Medical Careers in Starfleet

[SpyOne]

It's probably the same idiot thinking that made Sisko a Commander rather than a Captain.

Why was making Sisko a Commander "idiot thinking"?
At the beginning of DS9 he was being assigned to command a small station in an unimportant corner of the galaxy orbiting the 24th century version of a third-world nation. He had a crew about the size of the Engineering crew of the Enterprise, and his senior officers were Lieutenants, Junior Grade.
That totally sounds like a job for a Commander.

 

[Shamrock Holmes]

How do you think nurses fit into the "medical careers" progression in Starfleet. We don't have a great deal of explanation of the differences (given the increasing practice level and autonomy of nurses (incroaching on traditional MD roles) and the high level of practice of military medics (including many traditional civilian nurse roles). At least in TrekLit it is possible to progress from medic to doctor (potentially with a stop at nurse or life sciences officer). Based on comments by Simon Tarses and certain elements of Chapel's backstory I think it runs:

Medicial Technician: < 9 months academic and practical training before deployment to the Fleet as a Crewman. Promotable to Petty Officer and Chief. Expected to engage in Continuous Professional Development to Bachelors/Masters (usually in Nursing or Life Sciences). Upon completion of degree may be promoted to Ensign.
Nurse: 4 year program at Starfleet Medical Academy or similar accredited civilian facility (if the later to include at least an associates degree). Joins the Fleet as an Ensign, promotable to the flag grades (as HQ staff officer). May also complete truncated "upgrade" course at SMA or as part of in-Fleet CPD to convert to Doctor.
Doctor: 6-8 year Starfleet Medical Academy program or previous experience as MD plus 3-4 year Starfleet Academy course. Joins Fleet as LT-JG, promotable to Flag ranks (as HQ staff officer).

 

[SpyOne]

I have known a couple of RNs, and they all were annoyed at Nurse Chapel being an MD. They stressed that doctor and nurse are different jobs and there isn't a lot of over overlap in the training.
As such, I'm not sure being a nurse would allow one to "truncate" training to become a doctor.

However, as I noted above in modern America medical school requires an undergraduate degree but doesn't much care what in, so there's no reason it couldn't be nursing.
And I could see some doctors, especially in Starfleet*, wanting training in as many medical jobs as possible.

*Starfleet doctors routinely get called upon to do a wide variety of jobs already. They do emergency medicine, serve as GP for the crew, do lab work, do surgery, OB/GYN as-needed, etc. By TNG you can add pediatrics.
Heck, does pharmacy as a specialty even still exist, or did it just get subsumed into the training all doctors have?

 

[Laura Cynthia Chambers]

I suppose Chapel got a head start apprenticing under McCoy - I could see him regarding her as a student, knowing she would make a good one, and sharing the benefit of his experience with her.

 

[Shamrock Holmes]

As such, I'm not sure being a nurse would allow one to "truncate" training to become a doctor.

However, as I noted above in modern America medical school requires an undergraduate degree but doesn't much care what in, so there's no reason it couldn't be nursing.

In the UK, most RNs (and all new RNs) tend to have a BSc, and Masters aren't uncommon in the senior ranks. Given the value that UFP culture appears place on education, I could easily see them going this way. Also, as I understand it, a good chunk of the four year medical degree focuses on clinical teamwork and patient management skills which a qualified nurse would already be well aware of (but might require some time to 'reorrientate' to the doctor role within the team.)

Also, in the UK, at one point there was a 'fast track' route for undergraduate radiographers (holding a BSc or BSc (Hons) degree) to 'fast track' to doctor in three or four years, with the expectation that they would come out as radiologists (specialist registrars - equivalent to a antending/fellow in the US system) after their 'intern' period.

 

[J.T.B.]

I have known a couple of RNs, and they all were annoyed at Nurse Chapel being an MD. They stressed that doctor and nurse are different jobs and there isn't a lot of over overlap in the training.

The way it was presented, Chapel was a bio-medical researcher before entering Starfleet, which suggests a post-graduate education. It is possible that she took an entry-level position for which she was qualified just to get into space and try to find her fiancé, and later, deciding to make it a career, completed her MD.

 

[BK613]

^^ agreed (and ninja'd)

 

[Nerys Myk]

Why was making Sisko a Commander "idiot thinking"?
At the beginning of DS9 he was being assigned to command a small station in an unimportant corner of the galaxy orbiting the 24th century version of a third-world nation. He had a crew about the size of the Engineering crew of the Enterprise, and his senior officers were Lieutenants, Junior Grade.
That totally sounds like a job for a Commander.

Most of the base commanders I've encountered were O-6s, which seems to be the norm.

 

[JonnyQuest037]

The way it was presented, Chapel was a bio-medical researcher before entering Starfleet, which suggests a post-graduate education. It is possible that she took an entry-level position for which she was qualified just to get into space and try to find her fiancé, and later, deciding to make it a career, completed her MD.

That's pretty much how I take it now. It also really helps with her getting her MD between TOS and TMP. The timeline works much better if she was already working towards her MD before or during TOS.

 

[SpyOne]

Most of the base commanders I've encountered were O-6s, which seems to be the norm.

I'll wager most of the base commanders you've encountered had several hundred people under them, too.
The idea was that, before the discovery of the wormhole, DS9 was not important. Making the CO a commander serves that. (And once DS9 became important, Starfleet was kinda stuck with Sisko because he was important to the Bajorans).

If you could find a base like one of the old Texas Towers (6 officers and 48 enlisted), I suspect you would find the commanding officer is an O4.

 

[Timo]

As regards Chapel, the "problem" there is with her apparently being Ensign in TOS (because she is a Lieutenant in TAS soon thereafter, even before gaining her MD credentials and becoming a more natural recipient of a commission). Is that because she would be an atypical nurse? Apparently not, at least not by 24th century standards, as Crusher's apparent head nurse Ogawa is also Ensign in TNG.

Starfleet base commanders in turn are all across the map. We meet a Commodore at SB11 (or two, assuming Mendez also held the position even when only Stone was actually credited with it in dialogue), and hear of a Commodore in "The Ultimate Computer" (which in noncanon terms involves SB6, although a nameless station is shown), but of a "Space Commander" for a "starship base" in "Man Trap". And then we have Admirals of assorted ilk at TNG starbases big and small - although they may well just have an office in a facility commanded by a Commander for all we know. And, conversely, we see a Commander receive our heroes at the giant SB74, but we get no impression let alone confirmation that he would be the boss of the entire facility.

Timo Saloniemi

 

[Shamrock Holmes]

And, conversely, we see a Commander receive our heroes at the giant SB74, but we get no impression let alone confirmation that he would be the boss of the entire facility.

Indeed, given that he mainly concerned himself with repairs and such, Quinteros could (and perhaps should) logically have been a gold shirt "Chief of Operations" (or semi-canonical Operations Manager) rather than the station's CO, who might have been busy with other matters at the time.

 

[Timo]

Or one out of a dozen Commanders who dedicate themselves to specific maintenance, repair and overhaul projects as they arise - this station seemed to have its share of MRO jobs, and indeed any mushroom-type installation out there might be a "Spacedock" first and foremost, with the MRO ops employing a lot of staff, and with the base command ops being a separate and much higher level properly reflecting this vast number of underlings.

Getting the base commander involved would seem unlikely: only the matter of the E-D threatening to blow and ruin the fine base should command his or her attention, and there's basically no time for him or her to arrive on the spot from across the town (but plenty for Quinteros to do so, if he were already intimately involved in this particular operation).

Giving command of anything much to a non-redshirt (or non-goldshirt, or non-blueshirt, pick your era and command color) seems pretty rare in all Trek, so that Spock and that one goldshirted DS9 admiral stand out like sore tentacles. Scotty, too, seemed to change from engineering colors to command white/gold when getting that "captain of engineering" shtick (although mainly because the producers had stolen the engineering color altogether, and given it to the Academy!); Saavik only retained a sliver of Sciences grey on white while getting the job on the Grissom; etc.

Timo Saloniemi

 

[Shamrock Holmes]

Definately true post-TOS, during TOS we also had Operations Commodores Stocker and Stone (1/4 of all Commodores seen onscreen) and Science Captain Krasnovsky.

 

[SpyOne]

I just want to formally say that the reason I was dismissive of Troi being an MD or PhD is that I was apparently mistaken about her age.

A lot of what we "know" about these characters is based upon guesswork. Armed with VHS-era canon evidence, all I really knew was that when Riker and Troi met she was a student at the University of Betazed, and I thought she was probably and undergrad, and that meeting Riker had awakened her interest in entering Starfleet like her father, so she had either transferred to the Academy or (more likely IMO) attended an abbreviated version of the Academy for people who already hold a degree. This gave a small window of time for her to graduate from the university, attend the academy, and do whatever it was that got her promoted to Lieutenant Commander.

I now understand that the HD version of Conundrum makes it clear she had already attended and graduated Starfleet Academy when she met Riker, which means she was a graduate student working on a Masters or PhD or possibly an MD. And that she is much closer to Riker's age than I had thought.

 

[Shamrock Holmes]

I think the fact that she is refered to a Counsellor Troi rather than Doctor Troi suggests that she doesn't have an MD and a PhD is questionable. However, given that she is accredited with attending both Starfleet Academy and the University of Betazed then her possessing a post-graduate degree is virtually certain and her work as a therapist makes a Masters highly likely (for instance, in the UK a Psychotherapy degree is a Masters with a entry requirement of BSc to PhD/DSc depending on source career).

 

[Timo]

This in turn makes one wonder about her additional, unmentioned skills. She is apparently a Lieutenant in the memories of Will Riker when they at long last meet again in "Encounter at Farpoint", but wears the pips of a Lieutenant Commander from at least that day on. How did she ascend the rank ladder?

McCoy is shown as Lieutenant Commander basically right off the bat in the 2009 movie, having studied spacemanship while already a graduated and potentially practicing MD. Fine and well, except they do it differently in the 24th century, with the brilliant Bashir a mere Junior Lieutenant soon after graduation (it theoretically being possible that everybody graduates as Ensign, arguably because 50% of the graduates are academicians anyway). Bashir has all sorts of extradoctoral skills, and e.g. doesn't seem to have missed the Command&Conquer class that Troi only takes several years down her career path. He has also explicitly written papers that interest his peers, and is a candidate for Carrington. Yet he never makes it to Lieutenant Commander within the confines of his seven-year spot in the limelights.

Are we supposed to think that Troi keeps her candle under a forcefield, and in fact is professionally accomplished beyond her peers? Or that she has skills and qualities unrelated to her principal line of work, even though she hasn't even considered taking the bridge watch qualification test?

Or is it that she has performed heroic services to her organization, classically rewarded by promotions rather than decorations in Starfleet? What is the time window for those? And are there characteristics of hers or oddities in her timeline and backstory that would nicely be explained by her being a major hero?

Timo Saloniemi

 

[Laura Cynthia Chambers]

I think the fact that she is refered to a Counsellor Troi rather than Doctor Troi suggests that she doesn't have an MD and a PhD is questionable. However, given that she is accredited with attending both Starfleet Academy and the University of Betazed then her possessing a post-graduate degree is virtually certain and her work as a therapist makes a Masters highly likely (for instance, in the UK a Psychotherapy degree is a Masters with a entry requirement of BSc to PhD/DSc depending on source career).

Plus I suppose by calling her "counselor", it identifies her specialty.

 

[Dispaminite]

I always got the impression that Counselor was Troi's position on the ship, as oppose to her degree. Sort of like Odo was called Constable, even though that was his position, not his rank (not that it looked like he had an official rank in the bajoran militia.

 

[Shamrock Holmes]

There is some speculation that the different collar heights of the Militia "enlisted" personeel approximate rank or at least seniority. The collarless uniform would correspond to crewman or private, the tall collar (mostly worn by Odo from mid series onwards) denotes something like a chief or sergeant and the in-between height collar (worn by Rom) designates a leading crewman/petty officer or corporal.

I'm not sure if there's any canon on that though.