Endeavour Fellow Munro Moffat Might Have the Best Job Ever

Article written by Munro Moffat

Fancy spending your weekends cruising down some fresh powder and your weekdays reducing shoulders and strapping up knees? This is what I have just spent the past 5 months doing through the incredible sports medicine and general practice training programme at Niseko International Clinic.

Niseko, situated in northern Japan, is famed for its fresh powder; this makes it a world class destination for snow sports. During the busy winter months, Niseko transforms as seasonal workers and tourists descend on the area for their chance to ride on the slopes by day and enjoy the culinary delights of Japan by night. Niseko International Clinic is a private medical facility which provides medical care to tourists and residents alike during this busy time. With x-ray facilities, ultrasound, and on-site blood testing, the clinic is well  equipped to deal with dislocations, fractures, and ligament injuries, as well as the more typical general practice presentations. 

For the past 2 years the clinic has taken on international doctors for a Sports Medicine and General Practice Training Program, and I was lucky enough to bag one these roles for the 2024/2025 season. My days were divided between the fever clinic and the main clinic. In the fever clinic you see mainly coughs and colds, as well as a peppering of gastroenteritis. There was a lot of Influenza this year and, compared to UK practice, the Japanese are far more liberal with prescribing antiviral medication.  The fun stuff happens in the main clinic. This is where you get to reduce dislocations (lots of shoulders, some elbows, and one jaw), as well as fractures (primarily distal radial fractures from snowboarders).  On top of that there are lots of soft tissue injuries such as ACL ruptures to manage. With no radiographers at the clinic you are expected to perform your own x-rays. Having immediate access to the x-ray machine and being able to easily gain extra views has proven very useful at picking up more subtle fractures. You also work closely with physiotherapists which is a great way to expand your knowledge base.

Given how well set up the clinic is, it is easy to forget how remote you are in Niseko. This sometimes means that you need to rationalise your medical decision making to adapt to the limitations of the local health service, and this can be quite daunting.  With no official emergency department, the out of hours service at the local hospital could be run by anyone from a dermatologist to a general surgeon. On top of this, hospitals can and do refuse to take patients if they feel they do not have the capacity.  This means that depending on the ailment of your patient, you need to have a much higher threshold for referring them for inpatient management out of hours.  

Putting shoulders back in and reducing distal radial fractures is definitely satisfying, but it is the snow the draws people here. I came here as a total novice on the slopes, but spend most weekends skiing. If you are experienced then there is the incredible world of backcountry skiing to explore here as well, with skiing down the local volcano (Mt Yotei) being a rite of passage for travellers to the area. If you can pull yourself away from the powder there are other activities to engage in. There are various snow festivals in nearby towns (think building sized snow sculptures) and I have also tried ice fishing on a nearby frozen lake.  Many of my evenings have been spent in onsens (Japanese hot springs) and delving into the incredible culinary world of Japan.

Interested in securing this job for a future ski season? Munro has detailed how you too can do this:

Any qualified doctor with at least 3 years of practice behind and a willingness to move to Japan for 5 months can apply. A background in general practice, emergency medicine, or orthopaedics would suit the position best.  To apply for next season go through the Niseko International Clinic website. They are currently recruiting!