Surgical training and the RCSI


Sir, – It is ironic that a debate on the crisis in Irish health care and specifically in paediatric surgery should have taken place in the Royal College of Surgeons in Ireland (RCSI) (“Ireland at ‘cliff edge’ over paediatric surgeon shortages”, November 11th) and that the solution, according to an invited English colleague, is to pay surgeons more money to do their job. Perhaps, instead, the debate should finally address a significant root cause of the manpower crisis in surgery. It may come as a surprise to many patients to learn that surgical training in this country is a monopoly; the RCSI, a privately owned medical school, with a colonial royal charter, has a complete monopoly on surgical training; that is to say that public Irish universities and medical schools like TCD and UCC are prohibited from training surgeons locally.

This monopoly prevents competition, and lack of competition degrades the quality, although not the quantity of the end product. This monopoly of surgical training by a single and privately owned entity should be immediately scrutinised by the the Competition and Consumer Protection Commission. The fact that such a monopoly survives speaks to the weakness of that regulatory body.

It may also come as a shock to those on waiting lists to learn that one of the RCSI’s registered charities is ISABC, the Ireland Saudi Arabia Business Council, which promotes trade between Ireland and the House of Saud regime.

Those suffering adults and children who are dependent on a failing public health system deserve to know why they are waiting so long and suffering so much. – Yours, etc,



Paediatric Orthopaedic


Howth, Co Dublin.