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Background: The Medical Council in Ireland is currently implementing Competence Assurance Structures (CAS). Peer review has been proposed as a tool to measure physician competence., Aims: To assess the attitudes of physicians working in the Irish healthcare system to a peer review programme of competence assurance prior to its implementation., Methods: A postal survey was sent to all physicians in the Irish Medical Directory in November 2003. Nine questions were asked to gauge attitudes to peer review as a CA tool. The returned questionnaires were collated and data extracted based on responses., Results: The response rate was 67%. The majority of respondents (92%) felt peer review would inform competence assurance in Ireland. Most physicians who were surveyed felt an on-site assessment (88%) every 5 years (87%) was the preferred method. Over 30% responded that there should be a financial incentive for completing a review, and 70% would pay to be assessed. The UK model of competence assurance was the model most physicians preferred for the Irish setting (42%)., Conclusion: The majority of physicians practising in Ireland would favour a peer review system of competence assurance. The financial implications, and structure, of such a system would need to be explored prior to implementation.