Professor Tom Keane:

That is an issue that the college is struggling with at the moment, namely, the generalist versus the specialist. Clearly in the management of many chronic diseases, the role of the generalist is still hugely important. The way health care has gone, unfortunately, is towards being further subdivided into smaller and smaller subsets. That might be okay for a city of 20 million people but for a country of 4.5 million there is a limit to the level of sub-specialisation that is possible to achieve, simply because the critical mass necessary to have a dedicated, world-class unit is simply not there. One needs a certain volume but the numbers in Ireland argue that the number of specialised units will undoubtedly be relatively few compared to other countries. One needs very large catchments for significant sub-specialisation to work. A one person unit run by a sub-specialist, no matter how brilliant, is ultimately going to fail.