Thoughts on an "average" Starfleet career.

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Originally Posted by spyone

Now for the big question: Do you have to be a Captain to command a starship?

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Originally Posted by Tobian

One thing which does annoy me though is some of my players in the past have used the excuse of 'my character is a Doctor, so he should automatically be a Lieutenant'

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My own take on this is that neither of the positions of Captain or Doctor actually exists. It is just common words used instead of the real names for the positions of Commanding Officer (despite rank) or Medical Officer (of minimum rank and/or training). However, one can hold the rank of Captain or have the academic title of Doctor.
Why not call a medical officer, ensign a Nurse.. So if the player won't spend the points to become a lieutenant, then you have a good option of what the other crew members will call him ;)
Another thought is that a medical officer, captain probably would be the administrative head of a larger hospital.

Actually I think that's a good way of looking at it.. Without paying for it, you're a nurse :D

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Originally Posted by JALU3

To bad they never used any lowcost advisors . . . I can imagine alot of the more experienced prior service individuals here, of which I am not that experienced (IMHO), willing to do it for a couple walk on roles and basic cost of living.

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Yep, there is a vast untapped resource of geeks out here. :)
I have often thought they need a military advisor, not to give them a boatload of protocol but to keep them from doing the occasional incredably stupid thing. And I openly volunteered to be a Continuity Advisor for Voyager for "cost of living". My exact words were that I would relocate to California and do that job for them for whatever they pay the guy who fetches their coffee, and that I would be willing to include fetching coffee in my duties. :)

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Originally Posted by Cpt. Lundgren

My own take on this is that neither of the positions of Captain or Doctor actually exists. It is just common words used instead of the real names for the positions of Commanding Officer (despite rank) or Medical Officer (of minimum rank and/or training). However, one can hold the rank of Captain or have the academic title of Doctor.
Why not call a medical officer, ensign a Nurse.. So if the player won't spend the points to become a lieutenant, then you have a good option of what the other crew members will call him ;)
Another thought is that a medical officer, captain probably would be the administrative head of a larger hospital.

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Well, you're onto something here: There is no "Ship's Doctor". The job title is "Chief Medical Officer", abbreviated CMO.

However, Nurse and Doctor are two different jobs, and do not automatically substitute for each other. Based on long experience working together, one may learn a lot of the skills of the other, but ...
In the modern world, a Licensed Practicing Nurse likely got on-the-job training. Basicly, it involves knowing which prescription drugs you can give and in what doses without direct oversight by a Doctor. (5000mgs? That's GOT to be a typo: I can't give anything over 50mgs of this. Call the Doctor and make sure that's what he meant to write down."
A Registered Nurse has been to "Nursing School", but AFAIK this is normally combined with a Bachelor's Degree, essentially. (2 years of undergrad courses, then transfer to nursing school at the university for 2 years and graduate as an RN.) Thus, Starfleet Academy could be turning out Ensign RNs all the time.
Doctors, however, went to Medical School, and then did Internship and Residency before getting turned loose. In Starfleet, "Medical School" appears to be called "Starfleet Medical", and includes 4 years of classroom instruction and then 2 years of Internship. Thus, a Medical Doctor educated in Starfleet will have spent 4 years in the Academy, 4 years as a student at Starfleet Medical, and 2 years as an Intern under an existing Doctor before recieving his first assignment.

When Worf kept hopping into parallel universes, one of the universes he visited was distinguishable because Nurse Ogawa was a Doctor in that universe. She wasn't just called "Nurse" because Crusher was the Doctor: Crusher had other doctors working under her, but Ogawa's training was as a nurse, not a doctor.

Muddying the waters is the case of Christine Chapel: She was a Doctor, but in order to get passage on a ship heading towards her fiance she was willing to take a post as a Nurse when there were no job openings for a doctor. When things didn't work out with her fiance, she remained aboard Enterprise as McCoy's nurse. This is why she was a doctor in her own right in TMP: she always had been a doctor, but had taken a job as a nurse.

A decent model that is widely avaliable for this is MASH: One of the nurses outranked most of the doctors, but nobody thought she might be a doctor.
And a quickie rank conversion from MASH's Army to Starfleet:
MASH "Lieutenant" will be 2nd Lt or 1st Lt, which equate to Ensign and LT JG, respectively.
MASH "Captain" is a full Lieutenant
MASH "Major" is a Lt Cmdr
MASH "Lieutenant Colonel" (Henry Blake) is a Commander
MASH "Colonel" (Sherman Potter) is a Captain.


Given what I said above about "standard" time-in-grade for promotions, and how long a Doctor must spend in school to become a Doctor, ..... let me just say that an MD who is an Ensign would be really rare.
This should not be interpreted to mean that all Doctors are one rank higher that a character with the same number of promotions but not a doctor: I suppose think of it as geting the benefits of the first promotion whether you paid for it or not.
"You've graduated Starfleet Medical. Congratulations, you are now Lt JG Smith, MD."
"I'll take one promotion, that will make me a full LT."
"No, actually you're still a Lt JG. But at least now you came by it honestly.:)"

If you need in-world justification, then doctors are unlikely to be put in a position where glory is the result, so they probably get promoted slowly. Not "2 promotions per increase in rank" slowly, but certainly "5 promotions will NOT make you a Captain" slowly.

This is great stuff.

As for Nurse training lengths . . .

LVN/LPN have one year of schooling, of which 1/2 to 2/3 of the time is spent doing practical nursing. In the Army these tend to be sergeants or higher . . . most recieve their E-3 and/or E-4 automatic, with good conduct, promotions while still in school.

ASRNs are RNs who only hold an Associates in Science. This involves two years of schooling, of which atleast 1/2 is spend doing practical nursing. What they lack compared to BSN RNs, who have four years of schooling which accumulates to a Bachelors degree in Nursing Science, is administration skills, and additional medical training.

And the worse thing, is a burned out nurse . . . who only go through the motions, and whos passion for the job has been smoldered by several hundred, if not thousands, bedpans.

Therefore, one can say, they recieve their promotion at normal rate . . . however, since they are knee deep in learning their job skills . . . they lack certain base leadership skills other then that given to them at their basic training and/or at the Acadamy. Furthermore, they lack leadership experience . . . that would come during their normal time in grade.

Very often around an intern at a AMC (Army medical center) who have their Silver bar, but have yet to actually leave the internship phase of their training. By the time they leave, most are ready to recieve their "railroad tracks".

Hmm I like that idea.. make them an effective 'Lieutenant' but give it no power outside of the medical bay and they have to 'buy it' with XP before it becomes a real Lieutenant!

It is somewhat of a grey area what actual professional qualifications Starfleet Doctors have. They are clearly competent, and oviously liscenced practicioners, but Starfleet rank and medical proficiency are not the same thing. So yes a 'Nurse' may well be a fully qualified doctor and an ordinary MO - Medical Officer can be a nurse - they are medical - they are an officer, they just don't have a doctoral degree! it has to be said as well that with the resources on board a Starship there is no reason a Nurse can't train to be a Doctor, and because they function, often, as part of emergency reponse, they will probably be asked to perform way above 'Nurse' level on a lot of occasions! Having a handful of wonder-devices which can heal a wound with the wave of a hand meas they would do some things surgeons would do in todays era, so while I agree there is a clear line between them, What exactly a doctor and a nurse is in the 24th century is wooly!

I wonder if a non doctoral officer can become a CMO? Or even a non medical staff? Administrators in huge hospitals today need not be doctors, though I highly doubt it would happen (because much of their administration is handled automatically by computers) maybe at a Starbase? What happens if a 'Nurse' goes on to outrank the CMO. That shouldn't ordinarily happen, but I can imagine it coming up in a roleplaying environment where one player has more game-time under his belt than another and buys up his ranks! Oh just another nightmare for a GM :D

I agree that Nurse and Doctor is two different jobs today, but the border between them is not as clear cut as it used to be. Give another 200-300 years and the differences will probably become even less. Today, there are usually 3 different path; nursing auxiliary/assistant, requires no education or a rather low level of education; Nurse, bachelor degree; "Doctor," usually a master degree and one or two years of internship. Both of the non-doctor level are usually called Nurses by us laymen (there might be a couple of other career entry paths, but they are confused with nurses most of the time as well ;) ).

Given the future technology of Trek, and the structure of Starfleet, I basically assume that the Nurse track has been split up and incorporated into the other two.
The requirements of the Nursing assistant have increased to the point that it always require an education. That is the NCO track of the medical branch. After enough of on the job training and courses, they will become what we would consider a full nurse.
My own view of the academy is that only the first year is common between the different branches (to make sure that everyone knows how to use a phaser, assist in damage control, etc). SO that would give 3 years of medical training before even leaving the academy. During the cadet tour, they could very easily be considered a Nurse. When they have completed their cadet tour, they could apply to Starfleet Medical or, if they are sick of the school bench, apply for a position as Nurse. I could very well see a Nurse rise slowly to the rank of full lieutenant by becoming a specialist/expert. But a higher rank would probably require to become a "doctor" (but that might not be necessary as higher rank most likely means administrative duties and not medical).

I agree that MASH is a good example to show that a Medical Officer can hold a higher rank. But I don't think that the early 50's are a good example of nurses and doctors, as I guess that a woman at that time could outweigh a male doctor in both skill and education, but still never become a military doctor.

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Originally Posted by Tobian

What happens if a 'Nurse' goes on to outrank the CMO.

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Probably the same thing as when Geordi temporarily was in command of the Enterprise despite not being the highest ranking officer (can't remember the episode but it was in the first or second season). One of the other officers kept demanding that Geordi turned over command to him, but Command was given to Geordi by Picard so the chain of comman was clear.
Besides, to be CMO you probably need some form of leadership and command training to qualify, which the Nurse most likely don't have.

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Originally Posted by Tobain

Hmm I like that idea.. make them an effective 'Lieutenant' but give it no power outside of the medical bay and they have to 'buy it' with XP before it becomes a real Lieutenant!

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This can be stated as a difference between a line officer and a staff officer. This can be further be seperated due to the qualifications that an officer has to show the difference. Where as most, if not all, line officers recieve their bridge officer certification early . . . thius may be completely optional for some staff corps.

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Originally Posted by Tobain

What exactly a doctor and a nurse is in the 24th century is wooly!

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Alot of it does boil down to level of education . . . and thus practical medical abilities . . . but some of it is the way of approuching the patient and the medical issue. Recently there has been a move in the nursing field towards nursing diagnosis . . . where as medical diagnosis deals with the physical problem, the nursing diagnosis tends to look at impact on life functions.

But there will always be a need to have someone do those lower level things that a doctor maybe to busy to do, or which would tie up precious resources. Furthermore, you have to look at the ability to train such a force to a certain standard . . . and if all medical personnel would be doctors . . . then the resources needed, and time would be far larger.

As for level of training, it really depends on the unit. If you look at chat groups regarding this . . . alot of it depends on what your higher ups will teach you, and allow you to do. In the end, all medical personel work under a doctors license, under his/her guidence. There are limitations that a specific person can due based on their individual license/certification . . . but the doctor which they work under, is ultimatly responsible.

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Originally Posted by tobain

That shouldn't ordinarily happen, but I can imagine it coming up in a roleplaying environment where one player has more game-time under his belt than another and buys up his ranks! Oh just another nightmare for a GM

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This shouldn't happen as all character experience usage should be regulated by the GM. However, I doubt it would be possible. But there are positions such as Chief Nurse . . . that can have the same rank, depending on the size of the nursing staff.

Here's something a little similar to the blurryness between Doctor and Nurse skills-wise:
"Paramedic" covers a pretty broad spectrum. I knew a few EMTs when I was 18 or so, and I think I had a pretty good handle on their skills and duties: A year or so of schooling focussed on trauma medicine, and the authority to provide limited life-saving medical care in emergency circumstances, as well as the ability to administer certain doses of specific prescription drugs without consulting a physician. They are not a doctor, but can substitute for one in certain circumstances. Originally they were just a part of the First Responders: Fire, Rescue, and/or Police departments, but increasingly they were employed where a doctor was not really needed (and not within the budget), such as amateur athletic events.
Funny thing is, a lot of EMTs packed in a whole lot of Medical knowledge, and not only could treat your sprained ankle but could offer you good advice on how to avoid such injury in the future, from posture to diet.

I had the opportunity to see the pilot episode for Emergency, which I had been a big fan of as a kid. It is the tale of 2 paramedics in the LA Fire Department.
I was shocked at how little these guys had in terms of power and training. They were essentially remote-controlled hands for the doctors at the hospital: they could take vital signs, and they knew how to do several procedures and where to inject drugs, but they were not allowed to give drugs or undertake any other kind of treatment without specific orders from a doctor. In the pilot, one of them has jeopardized the entire program because the radio wouldn't work, so he used his training as an Army Medic and gave the patient some pain relievers and then set their leg before evacuating them to the ambulance.

I rather like the speech given to the state board by the doctor who everybody thought would kill the program. He explained about the "Golden Hour", and that patients who get care within that hour are far more likely to survive. He then said that he did not like the idea of paramedics, because their limit training would cause mistakes, and cause problems down the road.
What he wanted, he said, was for there to be a licenced cardiologist standing right next to every person who has a heart attack, so they could recieve top-flight care instantly. However, since that was a practical impossablility, he recognized the next best thing was to put a whole lot of partly trained caregivers throughout the community. Basicly, he hated the idea of paramedics, but agreed it was better than doing nothing, and that he did not have a better alternative.


Yes, especially with the advent of wonderous treknology, nurses can perform many of the same functions as doctors. I mean, how hard is it to wave a bone-knitter over a fracture?
The difference comes in the things that are harder to represent on screen. A nurse can repair the obvious damage, a doctor knows that an ankle injury like that will often have caused knee damage, or impinged upon a nerve, or creates a higher likelyhood of infection. And will often get mad at a nurse for treating such injury, because the treatment can erase clues to those other issues.


And, while I agree the job opportunities in medicine in the early 1950s were not exactly equal, I think it was made pretty clear that Margaret Hoolihan didn't want to be a Doctor, even if that avenue were open to her. The doctors operated and then went away: she liked getting to know the patients, and caring for them on a day-to-day basis. Even when they were dying.
But it is a good example of the cross-over of skills: I think Hawkeye would agree that Margaret Hoolihan was among the better surgeons he knew, for the nuts-and-bolts parts of surgety, and that he trusted her to finish up more than he trusted Frank Burns (whom he regarded as faintly better than no doctor at all), and she was often put in charge of triage, which began as part of her program to make the nurses more helpful to the doctors.


Doctors make bad nurses. Just ask any nurse. :)
The skill-set has some overlap, but it isn't just a matter of how much schooling they've had but also what they were taught. To suggest that a noob doctor should be called a nurse is insulting to nurses and doctors both.

Although .... here's an idea: an Ensign MD is an "Intern".
Think about it: during your internship you are the low man on the medical totem-pole. Watch some first season episodes of ER, and look at how the experienced nurses treat "Doctor" Carter. :) So there is no way they're going to promote you to JG until you've finished your Internship.
Also, this fits with what we've seen with Ezri (who was a Counselor, but followi the similarities): she was defined as an "Assistant Councelor" and still in training as an Ensign, and got promoted to JG immediately upon becoming a Councelor in her own right. So, perhaps the promotion to JG for doctors is fairly automatic upon leaving Internship/Residency.

And if you have a PC who is an Ensign MD, he is doning his Internship under the ships CMO. This may allow him to go on Away Missions and such, much like the 1st year residents on ER sometimes get to work unsupervised.

Hmm.

Hmm Intern.. I like it! :)
With regards to the promotion thing.. While I agree with you on the Gm controlling spending, the problem is mechanics and realism are not the same thing.. Technically speaking a 'Nurse' is built using the same points as a 'doctor' in any system you care to choose, and virtually matches skillsets. I Have no problems with players declaring they wish to go for their Doctorate and spend an ammount of downtime to get it... i guess the Nurse outranking the CMO isn't actually a huge issue.. with all things medical, the CMO has authority because department head takes precidence over 'rank' - you are in charge of that department, and the responsibility rests on your shoulders! I guess the situation of a Nurse outranking an MO Doctor, and that could be frustrating for the nurse... just like in the real world! But for non medical matters she outranks her! :)

We do know Brevet promotions do happen in Trek.. the Dominion war saw several, up to and includig the crew of acting ensigns on the Defiants sister ship! :) But yes, and 'Ensign' can be a 'captain' if the Captain (or other acting senior officer) places him in command. This of course can create some huge tensions, but then that's good for Drama :D

Maybe the entries concerning combat medicine in Starfleet should be combined with other threads that are similar to this issue, and be removed from the general starfleet thread . . . for we appear to be wondering off center, as it were.

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Originally Posted by spyone

Yes, especially with the advent of wonderous treknology, nurses can perform many of the same functions as doctors. I mean, how hard is it to wave a bone-knitter over a fracture?
The difference comes in the things that are harder to represent on screen. A nurse can repair the obvious damage, a doctor knows that an ankle injury like that will often have caused knee damage, or impinged upon a nerve, or creates a higher likelyhood of infection. And will often get mad at a nurse for treating such injury, because the treatment can erase clues to those other issues.

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When he should be mad at himself for delegating a duty to someone who lacked the knowledge and mindset required to do the job. ;) Sounds to me that we basically agrees, but mostly argue about semantics and how the education are structured.
This is basically what I am going to use myself:
Enlisted/NCO, equals a nursing assistant.
Medical Officer, basically a nurse by today standard
Medical Officer who have been to Starfleet Medical and completed their Internship, which would be a doctor.
This would mean that the education to become a nurse is a subset of becoming a doctor. So a doctor wouldn't have any problem to apply for a nursing position of he wanted.

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Originally Posted by JALU3

Maybe the entries concerning combat medicine in Starfleet should be combined with other threads that are similar to this issue, and be removed from the general starfleet thread . . . for we appear to be wondering off center, as it were.

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It have helped me to bring things into perspective. But I don't mind moving the combat medicine posts if that's general consensus.

Hm.. I just realised that I don't have a clue how a normal career in the science branch should look at all

But Cpt. Lundgren, your forgetting several other types of medical personnel
Enlisted/NCO:
Nursing Assistant (more of an admin. type job)
Medical Technician
Lab Technician
Paramedic
and the lowly Orderly.

Officers:
Medical Officer (the Doctors of Starfleet)
Medical Specialist
Nurse (again dealing with more of the admin. portion of the job)

The CMO, in my mind is some one who has taken extra steps in their training. Being able to not only deal with a variety of medical challenges (if a Specialist wants to go for CMO they will need to branch out so to speak) but also the administrating of a large force of other specialists, and the facility they work in. On Starships they'll need to be able to cover for any lack of specialists at least for a time, Starbases and Dedicated Medical ships not as much, as there should be full specialists coverage. Also they need to have the rank so as to command the Department they have.

Here's a (not complete) list of possible medical positions that would need to be filled:
Officers:
Chief Medical Officer
Senior Medical Officer (basically just a higher ranking Medical Officer)
Medical Officer (or Medical Generalist, when compared to the next entry)
Medical Specialists: Here's a list of some: Anesthesiologist (anesthetic), Cardiologist (heart), Dermatologist (skin disorder), Epidemiologist (epidemic disease), Forensic/Coroner (cause of death), Gynecologist (female reproductive), Neurologist (nervous system), Neuro-Psychologist (brain function relation), Obstetrician (child birth), Ophthalmologist (eye), Orthopedic Surgeon (skeletal and joints), Otorhinolaryngologist (ear, nose, and throat), Oral Surgeon/Dentist (teeth and mouth), Pediatrician (infant and child), Pharmacologist (medications), Cosmetic Surgeon (appearance), Psychiatrist (mental and emotional disorders), Radiologist (medical radiation use), Sports Medicine (muscle and soft tissue), Thoracologist (torso, heart, and lungs), Trauma Surgeon (emergency damages), Urologist (urinary tract and urogenital system), Vascular Surgeon (artery and veins), Virologist (viruses and viral disease), Xeno / Exo (add to any of the above specialties) (man does my spell checker hate me right now)
Head Nurse
Nurse

Enlisted:
Medical Technician
Lab Technician
Corpsman/Paramedic
Orderly

Special Description:
Intern (Normally only at a Star Base) I also refer to this as a Medical Midshipman. The equivalent of the Cadet Cruise for medical personnel.
Resident Physician (First Year Position for a Graduated Medical Officer)