and practice. It is worth noting that the objective of the founders of
our College as stated in the original Charter was "to establish a liberal
and extensive system of surgical education that should proceed on a
non-sectarian basis for the public good and the advancement of the
profession". These objectives emphasise the rightful role of RCSI in
advocating for the highest quality of surgical care for our patients and
all the conditions required for our surgeons to provide it, including
relevant training and work conditions.
In a recent survey, our Fellows expressed disappointment about a
perceived lack of engagement and debate with Government and
their agencies over surgical practice issues. We must be aware that an
advocacy role can attract unwanted attention and criticism but, if that
is the price we have to pay, so be it. We cannot sit on the fence when
issues of surgical care delivery are being debated.
In that spirit, although it may be controversial, I would like to draw
attention to what, in my view, is the increasing obsolescence of the
term `common contract'. It may have served a purpose at one time but
in the context of what we as surgeons do today, and the resources we
require to do the work for which we are trained, we are miles apart
from Consultant colleagues such as psychiatrists and dermatologists.
Presently, too many young surgeons are staying abroad. Alternatively,
those that do come home are taking up posts in hospitals with
enthusiasm, energy and expertise in the latest techniques from their
overseas Fellowships but without the appropriate resources being
provided by their hospitals to enable them to exercise their technical
skills and treat their patients in a timely fashion. It is common
practice for newly appointed surgeons to be offered a half-day's
operating a week or even, in some instances, a half-day a fortnight!
The same employing authorities, which do not provide them with
theatre resources, find it acceptable that these newly appointed young
surgeons have no proper secretarial help, no office and sometimes
very little access to junior staff.
We, as a College, have every right to be involved in advocacy for these
surgeons so that they are given the appropriate resources to perform
at the highest level. It is well-recognised that habits developed in the
early days shape and define life-long practice, so a busy work schedule
is very important in the early years. At a minimum, a newly appointed
surgeon should be operating two days a week and if the public system
cannot offer that to young surgeons then, in turn, employers should
ensure that they do not become deskilled. Let's work out how to use
under-utilised young surgeons to treat patients.
To encourage trained surgeons to return to Ireland after Fellowships, I
propose the re-establishment of sessional arrangements for provision
of care. For possibly a lesser salary or sessional-related payment,
the skills and expertise of the highly trained surgeon would be
available in public hospitals and, in his or her own time, private or
insured patients could be treated in the local private hospital. Surely,
in a country of our size we cannot continue to have two sets of
consultants: those in public hospitals which are over-regulated and
those in private hospitals which are, by comparison, under-regulated.
A `WIN-WIN' OUTCOME
A radical rethink of how our surgical services are provided is needed
if we are to successfully bring home our current crop of specialists
who are abroad, as well as give some support to recently appointed
surgeons. It is a potential `win-win' for the Department of Health
saving more of the public purse through less salary and pension
expenditure while restoring the consistency of surgical care delivery
between public and private hospitals and keeping surgeons operating.
The sessional commitment to public hospitals works extremely
well in Australia where larger numbers of consultants with sub-
specialty expertise are available to all the hospitals. The surgeons in
turn have plenty of resources available for them to do their work.
There is a serious commitment to train their juniors during these
public sessions but trainees can also attend/assist at private cases for
educational benefit. In an era when we are trying to reduce duration
of training, we should be maximising trainees' exposure to good
clinical cases irrespective of patient location.
LEADING THE WAY
The Francis Report identified leadership as a key factor in
overcoming the challenge of improving quality of care in the face of
ongoing financial constraint, which is exactly what we are faced with
here in Ireland over the next few years. There is a very unhelpful,
but widely held, misconception that leadership is something which
older people with `fancy' titles do. Leadership exists, and needs to
exist, at every level and is simply about giving others the tools and
support to do their job.
Every surgeon is a leader by definition. He or she leads their team,
leads the operating team, and leads the multi-disciplinary team.
Their natural leadership, enthusiasm and dedication to hard work
infects others who come in contact with them throughout their
working day and acts as a genuine force for positivity.
Leaders should as far as possible be upbeat about their organisation
and about their own job. The distinguished US statesman and
retired four star general, Colin Powell, said that perpetual optimism
is a force multiplier but leaders who whine and blame others
engender the same behaviour in their colleagues. That is not to
say that a surgeon can't be critical of inadequate resources and
inadequate management when it is identified. We are however, like
it or not, key leaders in word and deed and leading by example is
There are, I'm sure, other and wider issues that need to be addressed
in our health service but the ones I have highlighted I believe
are among the most important for us as surgeons to speak out
about and to provide leadership on. Retention of a strong surgical
workforce in Ireland is vital. Support for the National Audit
System by enabling the collection and supervision of high quality
data is hugely important. The bottom line is that RCSI's ultimate
aim, and mine as President, is to create a well regulated, properly
audited, attractive and fulfilling environment for our highly trained
surgeons, encouraging them to come home and to use their skills so
that our patients in Ireland can have the highest quality of surgical
Professor Michael Kerin, Mr. Les Nathanson, Mr Oliver McAnena
and Professor Paddy Broe pictured at the XXXVIIIth Sir Peter Freyer
Memorial Lecture & Surgical Symposium 2013 which took place at the
National University of Ireland, Galway. Photo: Martina Regan