[AlexanderHowl]

-10 to skill is not impossible, it is just difficult, and it is nothing that an adventurer would not face on a regular basis. For example, a character using Physician might suffer a -5 to skill for improvised equipment, a -7 to skill for poor visibility, and a -9 to skill for attempting to treat a patient in 10% of the normal time (all of which are quite possible in battlefield triage), for a grand total of -21 to skill, which really would be quite difficult and functionally impossible for most doctors. If they have Efficient, Night Vision 5, and Physician-25 though, they would succeed on an 11-.

When it comes to Recover Energy-20 though, that does not improve the character's efficiency per patient. They are still caped at 8 HP per day per patient if they want an effective skill of 16. In fact, Recover Energy-20 instead of Major Healing-25 would not really improve the effectiveness of the healer, as the higher skilled healer will only be down 4 FP by the time that they reach the limit of effectiveness of the lower skilled healer.