Horgan keeps surgeons' college in top health

The first non-medical chief of RCSI aims to boost its overseas revenue, writes Claire Shoesmith

Michael Horgan has tried his hand at a lot of things and, despite his latest position as chief executive of the Royal College of Surgeons in Ireland (RCSI), not a single one has been medical.

He started out at the RCSI in 1976 as the one and only administrative assistant. While spending his evenings studying for a degree in computer science and later a masters in industrial engineering, he moved around the college's departments before landing the position of deputy chief executive in 1996.

"In the space of 10 years I had done everything from administration and exams, to HR and project development," says the 54-year-old Corkman, who believes this variety, and a little bit of luck along the way, helped him to the position of deputy chief executive, which he held for eight years before taking over the top role two years ago.

In doing that, Horgan broke the mould. He became the RCSI's first non-medically trained chief executive since at least the 1800s, presiding over the college's 660 staff, 2,670 students and an annual turnover of €91 million.

While Horgan's own position within the RCSI has changed considerably over the years, the institution itself hasn't. It is now the largest undergraduate medical school in Ireland, and still holds onto the charter it was granted in 1784 to regulate surgical training.

Unlike Ireland's other main medical schools, the RCSI only receives a small proportion - namely 6 per cent - of its income from the Government. At other teaching institutions, State subvention is usually around 50-60 per cent. As a result, the college has to operate as a commercial entity and is constantly on the lookout for opportunities to make money.

One such opportunity comes in the form of international students, who account for about three-quarters of the college's intake, a figure that has remained unchanged since the 1950s.

The college's renown was such that, in the 1970s, it won a contract from the Norwegian government to educate 25 Norwegian students a year for 10 years because that country was lacking in resources.

While Irish students are exempt from paying fees, international students had to pay €36,000 each this year alone.

However, while these students play an important part in creating a healthy balance sheet, in most cases they take their skills home and do little to help reduce the shortage of medical staff here.

However, with training capacity at a maximum in Irish hospitals and the shortage of qualified doctors here becoming more and more acute, one could be forgiven for wondering why the majority of training places are filled by those from outside Ireland. While Horgan acknowledges this is a problem, he says it's one that he is unable to solve.

That responsibility, he says, lies with the Government, which themselves need to adopt similar tactics to the Norwegians, but within their own country.

As it stands, the not-for-profit college has to do what it can to survive, and under the reigns of Horgan, surviving it certainly is.

As well as running courses in subjects including medicine, pharmacy, dentistry and physiotherapy, the RCSI also has an extensive Irish property portfolio and a growing one overseas.

It currently runs several medical training programmes in Malaysia, Dubai, Bahrain, Kuwait and Jordan. It already has a medical school in Penang in Malaysia and is building a university hospital and health oasis in Bahrain.

"The overseas activities have the potential to generate significant revenue, which will allow us to grow all our activities," says Horgan, adding that, within the next eight years, the revenue from overseas businesses should match all the revenue generated in Ireland - and that's just on the basis of what the RCSI already has planned.

If Horgan has his way, the RCSI name will be spread all over the world. "The concept from Bahrain could be replicated anywhere," he says, adding that there are significant opportunities internationally and particularly in eastern Europe.

Another area that Horgan is looking to expand is research and development, something that's widely acknowledged to be critical to the future of the medical industry. The RCSI already has its own research institute, with facilities within the college's city centre campus and at Beaumont Hospital.

Horgan said he would be disappointed if the RCSI's research programme was not at a level close to €100 million within the next eight to 10 years - roughly four times its current size. "What we earn in this area will have an influence on both our reputation and what we can do in our core areas of business," he says.

Meanwhile, and probably luckily for Horgan considering everything else he has on his plate, the group's property portfolio, which includes a series of buildings in the vicinity of Dublin's Stephen's Green pretty much looks after itself. While some of the properties are used for college purposes, the remainder are leased out but remain on the books as income generators.

Horgan says that, for the time being, he sees the property portfolio as the group's endowment fund, estimating that two of the leased buildings alone are worth about €150 million. However, if the college should wish to expand, it has the potential to triple its current space using existing assets, he says.

It's pretty clear that the fact the RCSI is run in a different way to the other educational establishments isn't holding it back. "In some ways it's a blessing," says Horgan. "It gives us an edge because, to survive, we have to be innovative, agile and take advantage of all the opportunities available."

This is something the college is definitely taking literally.

It has already introduced an online training course and from this September will offer a graduate entry programme for the study of medicine.

"Medicine up until now has been an apprenticeship," he says. "In most other trades this has changed over the past 20-30 years and they now have a more systematic training programme. You have to wonder whether there isn't a totally different way of teaching medicine."

While he has no answer to this at the moment, you can rest assured that if there is an alternative method, then Horgan will find it. "We're going to need to do something," he says.

"Hospitals are already at capacity and things are only going to get worse as the shortage of doctors worsens, people live longer and there are more diseases around."