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Old 05-28-2013, 12:18 PM   #1
DangerousThing
 
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Default What level Physician skill should an MD have?

I know that 12 is the normal level of skill for a professional, but does an MD need a higher skill than 12 or just more skills (Physician, Diagnosis, and maybe Surgery or Psychology)?

I'm asking because one character in my SF campaign wants to be a doctor as well as a master martial artist.

And if this is in the rules, can you tell me where?

Thanks.
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Old 05-28-2013, 01:15 PM   #2
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Default Re: What level Physician skill should an MD have?

I think that today, in the US, you might be able to get a medical license with 12's in the major medical skills. Might. I think board-certification will be tougher, and almost all MD's in the US are certified: Family-practice MD's will have 14's in Diagnosis and Physician, ER docs will have 16's in Diagnosis and First Aid, internists might need 16+ in Diagnosis and Physician, and Surgeons will likely need 16+ in Surgery. Most specialities will involve skills outside the scope of GURPS, generally as Hyperspecialization perks and the like: A dermatologist is probably only even going to have 12 in the major skills if they are recently educated, more experienced dermatologists will probably have had most such skills atrophy.

In a more general sense, 12 as a professional minimum is really only for professions that happen with lots of time and acceptable errors - two things that many medical professions lack. I would say that if a job requires near-perfection or immediate on-demand performance then 14 is a more realistic minimum, and if it requires both then at least a 16. You can be a professional pilot with a 12, dusting crops and the like, but it might take 16 to be a 747 pilot, 18 to fly an F-22, and 20 to be a Blue Angel.
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Old 05-28-2013, 01:39 PM   #3
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Default Re: What level Physician skill should an MD have?

Skill 12 is a good baseline. Remember to add all applicable bonuses in your mind and ensure that the final result is a sensible level.

A TL8 GP who examines people in her office at her leisure, taking 20-40 minutes instead of the ~10 minutes assumed in the rules on pp. B424-425, gets +2 or +3 for a "very favorable" task (a mildly risky day-to-day job), +1 or +2 for extra time, and from +1 (quality) to +4 (quality) for a room full of TL8 gear, depending on budget. That's +4 to +9. Split the difference and call it +6 at TL8. Thus, someone with skill 12 is functioning at 18 most of the time, which is as good as can be expected.

A cinematic field medic who's routinely taking -9 for haste and getting at most +1 for good gear is at -8, and might want skill 20 just to have the basic professional 12 on adventures.
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Old 05-28-2013, 11:26 PM   #4
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kromm View Post
A TL8 GP who examines people in her office at her leisure, taking 20-40 minutes instead of the ~10 minutes assumed in the rules on pp. B424-425..
Jesus, Kromm (MYLF), do Canadian FPs really get 40 minute appointment slots? Here in the southern provinces 15 minutes is considered generous...

I guess I'd accept an FP having 12 points in a generous distribution of skills, including surgery (they do OB), nonetheless. And Research skill, and something that lets them consult and refer to experts, unless that's assumed in the job description.

FP residency is three years. Internal Medicine residency is also three years, and might either buy you a higher skill or a specialization. You'd certainly get a specialization and/or higher skill if you did a fellowship.

Surgery residencies start at five or six years, and especially when doing trauma you're under time constraints. I think Surgery-14 is defensible for most surgeons.*

Remember, First Aid defaults to Physician -0. An MD may not have to waste points on it.

*Full dosclosure- I'm a general surgeon.
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Old 05-28-2013, 11:38 PM   #5
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Default Re: What level Physician skill should an MD have?

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Originally Posted by acrosome View Post
Jesus, Kromm (MYLF), do Canadian FPs really get 40 minute appointment slots? Here in the southern provinces 15 minutes is considered generous...
LOL That was my first thought on reading his post.
I think 12 is ok for GP and most Residents but there usually not spending enough time to get a bonus. A lot of mistakes are made and a lot of trail and error but most of the time its not serious enough to kill anyone.
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Old 05-29-2013, 01:17 AM   #6
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Refplace View Post
LOL That was my first thought on reading his post.
I think 12 is ok for GP and most Residents but there usually not spending enough time to get a bonus. A lot of mistakes are made and a lot of trail and error but most of the time its not serious enough to kill anyone.
Yeah- remember, in the U.S. a GP is someone who has finished medical school and done a one-year internship, but they have not done a residency. An FP, on the other hand, has finished a three-year residency, as has an internist. A GP wouldn't have Surgery skill, but an FP would, albeit at a low level, since they do OB and can supposedly do cesarean sections and such. And I guess I'd give the FP higher levels of Physician and Diagnosis, too. From my way of thinking and internist would have Physician and Diagnosis at a higher level than the FP, but would lack Surgery skill. (But I'm pretty sure that in GURPS terms this isn't the case.)

Reminder: First Aid defaults to Physician-0, so someone with Physician skill probably doesn't need to waste points on First Aid.

A note to Peter Knutsen: anything a surgeon is doing in his office is covered by Physician or Diagnosis skill, not Surgery. Surgery seems, in GURPS terms, to almost be a physical skill. It's kind of odd- it covers bonesetting too, for example. (Yes, I would have done medical skills differently.) Well, actually, that's not 100% accurate, since surgeons do minor procedures in their offices- removing lipomas, even some breast biopsies, etc., and that would be Surgery skill. But just examining a patient, reviewing test results, and making a diagnosis is Diagnosis skill. Routine medical care like taking care of an inpatient after surgery is Physician skill.

And, usually there are not two surgeons in a surgical case. It's nice, but usually it's just one surgeon. For some ridiculous monstrosity case like a Whipple or something, yes, any sane surgeon would be sure one of his partners was there to help. Maybe also for a gastric bypass or a re-do Nissen. But for a cholecystectomy? A hernia? Or, heck, any emergency that happens in the middle of the night while you're on call? Not likely. I had to do an exploratory laparotomy in the middle of the night recently for a marginal ulcer at the gastrojejunal anastomosis of a gastric bypass that had been perforated for over a day- no backup, just me and an OR tech. What a mess. (If you're wondering, I just Graham patched it and she did fine.) Having a second surgeon in a routine case is a waste of that second surgeon's time. And, of course, Medicare doesn't reimburse well for a first-assist... ;P
But also, it would be pretty damned unusual for an OR tech or anesthetist or anyone else in the room to spot a surgical mistake made by the surgeon and "help" him by pointing it out. They all have their own jobs to do.

There was a long discussion here: http://forums.sjgames.com/showthread.php?t=100987. (It gets into a general medical discussion, not just PJs, later in the thread.)

And the more I think about it the more annoyed I get at the thought that someone might try to deny me my Surgery-14 after I did that five-year residency! Come and say that to my face, brother! What's a guy gotta do to get a freakin 14 around here? That was five years of 100+ hour work weeks! You're lucky I'm not asking for 16!

Consider- yes, we get +4 for "best" equipment at TL8 for using an OR in a hospital to do most cases. According to the injury rules in the basic set, stabilizing a mortal wound is an average task until -3xHT, when a -2 penalty is incurred, and it gets worse from there. And that's average for something that is very much under a time crunch. So, what is something like removing a gallbladder in GURPS terms? Easy? But let me assure you- I would not want an FP with Surgery-10 removing my gallbladder, and with +4 for using an OR and +4 for an easy task for effective skill Surgery-18 he basically won't fail. Even if you give him a familiarity penalty that's still a ridiculously high effective skill for a non-surgeon to not have some kind of a complication. No freakin way. It gets worse if you want to give the ER doc Surgery-12 (which is defensible, since part of their job is "stabilizing mortal wounds" in GURPS terms, which requires Surgery skill), so his effective skill wounf be Surgery-20. So you have to differentiate a surgeon somehow.

I would propose that removing a gallbladder is not an easy task. Stabilizing a mortal wound seems to be an average task, and would include things like placing a chest tube, ligating bleeding veins, pericardiocentesis, etc. This is all invasive, but not capital-I Invasive. I would propose that removing a gallbladder, or fixing a hernia, be about as hard as doing these things- so, an average surgical task. But it's not under a time constraint the way stabilizing is, so maybe favorable or very favorable if the GM is generous, from the descriptions on B345. (But those descriptions are hard to get a handle on- I won't hesitate at all to remove a gallbladder, but the patient might...) This gives the FP with Surgery-10 an effective skill of Surgery-15 or so to remove the gallbladder without complication in an equipped OR, or better if he takes longer than average (which for a laparoscopic cholecystectomy is probably about an hour- I've done them in half that when I was really on my game and the case was uncomplicated). That sounds a little more reasonable, but frankly still seems kind of high, and is where an actual surgeon with Surgery-14 would get differentiated, with an effective Surgery-19, so he's even good if the case is more difficult than most. As he should be. I've removed hundreds of incredibly sick not-your-average gallbladders, and had a few minor complications, but never a major one such as a duct injury (knock wood).

I mean, we're talking about people with doctorates, here- the equivalent of a PHD. And then 3 to 5 years of OJT in residency. And then maybe 1 to 3 years of specialty OJT in fellowship to become a subspecialist. I really don't think that having a skill-14 in their specialty field is out of line. A generalist like an FP? Sure, Physician-12, Diagnosis-12-14, Surgery-10 seems reasonable. ER doc: Physician-12, Diagnosis-12, Surgery-12. (Heck, half the time they don't make a diagnosis.) Internist: Physician-14, Diagnosis-14. Surgeon: Physician-14, Diagnosis-12-14, Surgeon-14 (five year residency, not three, remember?) Then, how about cardiac surgeon: Physician-14, Diagnosis-12-14, Surgeon-16! Chest surgery is at -3, remember? And they did a five or six year general surgery residency plus a two or three year fellowship to specialize in cardiac surgery. They deserve Surgery-16. Similarly, neurosurgery is a seven year residency, so it sort of has a fellowship built-in, doesn't it? And head surgery is also at -3, so the neurosurgeon gets Surgery-16.

Maybe an internist deserves a point in Surgery in GURPS terms, but I've known too many of them who fear putting in a central line or removing a dressing, let alone placing a chest tube or setting a bone. I'd be more likely to force them to default from Surgeon at -5. With Physician-14 this is a default Surgery-9, which jives with my experience of internists and would let them make reasonable attempts to stabilize a mortal wound if given a crash cart, for example. This is where GURPS skills loose granularity- what skill covers intravascular interventions such as placing a cardiac stent? I assure you, a cardiologist doesn't deserve Surgery skill any more than a pulmonologist does, but Surgery skill in GURPS terms covers anything invasive.

Last edited by acrosome; 05-29-2013 at 02:40 AM.
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Old 05-28-2013, 11:44 PM   #7
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Default Re: What level Physician skill should an MD have?

Huh. This is close to what I had thought, but I had been assuming skill 14 for pilots, surgeons, etc. on the grounds that they should receive more training because if they screw up, people die. Or at least, this is true for airline pilots, surgeons in countries that have rigorous certification standards, etc. Also assumed a Ph.D. very often means skill-14.
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Old 05-29-2013, 12:03 AM   #8
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Default Re: What level Physician skill should an MD have?

Generally, I think the more often someone is going to be relied on to use their skills under stress and in adverse conditions, the higher the skill they should have. This is why I think skill-12 is pretty low for someone in a stressful, chaotic occupation with very high expectations.
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Old 05-29-2013, 06:20 AM   #9
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Default Re: What level Physician skill should an MD have?

Quote:
Originally Posted by acrosome View Post
Jesus, Kromm (MYLF), do Canadian FPs really get 40 minute appointment slots? Here in the southern provinces 15 minutes is considered generous...
Add the extra prep time spent looking over the patient's chart. That's time a field medic doesn't and can't spend.
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Old 05-29-2013, 06:25 AM   #10
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Default Re: What level Physician skill should an MD have?

Most of the diseases will be head colds, and sprains. Routine, +4 TDM.
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