan.

As Japan continues to experience profound demographic change, the future of pediatric healthcare cannot be taken for granted. The Japanese Society of Pediatric Surgeons remains committed to advancing clinical care, education, research, and public policy while working collaboratively with all stakeholders to build a sustainable future for pediatric surgery and for the children we serve.

Looking Ahead

Reflecting on the past year, I am deeply encouraged by the dedication, resilience, and professionalism demonstrated by our members. Despite the many challenges confronting pediatric surgery in Japan, our Society has continued to move forward with a shared sense of purpose and responsibility.

There is no doubt that the environment surrounding pediatric surgery will become increasingly complex in the years ahead. Japan’s continuing demographic transition, regional disparities in healthcare resources, evolving workforce expectations, rapid technological innovation, and the globalization of medical practice will continue to reshape our profession. These challenges, however, also present opportunities for innovation, collaboration, and renewal.

As the Japanese Society of Pediatric Surgeons, our mission extends beyond responding to change. We must actively shape the future of pediatric surgery by fostering excellence in clinical practice, advancing scientific research, nurturing the next generation of pediatric surgeons, strengthening international partnerships, and advocating for healthcare policies that ensure every child has access to the highest standard of surgical care.

The future of our specialty will depend not only on technological advances but also on our ability to cultivate compassionate surgeons, visionary leaders, and collaborative professionals who are prepared to meet the changing needs of society. By embracing innovation while preserving the core values of pediatric surgery, we can continue to provide the best possible care for children and their families.

I firmly believe that the strength of our Society lies in the collective wisdom and commitment of its members. Together, we have built a proud tradition of excellence, and together, we will continue to shape the next chapter of pediatric surgery in Japan.

As President, I remain fully committed to serving our members with transparency, integrity, and a clear vision for the future. I sincerely appreciate the continued dedication of our Board of Directors, committee members, and administrative staff, whose tireless efforts make the Society’s activities possible.

Finally, I would like to express my heartfelt gratitude to all members of the Japanese Society of Pediatric Surgeons for your continued trust, support, and active participation. I look forward to working together with you as we continue to advance pediatric surgery in Japan while contributing to the global pediatric surgical community.

Together, let us continue to build a brighter future for pediatric surgery—and, above all, for the children and families who place their trust in us.

June 2026

Satoshi Ieiri, MD, PhD, FACS

President
Japanese Society of Pediatric Surgeons
Professor and Chairman
Department of Pediatric Surgery, Kagoshima University