The Religious and Spiritual Practices Among Internal Medicine Physicians in Japan and the United States: A Comparative Cross-National Study
Kota Sakaguchi, Shimane University Hospital, Kristin Collier, MD, University of Michigan Medical School, Reiko Sakama, NTT Medical Center, Sanjay Saint, University of Michigan Medical School, Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, M. Todd Greene, University of Michigan Medical School, Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Nathan Houchens, University of Michigan Medical School, Veterans Affairs Ann Arbor Healthcare System, Karen Fowler, Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Jason Engle, University of Michigan Medical School, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ikuo Shimizu, Chiba University, Yasuharu Tokuda, Muribushi Center for Teaching Hospitals, Kiyoshi Kurokawa, Health and Global Policy Institute, and Takashi Watari, Kyoto University Hospital
Physician burnout is recognized as a global crisis that threatens the quality of medical care. Intrinsic values – namely spirituality and religious practices – have been reported in Western studies as vital countermeasures for coping with stress and deriving meaning at work. Because these studies were conducted largely within specific religious and cultural contexts, the foundational landscape of beliefs and practices among physicians in non-Western countries remains poorly understood. Therefore, we aimed to describe the current state of religious and spiritual beliefs and practices among Japanese internal medicine physicians and to compare the findings to those of U.S. internists.
Similar cross-sectional surveys assessing religious and spiritual beliefs and practices were distributed to internal medicine physicians in Japan (n=3,320) and the U.S. (n=1,421). Differences in descriptive statistics by country were assessed using t-tests and chi-square tests. Multivariable logistic regression, adjusting for sex, the number of years practicing as an internist, and religious affiliation, was used to evaluate the odds of engaging in religious and spiritual practices.
A total of 353 (10.6%) Japanese and 629 (44.3%) U.S. physicians responded. The distribution of religious affiliations varied significantly between the two countries. In Japan, the religious breakdown was the following: None (51.4%), Buddhist (34.5%), Shinto (7.5%), Christian (5.8%), and Other (0.9%). Among U.S. physicians, the religious breakdown was: Christian (51.0%), Hindu (11.8%), Jewish (6.1%), Muslim (5.8%), Other (5.8%), Buddhist (2.6%), and None (17.1%).
A significantly higher proportion of U.S. physicians reported a religious affiliation (82.9% vs. 48.6%, p <0.001), believing in God or a higher power (U.S. 69.7% v. Japan 33.9%, p <0.001), and having experienced sacred moments with a patient (U.S. 67.7% v. Japan 40.2%, p<0.001). In multivariable analyses, U.S. physicians had significantly greater odds of regularly attending religious services (OR = 9.2, p<0.001), praying privately (OR = 5.0, p<0.001), believing in God (OR = 2.5, p<0.001) and in an afterlife (OR = 2.6, p<0.001), and considering themselves as very spiritual (OR = 12.5, 95% CI = 5.4-29.3, p<0.001). Reported mindfulness was also higher among U.S. physicians, with U.S. physicians having greater odds of very infrequently to never reporting running on automatic (OR = 2.3, 95% CI = 1.7-3.2, p<0.001), rushing through activities (OR = 2.4, 95% CI = 1.7-3.4, p<0.001), preoccupation with the future or past (OR = 1.6, 95% CI = 1.1-2.2, p=0.01), and completing tasks without paying attention (OR = 2.6, 95% CI = 1.9-3.7, p<0.001).
Our study of physicians in Japan and the U.S. revealed substantial differences in religious involvement and spirituality. U.S. physicians were significantly more likely to report a religious affiliation, engage in spiritual and religious practices, believe in God and an afterlife, and experience a sacred moment with one or more patients. These findings align with established cultural patterns: religiosity tends to be more formal and institutionally expressed in the U.S., whereas spirituality in Japan often takes more implicit or non-theistic forms shaped by Buddhist and Shinto traditions. Consequently, Japanese physicians’ lower endorsement of conventional religious measures may reflect cultural conceptions of spirituality that are less tied to doctrine or worship and more oriented toward harmony and interconnectedness.
The observed difference in mindfulness levels is also noteworthy. Mindfulness has been associated with lower burnout, greater empathy, and improved physician well-being. The higher mindfulness scores among U.S. physicians may stem from the integration of mindfulness-based stress reduction and related programs into U.S. medical training and institutional wellness initiatives. Although mindfulness has deep historical roots in Japanese contemplative traditions, it may be less emphasized in contemporary medical education and professional culture.
Our findings have several potential implications for patient care. Physicians’ personal beliefs and contemplative practices can influence how they engage with patients around issues of meaning, suffering, and end-of-life care. U.S. physicians who are more comfortable discussing spirituality may be better positioned to address patients’ expressed religious or existential concerns, which has been associated with improved patient satisfaction and perceived quality of care. In contrast, Japanese physicians may convey compassion and presence through subtler, relational approaches that reflect cultural norms emphasizing respect, humility, and attentive listening. Both models offer valuable lessons for patient-centered care and highlight that spirituality in clinical practice need not depend on explicit religious dialogue.
Understanding these differences is critical for developing culturally responsive strategies to support both clinician well-being and patient care. Future research should examine how these inner dimensions translate into clinical behavior and explore interventions that acknowledge diverse cultural expressions of spirituality and mindfulness while promoting physician flourishing globally.
Similar cross-sectional surveys assessing religious and spiritual beliefs and practices were distributed to internal medicine physicians in Japan (n=3,320) and the U.S. (n=1,421). Differences in descriptive statistics by country were assessed using t-tests and chi-square tests. Multivariable logistic regression, adjusting for sex, the number of years practicing as an internist, and religious affiliation, was used to evaluate the odds of engaging in religious and spiritual practices.
A total of 353 (10.6%) Japanese and 629 (44.3%) U.S. physicians responded. The distribution of religious affiliations varied significantly between the two countries. In Japan, the religious breakdown was the following: None (51.4%), Buddhist (34.5%), Shinto (7.5%), Christian (5.8%), and Other (0.9%). Among U.S. physicians, the religious breakdown was: Christian (51.0%), Hindu (11.8%), Jewish (6.1%), Muslim (5.8%), Other (5.8%), Buddhist (2.6%), and None (17.1%).
A significantly higher proportion of U.S. physicians reported a religious affiliation (82.9% vs. 48.6%, p <0.001), believing in God or a higher power (U.S. 69.7% v. Japan 33.9%, p <0.001), and having experienced sacred moments with a patient (U.S. 67.7% v. Japan 40.2%, p<0.001). In multivariable analyses, U.S. physicians had significantly greater odds of regularly attending religious services (OR = 9.2, p<0.001), praying privately (OR = 5.0, p<0.001), believing in God (OR = 2.5, p<0.001) and in an afterlife (OR = 2.6, p<0.001), and considering themselves as very spiritual (OR = 12.5, 95% CI = 5.4-29.3, p<0.001). Reported mindfulness was also higher among U.S. physicians, with U.S. physicians having greater odds of very infrequently to never reporting running on automatic (OR = 2.3, 95% CI = 1.7-3.2, p<0.001), rushing through activities (OR = 2.4, 95% CI = 1.7-3.4, p<0.001), preoccupation with the future or past (OR = 1.6, 95% CI = 1.1-2.2, p=0.01), and completing tasks without paying attention (OR = 2.6, 95% CI = 1.9-3.7, p<0.001).
Our study of physicians in Japan and the U.S. revealed substantial differences in religious involvement and spirituality. U.S. physicians were significantly more likely to report a religious affiliation, engage in spiritual and religious practices, believe in God and an afterlife, and experience a sacred moment with one or more patients. These findings align with established cultural patterns: religiosity tends to be more formal and institutionally expressed in the U.S., whereas spirituality in Japan often takes more implicit or non-theistic forms shaped by Buddhist and Shinto traditions. Consequently, Japanese physicians’ lower endorsement of conventional religious measures may reflect cultural conceptions of spirituality that are less tied to doctrine or worship and more oriented toward harmony and interconnectedness.
The observed difference in mindfulness levels is also noteworthy. Mindfulness has been associated with lower burnout, greater empathy, and improved physician well-being. The higher mindfulness scores among U.S. physicians may stem from the integration of mindfulness-based stress reduction and related programs into U.S. medical training and institutional wellness initiatives. Although mindfulness has deep historical roots in Japanese contemplative traditions, it may be less emphasized in contemporary medical education and professional culture.
Our findings have several potential implications for patient care. Physicians’ personal beliefs and contemplative practices can influence how they engage with patients around issues of meaning, suffering, and end-of-life care. U.S. physicians who are more comfortable discussing spirituality may be better positioned to address patients’ expressed religious or existential concerns, which has been associated with improved patient satisfaction and perceived quality of care. In contrast, Japanese physicians may convey compassion and presence through subtler, relational approaches that reflect cultural norms emphasizing respect, humility, and attentive listening. Both models offer valuable lessons for patient-centered care and highlight that spirituality in clinical practice need not depend on explicit religious dialogue.
Understanding these differences is critical for developing culturally responsive strategies to support both clinician well-being and patient care. Future research should examine how these inner dimensions translate into clinical behavior and explore interventions that acknowledge diverse cultural expressions of spirituality and mindfulness while promoting physician flourishing globally.