Japan's New Middle Class: The Salary Man and His Family in a Tokyo Suburb (4 page)

basis of convenience of location, his general attitude and reputation, and the introduction of friends. The Mamachi doctor's business interests are more overt than those of his American counterpart. He dispenses drugs to his patients for a profit, and he may also operate his ward at a profit. He is permitted to advertise, and at the least he has a billboard calling attention to his location. Since the financial security of his family depends on his practice, he tries to accumulate some savings. Some professionals have formed mutual-benefit groups to help a member's family in case of need, but usually they cannot equal the security offered by the large organization in times of economic recession, accident, sickness, or retirement.

Setting up a private practice poses considerable financial risks because it requires a sizeable outlay of initial capital for machinery, much more so than a few years ago. with the standardization of medical education through medical schools, the cost of education has risen, and the age at which one can begin earning has also risen. It may take many years of practice before a young doctor can build up a practice, repay his debts to benefactors, and earn a comfortable living. Only a few decades ago it was common to serve a long period of apprenticeship with another doctor or dentist and then open a practice with the help of the older doctor and the savings accumulated during the apprenticeship. Most middle-aged practitioners of Mamachi got their start this way and now have no difficulty making an adequate living. Indeed, their income tends to be much higher than that of the salary man.

The basic problem confronting the older practitioners is that of assimilating the technical advances introduced from the West since the war. Some have not kept fully abreast of these changes, but other conscientious doctors have enrolled in special courses in addition to reading professional journals and attending special lectures or demonstrations sponsored by their former university or by the medical societies. The amount of skill required for such technical work and the individual responsibility for pursuing training while engaging in practice have made this problem particularly acute among the professionals.

Unlike the successful businessman who has broad responsibilities in community affairs, a doctor's activities, with few exceptions, are limited to his relationships with his patients, relatives, and profes-

sional colleagues. So much of his time is spent in his office or calling on his patients, that he has little time for outside activities. His professional relationships are more likely to be determined by the school he attended than by the community in which he now lives. Not only do fellow alumni have professional relationships but together they may engage in the full range of leisure-time activities, including drinking, group games, parties, and trips. Some doctors feel competitive with other doctors in Mamachi, but they generally do not feel competitive with fellow alumni. However, because of professional ethics and a steady clientele and income, doctors and dentists do not compete as bitterly as, for example, small shopkeepers.

Like successful businessmen, doctors rarely make a sharp separation between work and leisure hours, and to some extent working hours are determined by the arrival of patients. Most offices are open until eight or nine in the evening, and even in non-emergency situations, patients sometimes call the doctor at later hours. It has not been customary to schedule appointments, but now some doctors are attempting to set up regular appointments. The doctor-patient relationship is now coming to resemble the more contractual business-like arrangements between doctor and patient in the West, but even now, some patients bring presents and pay on a more informal basis than in the West. As one dentist jokingly remarked, he was starting to charge his customers standard prices just as if he were running a department store. For doctors, the standardization of prices has been greatly accelerated by the national health insurance which has set up a regular scale of fees. Nevertheless, doctors often do engage in informal visiting with a patient, provided there is no pressing work.

Because of the physical proximity of office to family, the doctor-husband spends considerable time at home, eating and visiting with the family between patients. Hence, he knows more about family activities, and exercises more authority in the home than the salary man or the businessman. For example, he may decide when his nurse or office assistant will help his wife with housework. If his wife is also his nurse, bill collector, and drug mixer, she is likely to be under her husband's constant supervision. Even the wife who does not help in his office and has a maid for the home does not have

the freedom from her husband's wishes that wives of salaried employees or of successful businessmen have. Concurrently, the wife is likely to know more about the activities of her husband, and he can have few monetary secrets from her. She has less reason to worry about her husband's recreational activities and expenses than the wife of the businessman, but she may get tired of her husband's tight supervision of her daily activities and may even wish that he spent less time at home.

Because professionals typically have more money than salaried employees, they are more likely to own the household articles they desire. Nevertheless, the decision to purchase may create more anxiety and worry than in the family of the salary man. Since professionals feel they must rely on their own savings in case of emergency, they are likely to put a large portion of their income into savings for emergencies and every purchase detracts from security. Despite the concern over savings, however, the successful private practitioner is likely to have a better house and furnishings than the average salary man.

To assure themselves of continuing income in old age, most professional families strongly encourage one of their children to take over the practice. The nature of family succession makes the independent professional family pattern most similar to the traditional farm family system. Just as the farm family often had too small a plot of land to divide among several sons, so the independent professional has a practice too small to divide among his children. One son is likely to inherit not only the practice but the home as well, and often this son and his wife and children continue to live with the parents even after the father's retirement. The son who inherits the father's practice is likely to be closer to his parents even before he goes into practice and to be allowed more participation in family decisions and arrangements. The other sons are then forced to go elsewhere and receive less financial help from their parents. Since passing on a practice to a son is a psychological and financial advantage to the father and an even greater financial advantage to the son, it is not surprising that a large percentage of dental and medical students are children of professionals who intend to take over their fathers' practice, or children of nonprofessionals who hope to marry a girl whose father has a practice to pass on. For these reasons, the

stem family remains a viable form among independent professionals.

For the son who succeeds to the father's profession, entrance examinations for a particular school are not overly important; as long as the son can get into any medical or dental school he will be able to continue his father's practice. For other sons who are likely to become salary men, examinations are more important, but professional fathers can finance private education more easily than salary men and therefore examination pressure on their sons is not so great.

Since the independent professional has little hope of being as powerful a community leader as the successful businessman, he is more likely to compare himself with the salary man. He has neither the security nor the short regular hours of the salary man. His style of life tends to be more comfortable than that of the salary man, and he can avoid the long daily commuting. If commuting time is added to working hours, the salary man probably puts in almost as many hours as the professional. The independent professional generally feels that his real advantage lies in his freedom to work when and how he pleases without having continually to strive to satisfy his superiors.