The right procedure to ease the pressure

Ireland is currently experiencing a shortage of surgeons. So says the president of the Royal College of Surgeons in Ireland, Professor George Parks. In general surgery in Northern Ireland, the consultant surgeon to population ratio is 1:25,000. In the Republic, the ratio is 1:38,000.

"The number of consultants in each and every surgical speciality is lower in the Republic, relative to population, than in Northern Ireland," he says. "Taking surgery as a whole, the consultant provision in the Republic, compared with that in Northern Ireland, is a ratio of 1:45. To have an equivalent, we could do with a 50 per cent increase in consultant surgeon numbers. In some specialities the shortage is even greater than that." The current shortage of consultant surgeons is caused by many factors, not least of which is the fact that our ageing demographic profile puts increased pressure on surgical services.

"These days people are living longer, into their 80s and 90s," says Prof Parks. "On top of that you have an increase in new surgical techniques. For example, 30 years ago such procedures as hip and knee replacements simply weren't available."

It isn't just elective work which has increased either, but with an ageing population you get an increase in accidents, such as falls, which may also require surgery, he points out. Steps are being taken to increase the number of undergraduate medical students in both Britain and Ireland. Whether or not this leads to an increase in surgeons, depends on how many of these opt to make a career in surgery, he says.

"In the training grades in the past there has been a reasonable number going into surgery, but the numbers are rather less now." The fact that there have been limited numbers of senior posts, partly for financial reasons, has had much to do with this, he feels.

"Here in Ireland quite significantly more money is now being put into the health services, however. It will take time, but I think there is a lot of goodwill there to increase the number of consultants, and I think it will come." Surgeons from the RCSI are second to none, he points out: "The Royal College is looked up to by people from around the world. People from countries that don't have the many years of experience that we have here have always come to train and to sit the fellowship examinations. They look on the fellowship examinations as being of not only a high standard, but examinations that can be relied upon to maintain standards in their own countries." There are, he says, many aspects to being a good surgeon. "Firstly, one has to be a good practical surgeon. That is, after all, their raison d'etre. But they must also be a good trainer and teacher. As such, it is important that the surgeon be a good communicator.

"The surgeon has also to be a good diagnostician, must be able to make the right decision, and sometimes that means deciding not to operate. He must also be able to handle patients. Surgery isn't only about what happens in theatre, at ward level they have to be able to ensure the right decisions are being taken in short term follow up care.

"Here, too, communications skills are important. Patients are more inquiring these days. They want to know more. That said, however, if a person is not good technically, even though is kind, considerate and a good diagnostician, he's not going to make a good surgeon. At the end of the day, he has to have the practical skills." Not all those who feel the calling to go into medicine, and he believes it is a vocation, will graduate to surgery.

SUCH practical work does, however, have its downside: "Surgery is physically exhausting in the sense of having to concentrate for very long periods of time. Moreover, there are very long hours involved. Often you will have done your day's work, only to be called in at night for emergency work. You then have to get up the next day and face another full day's work. It can be exhausting."

It is, though, a very satisfying career - "certainly I wouldn't have chosen any other". George Parks' own area of expertise is in colorectal surgery. He held surgical posts at the Royal Victoria Hospital and Belfast City Hospital in Northern Ireland. Throughout his career he has played a pivotal role in the development of surgical training and research programmes for surgical trainees in the North.

He is past-president of a number of medical associations, and is a fellow of the RCSI as well as of the royal colleges of both Glasgow and Edinburgh. He has served on the editorial boards of the Ulster Medical Journal and the British Journal of Surgery. Prof Parks is particularly proud of the ethos of the RCSI. "Obviously the pursuance of excellence is a vital part of it, but within that there is an emphasis on friendliness, compassion and harmony.

"When people are working together in clinical practice for 30 or 40 years, often in the same unit, it is vitally important that they can get on with their colleagues. The days of the consultant `lording it' are gone. There has to be respect for both junior staff, nursing staff and administrative staff. In the RCSI all of those apply."