UCD's decision to move to graduate entry in medicine will force the Government's hand on the issue argues Brian Mooney

The decision by UCD to introduce a graduate entry programme to medicine effectively puts the gun to the head of the Ministers for Health and Education. It forces them to address the mess that our medical education system has become over the last 20 years.

At a time of severe economic hardship in the early 1980s, the Government capped the number of publicly-funded medical places in the five Irish medical schools at just over 300 places. The economic reasoning for doing this disappeared many years ago. So why is the cap still in place?

The answer is simple. Who is to pay the cost of training our medical staff - the student, the taxpayer, or a combination of both?

The medical colleges found themselves in an impossible situation. The Government was only willing to pay a fraction of the cost of training a doctor. It provides only €7,000 per year in lieu of the "free fees" for students. The colleges, of course, cannot charge Irish and EU students fees. So they have been forced to cast around for other income.

The five Irish medical schools, the Royal College of Surgeons, TCD, UCD, NUI Galway and UCC have an illustrious reputation throughout the world. The colleges discovered that in the marketplace for undergraduate medical places entry to our undergraduate programmes could command prices ranging from €23,000 to €30,000.

Given the Government's cap on places, they had a surplus of available training and lecturing resources. The colleges, therefore, did what any stallholder on Moore Street would do in the circumstances - they sold the spare capacity to non-EU students and non-EU governments willing to fund their students through our medical colleges.

The financial premium over and above the cost price of delivering a medical education, which the colleges could charge given their excellent reputation, was sufficient to bridge the gap between what the Government was prepared to pay towards the training of Irish and other EU students and the actual cost of delivery.

This system has now developed to the stage where the colleges have more non-EU students, paying the full market price for their medical education, than they have Irish and EU students.

This situation, which nobody designed, is creating the points race for medical places in Ireland. It is leaving our medical services acutely short of trained doctors, at all levels, and is creating a market for overseas institutions, such as the University of Budapest, to sell their English language medical places to frustrated Irish students. These students are thousands of Euro per place as they cannot get into medical school in their own country.

The sheer number of students seeking one of the 308 places available to Irish and EU students each year has created its own distortions.

In the current year, the CAO - on behalf of the five medical schools - offered a place to study medicine to only 143 students who did the Leaving Certificate for the first time in June 2005.

Included in that number are those students who were admitted to the programme on reduced points, through the various access programmes that provide for disadvantaged students.

Fifty-eight students who did the exam in 2004 and 2005 got an offer, as did four students who did the exam in 2003, 2004 and 2005. Sixty-five students, who sat the examination on one occasion previously and secured the required points at that sitting, received an offer.

Many of these students would have been deferred entries from 2004, but would also include mature entry students who had possibly done a primary degree in science, following on from a single Leaving Certificate result. Seventeen students who had sat the Leaving Certificate on a number of occasions, but not in the last three years, were also offered places.

Finally, 63 students who presented with A-levels were offered places, plus one other. These 351 offers were designed to fill all 308 places available to EU students.

The immense pressure on medical places, caused by the small number available, has created a backlog of demand, which leaves the first-time, current year's Leaving Certificate applicants at the back of a very long queue.

This year, they secured less than 4 per cent of available EU places, or 20 per cent of overall places when non-EU applicants are counted.

We have to view the announcement by UCD of the introduction of graduate entry in the light of the above situation.

UCD is offering a a 50:50 balance between school-leavers and graduate entrants on their medical degree programmes by 2010. The graduates will be drawn from the existing pool of 108 places available to UCD in medicine.

Essentially, UCD is forcing the Government's hand on this issue. It will be politically impossible for the Government to stand by and let the number of places available to first-time Leaving Certificate students dwindle to nothing.

The only way of avoiding this situation is to lift the cap on places. In lifting the cap on postgraduate places, the Government could also sidestep the politically explosive issue of undergraduate student fees.

Postgraduate students pay fees for their courses. If UCD were to charge an annual fee of €15,000 per medical place and the Government were to provide the same level of subvention as they currently do of €7,000 per year per student, the college could phase out non-EU places - priced at €23,500 per place - and replace them with post graduate EU places.

They could do this without any loss of revenue and without having to address the thorny issue of free undergraduate fees.

This solution also addresses the issue of increasing the number of trained doctors who will come on stream and flow into our medical services if the plan is implemented.

It also addresses the issue of the retention of graduates in medicine, recently highlighted in The Irish Times, showing that less than 50 per cent of medical graduates were found to be active in the Irish health services a short number of years after graduation. Undergraduates in their early twenties are unlikely to spend four years and €60,000 in fees to qualify as a doctor if they do not anticipate remaining active in medical service delivery.

The UCD initiative is likely to be facilitated by the Government. It seems poised to lift the cap and raise the number of training places to over 700 - as proposed by a recent expert group.

An extension of places will provide cash-strapped colleges with a solution to the problem of providing a first-class higher education - without having to introduce the politically explosive issue of undergraduate fees.

It would not be surprising if we saw a major growth in the range of fee-paying, postgraduate course offered throughout all our third-level colleges in the coming years. We may find ourselves moving to a US model of higher education, with students taking a basket of modules in their general area of interest at undergraduate level before progressing to a vocationally-focussed, fee-paying postgraduate degree.

In introducing this initiative, UCD may be setting the agenda for third-level education for a generation to come.