Fellowship of the Royal College of Surgeons

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Fellowship of the Royal College of Surgeons (FRCS) is a professional qualification for practising as a surgeon in the British Isles. It is bestowed by the Royal College of Surgeons of England, Royal College of Surgeons in Ireland (chartered 1784), Royal College of Surgeons of Edinburgh (chartered 1505), and Royal College of Physicians and Surgeons of Glasgow though strictly the unqualified initials refer to the London College. Several Commonwealth countries have similar-sounding qualifications: FRCSC in Canada, FRACS in "Australasia," FCS(SA) in South Africa, and some others.

The original fellowship was available in general surgery and in certain specialties - ophthalmic or ENT surgery, or obstetrics and gynaecology - which were not indicated in the initials. It came to be taken mid-way through training.

There is now a range of higher fellowships, taken at the end of higher specialist training and often in narrower fields, the first of which was FRCS (Orth) in orthopaedics. Others include FRCS(Urol) in urology.

To avoid confusion, the original fellowship was renamed to either membership (MRCS) or associate fellowship (AFRCS). Unfortunately this introduced a new confusion, as the Royal Colleges also held qualifying examinations in medicine, after which most of them awarded licentiate diplomas (LRCP, LRCS, etc). However the Royal College of Surgeons of England used to award its membership at this level, in conjunction with the Licentiate of the Royal College of Physicians of London, so thousands of doctors have "MRCS, LRCP" in place of or in addition to "MB BS", etc, without being specialised in surgery.

[edit] Mr Surgeon

Holders of FRCS (and the new, but not old, Membership - MRCS) qualifications lose their title of Doctor, reverting to Mr, Mrs or Miss. This is a hangover from times past when surgeons were not qualified doctors as they are today and were simply skilled tradesmen, amputating limbs or removing bladder stones. Note that in the 1500s, the colleges of Barbers and Surgeons was one and the same, as many people practised both before surgery became a more skilled and separate profession.

An alternative explanation that has been offered for this is the section of the Hippocratic Oath that runs "I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone," - surgery by its implicit nature does harm to the patient, so the surgeon was not considered worthy of the title doctor. Again, this is an ancient practice, that has remained to this day even though it has no real grounding.

"First, do no harm," can be applied to prescribing as much as to operating. Also, many Greek practitioners who followed Hippocrates performed surgery as well as prescribing medicine. The separation was enforced much later by the Catholic Church, through a Council of Tours in 1169 which halted the practice of surgery by clerical physicians by proclaiming, "Ecclesia abhorret a sanguine." This would have relegated the art to the barber surgeons associated with the monasteries.

It is also important to recall that the use of Mr. as a courtesy title for all men is a relatively recent invention, and implied a larger degree of status in past years than at present. Compare Esquire.

The practice of surgeons reverting to "Mr" (etc) is obsolete in the rest of the Commonwealth. In the British Isles, holders of an FRCS who move into non-surgical fields tend to go back to being "Dr." In Scotland, only certain surgeons change to "Mr": in Edinburgh ophthalmologists, ENT surgeons and obstetricians & gynaecologists would remain "Dr," but in other cities usage is more like England.