The admissions scandal in which Tokyo Medical University admitted to manipulating females’ entrance exams did not come as a surprise for many women doctors, but rather was verification of what they had suspected for a long time: Some medical universities set the bar higher for women.

That suspicion was backed up by the fact that the ratio of women who have passed the national medical exam consistently stayed at around 30 percent for nearly 20 years.

“We heard rumors a number of times that medical universities were placing caps on the number of female students,” said Ruriko Tsushima, an obstetrician and the head of Tsushima Ruriko Women’s Life Clinic Ginza in Tokyo. “Such practices should not be forgiven.”

Another doctor who currently works at a private hospital in Tokyo also said it was “common knowledge” among female students who were planning to apply for medical school.

“I believe many applicants were aware that the bar is set higher for women at some universities. The subject came up in conversation many times while I was a high school student,” said the woman in her 30s who spoke on the condition of anonymity.

“I don’t want to show my understanding of such practices. But I’m also aware of the fact that many women struggle to juggle work and child-rearing, and leave the university hospital,” which could result in a shortage of staff, and was the excuse by which Tokyo Medical University tried to justify the practice.

It’s tough to continue pursuing a career in medicine once you have a child, especially in certain departments such as surgery where doctors are expected to work long hours and be on call around the clock regardless of what day it is, some female doctors said.

Even though more hospitals these days have created more family-friendly environments that include the addition of nurseries and exemptions for medical staff with small children from late night shifts, the introduction of such measures has been slow at university hospitals where male medical practitioners dominate executive positions, they added.

Kyoko Tanebe, an obstetrician and the head of Ladies’ Clinic We! Toyama in Toyama Prefecture, said doctors’ working conditions will improve if female doctors become a majority in the medical community, and if more women take managerial positions.

“I believe it will be much easier to work not only for women but also for men. But under the current situation, it’s not likely to happen and I’m furious about it,” Tanebe said.

“If you go abroad, 50 percent of doctors are women, and there are many female professors (at medical schools),” she said. “That always made me question the state of Japan, where we rarely see a woman in the professor’s seat.” she said.

Japan indeed lags far behind other countries when it comes to the ratio of female doctors.

In 2015, the share of female doctors in Japan stood at 20.3 percent, the lowest among 34 countries according to data compiled by the Organization for Economic Co-operation and Development. Latvia topped the list with 74 percent, followed by Estonia’s 73 percent, Slovenia’s 62 percent and Finland’s 58 percent.

The proportion of females was even lower in departments known for long working hours, such as in surgical departments at 7.8 percent and neurosurgery at 5.2 percent, according to a 2014 health ministry survey.

A woman in her 30s who declined to be named said when she told her male boss that she was pregnant, he replied: “You will quit then, right?”

“He said it like it was a natural thing for me to do, and there was no room for me to negotiate,” said the woman, now a mother of two. She currently works at a private hospital that allows her to leave at 5 p.m.

“It’s a closed world. It’s not like a corporation where you can come back to a position you held after taking maternity leave,” she said. “In a university hospital, your post is decided by the professor’s discretion. Once you leave, there won’t be a career path for you to climb up.”

A 35-year-old woman who worked at a university hospital in Tokyo for a year said all the important positions, such as professorships or assistant professorships, were dominated by men.

She said there once was a woman in a management position, but she left after having a child.

“She was an ace doctor, like a superwoman. Seeing such a talented person leave the university made me think I can’t work there if I have a child,” the woman who now works at a small clinic said.

At the university hospital, there was no substitute doctor to cover for staff who took maternity leave, she continued. Considering that taking maternity leave would further burden their already-busy colleagues, it is difficult to stay at the hospital after having a child, she said.

Tanebe of the Ladies’ Clinic We! in Toyama said the issue is not that women tend to take leave, the core of the problem is overwork.

“They are putting the blame on women. But the problem is medical institutions that cannot change the way doctors work,” Tanebe said. “I’m glad that the university’s scandal came to light because, I believe, it opened a Pandora’s box.”