Medical Careers in Starfleet

[SpyOne]

This is going to focus on the TNG era, though discussions of other eras are welcome.

We don't have a lot of data about what it takes to become a doctor in Starfleet. The only doctors where we know much about their education are Crusher and Bashir. And while Doctor Crusher had basically what you'd expect, Doctor Bashir didn't.

From what we have seen, higher education in the 24th century is very like it is today. (As the saying goes, science fiction is always more about the present than the future.)
Dr. Crusher's personnel file in "Conundrum" shows her attending Starfleet Academy for eight years. This would match with four years for an undergraduate degree, and then four more to obtain an MD.
In the modern world an MD is not enough to become a doctor: you need to earn a license, which involves essentially an apprenticeship called Residency. In some cases Residents are called Interns (though apparently use of those terms is not 100% consistent).
And again, we have Dr. Crusher mentioning that she served as an Intern under another doctor years ago.

But Dr. Bashir doesn't appear to have done a Residency.
I am not certain he never mentions one, but he definitely didn't have time for one: Residency runs for three to eight years depending on specialty.
But if Julian Bashir started Starfleet Academy at 18 (it is rare for anyone younger to be accepted and he never mentions getting in early), then he would have completed his undergraduate degree at 21 or 22 (depending on when his birthday is).
Then add four years of Medical School and he's 25 or 26.
And he was 26 when he was posted to DS9.
So he skipped Residency. He was never an Intern. And while maybe the education system has changed in 300 years, Doctor Crusher was an Intern.

Another thing (though less bothersome): in the modern military Doctors enter at a fairly high rank: in the army as Captains in the Navy as full Lieutenants. And given Data's description of what was probably a typical Starfleet career this fits pretty well: graduate the Academy as an Ensign, become a Lieutenant Junior Grade halfway through med school, and become a Lieutenant when you finish your Residency.
But Doctor Julian Bashir was a LtJG when he arrived at DS9. As far as I know he is the only Doctor ever shown who held such a low rank.

I'm not sure what my point is. I guess I'm wondering if anyone has a decent theory to explain this inconsistency that isn't "sometimes they do it differently", or worse "they wanted Bashir and Dax to be young fresh-faced junior officers, and they weren't paying attention to how rare it is for a doctor to be under 30".
I mean, that last one is probably it, but it isn't very satisfying,

 

[The Old Mixer]

Part of McCoy's backstory from the writer's bible is that he was already a practicing civilian doctor before he joined Starfleet, which involved him taking some courses in "Space Medicine". Hence his unfamiliarity with the Academy in TOS.

 

[1001001]

Part of McCoy's backstory from the writer's bible is that he was already a practicing civilian doctor before he joined Starfleet....

That's also made clear in ST09.

 

[Longinus]

Other doctors we see have been in service for a while, while Bashir is just at the beginning of his career when we first see him. This would explain the rank. Starfleet doctors probably graduate as ensigns like everybody else, or as Lt. JG. at most. Also, Bashir is a genius. It is perfectly possible that he was accepted in the Academy at younger age (there was a program for such, Wesley tried to get in that way when he was 15, but failed), and even completed the Academy faster than is usual. It also might be possible that he was an intern when he was still studying (some special dispensation for super gifted students allowing this.)

But yes, it is interesting that both Crusher and Bashir are graduates of the Academy, while McCoy isn't. Perhaps at some point Starfleet decided that it was better to just train their space doctors from the get-go, rather than commission Doctors that have studied elsewhere. Though it also possible (and even likely) that both career paths were available. It is also possible that if McCoy was already an experienced doctor with an impressive CV when he joined the Starfleet, he was commissioned at higher rank than a mere rookie would.

 

[Cymriu]

I never thought of Bashir as a doctor....

 

[The Wormhole]

But if Julian Bashir started Starfleet Academy

Actually, Bashir doesn't seem to have attended the Academy, but rather "Starfleet Medical School" which is still in San Francisco anyway. There's no real mention in DS9 of him being at the Academy, always Medical School, though he apparently did attend parties with other Starfleet cadets. The Medical School also offers an Engineering Extension Course.

 

[Bry_Sinclair]

Bashir was 27 when he was assigned to DS9. With 8 years of training he entered Starfleet Academy at 19, after a very brief time spent aiming to become a professional tennis player.

 

[Cymriu]

what a wonderful thing to be genetically better, but have to prove it at every turn...

 

[Laura Cynthia Chambers]

But yes, it is interesting that both Crusher and Bashir are graduates of the Academy, while McCoy isn't. Perhaps at some point Starfleet decided that it was better to just train their space doctors from the get-go, rather than commission Doctors that have studied elsewhere. Though it also possible (and even likely) that both career paths were available. It is also possible that if McCoy was already an experienced doctor with an impressive CV when he joined the Starfleet, he was commissioned at higher rank than a mere rookie would.

Well, it would certainly be easier to recruit people who go in wanting Starfleet and doctorates, rather than having to stir up interest in a pool of candidates who currently aren't interested.

 

[Tim Thomason]

Bashir was 27 when he was assigned to DS9. With 8 years of training he entered Starfleet Academy at 19, after a very brief time spent aiming to become a professional tennis player.

And if he pulled a Wesley and entered at 15, that gives him four years to practice as an intern/resident/junior doctor elsewhere. Heck, he was salutatorian, so it's easily possible that he graduated early, giving him possibly another year or two to add to his downtime between school and DS9.

 

[Levi]

After graduation from Officers Training at the Academy, some Cadets continue with specialty training. Starfleet Medical School is an additional 4 years.
After graduating from Medical School, Cadets are promoted to the first rank above Ensign, Lieutenant Junior Grade (jg). This advancement in rank is to signify their additional time in training required to attain their position.

During their first posting, before being promoted to full Lieutenant, could be thought of as an 'Internship'. From there, they would spend their time as a Lieutenant doing their 'Residency'. It can take about the same time to complete a residency and become an attending physician, as it does to become a Lieutenant Commander, and/or a Department Head. However, a Medical Officer is able to practice medicine after graduating from Medical School, unlike the classic term of an 'intern'.
So, it's still all there, just some changes, and a bit of a different format.

Just in general. Starfleet always allows for exceptions to the rules to accommodate varying circumstances. People with previous Medical Training can be allowed to join, and their time as a Doctor can be converted to service time.

 

[Timo]

Everybody graduating as Ensign goes well with everybody being an academician. Today's militaries seldom enlist the skills of academicians, except in medicine; Starfleet is full of scientists and engineers who just do soldiering as a hobby of sorts.

A doctor needing to do four years more than the other academicians is the oddity here. No doubt some of it is done in a facility formally known as Starfleet Medical (School), although the ratio between such a special entity and "standard" Starfleet Academy within the total of eight years is unknown. But how come LaForge doesn't do eight or twelve years in order to qualify as a rocket scientist? Why does his hands-on profession require less of an "internship" than Crusher's?

But yes, "in general". Kirk can do both basic Academy and the optional Command studies in just three years, Picard takes four, Merrick would have taken five, and other heroes or sidekicks do an unknown number of years without the Command qualifications or the adjoining no-win test. And there's no hurry, no known maximum age for getting in or out (Crusher gets her red shirt and center seat at an advanced age, say). No doubt the flexibility would extend to all the professions within Starfleet.

Timo Saloniemi

 

[Bry_Sinclair]

And if he pulled a Wesley and entered at 15, that gives him four years to practice as an intern/resident/junior doctor elsewhere. Heck, he was salutatorian, so it's easily possible that he graduated early, giving him possibly another year or two to add to his downtime between school and DS9.

Doubtful, seeing as how that might shine the spotlight on him and risk exposing his genetic engineering (which kinda poses the question, was Wesley not actually some fort of genius but actually genetically modified?).

 

[SpyOne]

After graduating from Medical School, Cadets are promoted to the first rank above Ensign, Lieutenant Junior Grade (jg). This advancement in rank is to signify their additional time in training required to attain their position.

I just want to note that this advancement in rank isn't special: Data's description of a typical career put promotion from Ensign to LtJG at two years after spending four years at the Academy. So those who go on to spend four more years getting an advanced degree (Starfleet might offer others) would get promoted halfway through.
If Starfleet Medical works like current medical schools, this happens right when they start doing rotations (so when they start working with patients, as the first two years are all classroom stuff).

... It can take about the same time to complete a residency and become an attending physician, as it does to become a Lieutenant Commander, and/or a Department Head.

. Data says one would spend "twelve years in the Lieutenant grades" before becoming a Lieutenant Commander. Even if one spent six years in Residency, you would spend four years as a full physician before being promoted to Lieutenant Commander.
And I would guess that around this point doctors start getting promoted slower than the Career Data described. I think a lot of doctors spend a decade at full Lieutenant, and many never make Commander.

People with previous Medical Training can be allowed to join, and their time as a Doctor can be converted to service time.

I totally agree. I assume there is a shorter version of Starfleet Academy for people who already hold degrees that just teaches the rules and procedures without also getting you a degree.
In fact, I used to think Troi went through something like that, since when she and Riker met she was a student at the University of Betazed. I had assumed she was an undergraduate there, and meeting Riker convinced her to join Starfleet. But her personnel file in Conundrum shows that when she met Riker she had already graduated from the Academy and therefore must have been doing post-graduate studies.
I assume that the U-of-B is recognized as the best school of psychology/psychiatry for students with telepathy (and Troi's empathy counts).

 

[Timo]

Well, in the 2009 movie, McCoy seems to hold both high commissioned rank (LtCmdr) and a high position aboard a big starship (next in medical command after CMO) while Kirk still struggles with graduating or at least is consistently referred to as Cadet until Pike shoves him to a command position. Yet the two started at the same time, and Kirk is the supposed super-duper overachiever here.

So standard Academy studies including Command-as-undergraduate can be completed in three years by supermen only, but standard Academy studies not including said and not necessarily including any medical extras either may be completed in just one or two years by neurotic old men. And if McCoy graduated as Ensign, we want to shorten his Academy as much as possible to allow for him to rise in rank, but even if he were allowed to graduate as LtCmdr for his preexisting medical qualifications, he still needs some time to settle in the cushy position he holds while Kirk holds nothing at all.

Timo Saloniemi

 

[SpyOne]

A doctor needing to do four years more than the other academicians is the oddity here. No doubt some of it is done in a facility formally known as Starfleet Medical (School), although the ratio between such a special entity and "standard" Starfleet Academy within the total of eight years is unknown. But how come LaForge doesn't do eight or twelve years in order to qualify as a rocket scientist? Why does his hands-on profession require less of an "internship" than Crusher's?

Well, the answer to ghe first part is that Geordi doesn't have a PhD in Engineering. We've seen some people who do (like Doctor Leah Brahms, one of the designers of the Enterprise's engines), but Geordi only has a Bachelor's Degree like most of the rest of Starfleet.
And for the second part, I'm not sure there really is less internship for an Engineer, but it is less formal.
I mean, I would think that Ensigns in engineering spend a lot of time being trained and supervised by senior engineers. But there isn't an explicit rule saying they aren't allowed to "practice engineering" unless being supervised.

It does seem odd that medicine seems to be handled so differently from other jobs in Starfleet. We have lots of evidence that everyone is taught some basic engineering, how to steer the ship, how to fire the weapons and the basic capabilities thereof, a wee bit about how transporters work, ... but nobody who isn't a doctor seems to know more about first aid than you would learn in the Boy Scouts, where a more apt parallel would have a lot of them be paramedics.

 

[Kor]

And some on the command track come out of the academy as Lieutenants, such as Saavik and NuKirk.

Kor

 

[Tim Thomason]

Doubtful, seeing as how that might shine the spotlight on him and risk exposing his genetic engineering (which kinda poses the question, was Wesley not actually some fort of genius but actually genetically modified?).

You would think so, but remember that he graduated as salutatorian and wanted to be valedictorian. He wasn't secretive about his genius attributes, just his physical ones (and even then, only later on, if we believe his attempt at professional tennis).

Since genetic engineering is apparently undetectable, outside of mistakes in the process, I wonder if there's a large underground network for it. Probably not Wesley, but maybe many of the all-around greater men were tampered with. Hell, Jean-Luc Picard was the Academy marathon winner as well as someone with diverse interests in the sciences and archaeology. Maybe they messed up Geordi's eyes. Reg Barclay is a more socially acceptable version of Jack. How come Tom Paris can do everything?

 

[Shamrock Holmes]

Well, the answer to ghe first part is that Geordi doesn't have a PhD in Engineering. We've seen some people who do (like Doctor Leah Brahms, one of the designers of the Enterprise's engines), but Geordi only has a Bachelor's Degree like most of the rest of Starfleet.

Given his interest in engineering research and knowledge outside his primary field I'd suggest he might have a Masters, but definately not a PhD/DSc.

It does seem odd that medicine seems to be handled so differently from other jobs in Starfleet. We have lots of evidence that everyone is taught some basic engineering, how to steer the ship, how to fire the weapons and the basic capabilities thereof, a wee bit about how transporters work, ... but nobody who isn't a doctor seems to know more about first aid than you would learn in the Boy Scouts, where a more apt parallel would have a lot of them be paramedics.

Not really, even the academics heavy "every officer has a degree" US Armed Forces make only 4 years qualify a Line Officer (broadly Command or Operations, average age 22-23) but Medical Corps will typically have both an undergraduate degree and their MD before commissioning.

Paramedic (Corpsman?) courses are available to non-blue shirts, as Worf of all people has taken it (he acted as "midwife"/medic during Molly O'Brien's birth and was apparently qualified to do so). While the sortage of qualified medics on Voyager would seem to suggest otherwise, IMO it's likely that most "Operations" personnel are qualified responders though probably not to paramedic level (that's probably for Chiefs and officers).

And some on the command track come out of the academy as Lieutenants, such as Saavik and NuKirk.

Kor

Given that Pike (presumably) had some basis for declaring NuKirk the "only genius-level repeat offender in the Mid-West" that he already had a Bachelors or Masters Degree from a civilian university (most likely UI),

Likewise, Saavik probably had a commission as a science officer, maybe even a tour or two under her belt, prior to the events of TWoK and was at Command School to fast track to the big chair.

 

[Laura Cynthia Chambers]

Given that Pike (presumably) had some basis for declaring NuKirk the "only genius-level repeat offender in the Mid-West" that he already had a Bachelors or Masters Degree from a civilian university (most likely UI),

Not necessarily. Here's the full line:

'Cause I looked up your file while you were drooling on the floor. Your aptitude tests are off the charts, so what is it? You like being the only genius-level repeat offender in the midwest?

These could have been tests he took in high school, or while moving through the correctional system - Pike implies that Kirk has committed crimes before (likely other brawls, hence "repeat offender" - assault and battery, then).

IMO it's likely that most "Operations" personnel are qualified responders though probably not to paramedic level (that's probably for Chiefs and officers).

Particularly security personnel, I imagine. First responders, much like police are today.