Over the 73 years from inception of the College to 2000, selection into surgery in Australia moved from admission by a Board of Censors, through a post WWII exit examination to a structured program training program (Advanced Surgical Training – AST) from 1970. Basic Surgical Training was only fully embraced by the College with accredited hospitals and educational material in 2000. In 2000 the RACS was required by the Australian Competition and Consumer Commission to apply for authorisation for its monopoly position for selection, examination and certification of surgeons in Australia, based on public benefit. The application succeeded but the ACCC imposed stringent processes, including strict criteria for accreditation for both BST hospitals and AST posts plus adoption of the Brennan framework in selection processes, leading to a binational selection process with mixed benefits. In 2004/5 the Council moved towards a new program intended to replace both BST and AST - the Surgical Education and Training (SET) program – implemented in 2008. Once the surgical science examination was moved back to being a prerequisite for SET, in reality SET was AST by another name. Unfortunately these changes allowed Fellows to consider that their responsibilities began and ended with the SET trainees on their department; these changes have led to a vicious cycle leading to longer and longer training without clear benefit for trainees or patients. Is it time for a review of selection and programs before surgery loses its appeal?