Thou Not Special Anymore - [Medical Job Changes]

[Hunt]

On a chilly morning of February 25th, 2022, the Aurora Relay discord sparked into a unionized opinion on medical changes and specifically, the removal of the 'surgeon' position in favor of either have alt-titles or a singular 'physician' title for all. As a participant of the debate on this brisk morning, in favor of the removal and changes I stated quite eloquently that a forum post would be made so those not present in the relay could be involved. Thus, I come to you today my dear friends and colleagues, to request your opinion on the matter in pursuit of a resolution which works for 90% of the medical player base. 

 

In all seriousness, the separation of title/duties between physician and surgeon is present to either prevent super-doctors, making other players obsolete, or some archaic sense of importance as surgeons are separate from physicians but have the exact same training. In my opinion, those within the medical profession receive most if not all the same training, education, experience throughout their MD/DO graduate studies, meaning their residency is where specialization takes place. Residency durations change depending on specialization chosen and time dedicated. I fail to see why the experience one would gain in their residency has resulted in two entirely different 'roles' in the Infirmary instead of just having one title for all or alt-titles be available. They have the same education from academia, the experience received should be entirely up to the player and their records/skillset, records which can be viewed by the CMO to determine who should take priority in surgeries each shift, which is part of their job as Infirmary management.

Present Options:

• Alternative titles for one position in medical which has six slots in total, combining the present four that physician has and the two that surgeon has. These alternative titles could be anything including the options trauma physician, surgical specialist, physician, attending physician, surgeon, general practitioner, etc. This can be discussed further as the thread continues and if this option is taken, I would personally limit the titles between two options only for simplicity.
• Removal of the surgeon position, exchanged for a position in its place which would serve with the title of 'attending physician' or something similar; with fellows or something similar being the general four slot position which would be under the attending in a hierarchy system. Basically, those two would take priority with surgical affairs and would serve as second in command of the Infirmary, as they would be expected to have the largest span of training/experience. I would not enforce an age restriction as an attending would just be fully trained/specialized in their field, which could be surgery, but would assist in the delegation/management of the Infirmary. Thus allowing for two slots to still be present and have priority with handling surgery while not outright making the fellow/general physician position incapable of surgery in an emergency.
• No alternative title. Six slots in physician. That is it. Your records can state what you specialize in and you can all debate as to who gets the OR next, like a real hospital/surgical environment, which is extremely competitive. Further allowing present CMOs to delegate who gets priority in ORs and establish rotations.
• Removal of the surgeon position, keep the four slots for physician, add two more slots to medical interns/residents so there can be individuals who play doctors in their residency.

 

While this may seem pointless, to my knowledge the present plan/reasoning is to remove the chart which limits what physicians can/can not do and what surgeons can do. While in the grand-scheme of ensuring there are no 'super doctors' or preventing from surgeons being obsolete, this entire system for lack of better words is stupid. Let it be up to the players to write in their records what their experience is/specialization, for CMOs to read, for management to be had internally ICly, and if super doctors do appear it can be handled by staff on a case by case basis. Having this 'system' which says physicians can repair the heart but can not repair a liver, means they somehow experienced surgical specialization but just forgot large aspects of it in my opinion. I rather see all individuals in the Infirmary (physicians) be equal, with the expertise set forth in records to take priority in an individuals experience, for CMOs to be capable of managing who does what, etc. That or the addition of a hierarchy system where two individuals would be second in command of the Infirmary, have priority to surgical needs as they are the attending physicians, while also allowing for the entire removal of this chart found below so in an emergency or if no attendings are in-round, a physician is not limited by what the wiki says and can try to save a life.

 

If I forgot something to mention, oh well, you may all now commence the debate; may the odds be ever in your favor, happy medical games.

P.S. I tagged coders/wiki since those pages and code would need to be changed, just incase either party wishes to add on how simple/complicated this change will be.

 

[Montyfatcat]

We probably need to give foreign body removal a "yes, if mechanical" clause cause rounds CAN embed into a mechanical arm and I don't wanna call over a physician to remove it

[Sparky_hotdog]

Oh boy! Is this a thread about surgeons! Get ready for a long one (I will put a tl;dr at the bottom if I remember).

So I'm going to be blunt in saying I dislike super doctors. Personally, I find the whole "I can cure all ailments" thing to be a little lacklustre, given my favourite medical moments have come from the department working well together, rather than just individually treating whichever patients get handed over to us. This is why I have particularly enjoyed switching over to FR recently, as my role in the chain of treatment feels a little more secure than when I played physician.

So naturally, I have a distaste for the surgeon role entirely. It is inherently a super doctor role, and while I greatly appreciate all those surgeons who do a good job of avoiding that by staying out of the GTR when there's a physician working, they are fundamentally "physicians but better" as there's not really a way to justify a character that can perform brain surgery but doesn't know how to use butazoline.

However, similarly, through removing surgeon and just making all physicians (or whatever their title may be) able to do every surgery, you just shift the super doctor to another role, this time with no reason to do any form of delegation without a CMO (And even then, they might not deem it a good idea). Alt-titles sound like a good idea to fix this, giving people specialisations, but ultimately there's the risk (albeit a low one) that you end up with all non-surgery spec characters filling up the department, or just the entire department filled with whatever the surgeon equivalent title is. So I don't think that's a good idea.

For the love of god don't give the surgical slots to the intern role. As someone who spent way too long playing a resident back in the day because I thought (in hindsight stupidly) that you should play that character for an entire 2 year residency, adding more slots just sounds like we're encouraging people to make characters more permanent in their learning roles, which isn't the purpose of those jobs imho. Adding a nurse or other such role instead to be a less skilled role in leu of this option making physicians super doctors again sounds good on paper, until you realise that's just having 2 physicians and 4 surgeons with different names.

The 'attending physician' (As much as I think that name could use some work) doesn't actually sound like that bad of an idea. Sorta like a warden, but for medbay. Having two of them might be a bit much (in which case give physician the spare slot I guess), or it might actually work well as the CMO delegating "AP one, you manage physician X and Y in the GTR, AP two, you manage physician A and B in surgery", and then the AP's subdelegating. I'm not sure how it would swing, but it sounds like the most likely to not cause headaches, though it might take some getting used to.

A few things on the side that don't really fit anywhere else:

• Specialisations being in records is definitely the way to go. Alt-titles are often just clutter on the manifest that confuse people. If physicians are given all of surgery, any physician should be able to do all of surgery, regardless of whether they specialise in it (For the sake of that sec officer who broke every bone in his body), and it should be up to characters to ICly delegate beyond that.
• The super doctor thing being handled by admins on a case by case basis as you mention sounds like a good idea, but I'm honestly not sure how easy that is to spot. Is a surgical specialist treating someone with burns on low pop "super doctoring"? Arguably. Does it deserve a bwoink? Probably not. What about on a higher pop round? Is their character just an asshole with no respect for their lane, or is it the player being non-cooperative?
• If the table goes (And by golly gosh I hope it does), as a point someone should include the whopping two "surgeries" we FRs can do on the wiki page elsewhere. They don't come up often, but being able to cut someone out of their hardsuit or chop off a necrotic limb can be huge when you're solo med.
• Maybe adding some uniform items (sleeve patches, armbands, etc.) that do a rough job of being like "Hey! I'd like to do surgery", or "Please, don't put me in an OR!" could be a shout if we go down the 'Physicians do everything' route, as there isn't always a CMO to check records, and if we go down the AP route as well, they may or may not check them. Also, not everyone writes records, so we've got to be considerate or something.

As promised, tl;dr I think the attending physician idea is the best option for allowing IC delegation of tasks.

[Gr33d]

The attending physician idea is genuis! Currently I have always felt physicians are in a weird place. It's really nice to have them around, but without them, sadly, a first responder can just do their job passively as long as theirs not much else going on. Having a single role based on watching patients and making sure they are all not dying however, sounds genuinely wonderful. I do have concerns about how surgery would be treated however after a split. People who wish to still do no surgery, how will they differ from the AP? It seems like they would have less authority and not much to do unless the AP is not working, or there's a whole station of people in the medbay. Still, I think the change would be for the best as atm physicians are in a weird place.

[Boggle08]

There needs to be an immediate distinction and a concrete obligation for the people that we will defer most of our surgical operations to. A cordoned off job title does this best. An alt title would do it too, but there would be some confusion. Ripping out the distinction completely, and making the deciding factor character records, knowledge, and preferences sounds like a recipe for confusion and bitchfighting. I don't like the idea of inconsistent doctors who can do everything or nothing.

The reason why we have the roles cracked in half in the first place is to prevent a single doctor from dominating one patient or more's journey through the GTR, into the OR, then back out again. In my view, someone who hoards activity like this falls into the category of a super doctor, and our current arrangement works perfectly at preventing this from happening.

Attending physician seems like the best change out of the proposed options, since it's just a modified surgeon role. For now, I just have two things against this idea: First thing is lowering the ages and making them a physician equivalent will make them an extremely contested role. More than they were with just two surgeon slots, since you've at least doubled the pool of characters that qualify for the role.

2 hours ago, Hunt said:

Basically, those two would take priority with surgical affairs and would serve as second in command of the Infirmary, as they would be expected to have the largest span of training/experience. 

The second thing is that I don't want to have these nerds have any kind of inherent managerial authority in medical. Medical sans the CMO manages just fine with each role doing what it's supposed to do; we don't need two Quartermasters. It's a recipe for bitchfighting, and takes away focus from what the Primary physician is supposed to replace.

 

[KingOfThePing]

This is basically going back to how things were and did not really work out well. Boggle summed it up very well actually. There used to be a time where everyone just played surgeon (and thus picked the alt-title for it) because surgeries apaprently were the hot shit, for some reason. There are two ORs, there should be two surgeons, period, since that is how it works in-game. You dont need more than one surgeon for a surgery. 

I find the "attending physician" equally bad, for the reasons Boggle also stated. The Medbay's jobs have clear definitions on who does what. Chemistry (bless them) prepares medication, Medics bring injured into the Medbay, Physicians tend to GTR and ICU and surgeons operate. I dont see the reason why this should be changed. It is one of the better working departmental systems on the server. 

 

I'd like to hear some arguments that were brought up in the discussion you mentioend and that "work for 90% of the medical player base". I have very recently started playing medical again after over 2 years of not being able to channel the mental capacity nessecary for it and I have yet to see one of the "problematic super doctors". The only thing I agree with is that the graphic on who is allowed to do what looks a bit like a shitpost. But it helps to differentiate both professions, in a good way.

 

[Gem]

alt-titles won't work because people will choose one and then go, just for example, "i'm a wall builder, that means i can't build tables. sorry." which is how it was before when medical had a million alt-titles.

having specialization in records won't work either because everyone doesn't write records and they are not required to. it also relies on there being someone in-round with records access.

other than that, i echo what Boggle and KingOfThePing wrote.

[WickedCybs]

Alt titles are something Aurora moved away from. Trying to establish a solid authority that's not the CMO is also something that I won't really be desired (the surgeons already aren't). Having people "pick" what they can do would lead to the issue Gem stated. 

Physician does feel superfluous since it's overlapped by every other role and has no real "thing" that only it does. On paper they run the GTR yet in practice practicality anyone can and will do so as well, especially in a crisis. I found medical unused to having physicians present much and the ones that did play eventually stopped or went surgeon. Which mandated helping out in the GTR by others even if they wanted to "stay" in their lane due to lack of numbers. Those were my experiences when I mained it, though I have not done much medical lately.

The option I'd see as having some potential is the last one.

[Peppermint]

I maintain that the removal of the previous alt titles was a mistake, as they allowed a lot more character growth.

To be blunt, if I want to play ss13 medical to do mechanics, I'll play CM or paradise or something similar where you just have to worry about said mechanics. Removing RP and character flavour on an RP server is not a good move imo, and just letting staff know if a surgeon is overstepping and being an asshole is a much better idea. Further removing medical flavour is not the best plan, and all the issues will still exist -seems a department certain people love to feel superior over anyway (med students, admittedly, as it tends to be) and they'll manage to figure it out. 

Surgeon overstaying their lane? Let staff know instead imo.

[Lucaken]

As I said in the discord discussion and Peppermint said just now, I believe Surgeons who butt their heads into managing the GTR are already ahelpable, and if they are not, then they 100% should be. In my eyes, it is the equivelent of an investigator going frag-mode because they have a shot on the antagonist, and should be punished in the same way (unless there are no Officers up and the situation is dire, or in this case, not enough physicians functional to help patients in need). Removing or further blurring the lines between the two titles only creates confusion, which is doubly important with medical, where you don't really have the time to deep-dive into records and check who has surgery permits as a guy lays dying on the table.

That said, I agree Physicians are not in the best shape as a role and could use help. The 'second-in-command' role is something to look into, a Warden-style role as others have described it. We'd have to do it in a careful way though, as medical already has a lot of roles and adding something like that might make it worse. It would still be leagues better than just outright removing Surgeons, though.

[WickedCybs]

I don't think this is an issue that can be solved by ahelping because there's really nothing to ahelp about often. I rarely see power-surgeons these days that try to do everything at the expense of overs and they tend to get ICly reminded if they slip up. They still often seem encouraged to do things like the GTR along with their usual duties as I mentioned earlier, unless the department is full and coordinated enough for them to be able to relax in the reception or sit tight in an OR.

It all happens due to the way medical is structured and a consequence of the gameplay loop, is my perspective. 

[Sparky_hotdog]

Part of the issue, as has been raised above, does stem from the fact that physician is ultimately a role that has every single part of its responsibility overlapped by another role in the department. Sure, having someone to deal with the GTR is useful, but most rounds (at least at the times I play on, where we probably see peak 25 people playing) a surgeon, 2 FRs and a chemist can literally take anything the round throws at them.

The issue then stems from physician burn out, which personally I have experienced, and have noticed myself (no matter how hard I try) also contributing to now that I play FR. Ultimately we get so used to managing without physicians, because we can and because there aren't all that many of them, that by instinct we often take away most of their gameplay and RP opportunities. As a responder, if I can't treat someone with whatever meds are on my belt at the scene, chances are they need emergency surgery, in which case they're gonna get whipped right past the physician into a surgeon's hands to plug that arterial or burst lung. Thus, physicians either give up on medical or switch to playing one of the other roles in the department with a more defined niche. And the whole thing repeats in one vicious, vicious cycle.

Do I have a solution to this? Not really. Most vicious cycles can be solved with critical masses, but I'm not sure that's going to help much. Ultimately as long as low pop exists (and it always will) people will play solo med. And as long as solo med exists, physicians will be the least appreciated role, because almost anyone can do their job in their place. And as long as physicians are the least appreciated role, the more people will get used to filling in for them.

[Pedantic]

Tossing in my two cents here.

So. As a semi-former phys main, I can attest that its freakin' infuriating to get passed over by the overlap. But, that's kinda the point of Physician. You're the everyman. The generalist. You fill holes where they exist, and support when those holes are filled. You also have a choice in how much of the rest of Medical you want to deal with. Don't like running to the crime scene? Don't have to (unless both FR's got fragged...). Don't like doing surgery? Sorry, no loicense mate. Time to patch you up with sticks and whatever wall mold the engineers brought in. It allows for a lot of customization and role filling in the department, at the cost of being overshadowed heavily in a fully staffed one. And, like Sparky and Cybs mentioned, this is just kinda the natural progression of our mechanics. I do think that constricting it by over-specialized roles would be detrimental to its intended function, and probably lead to at least a few extra headaches for mods. I'm in favor of keeping the current 4 physician slots, since they allow for a larger department, even if its really only in apocalyptic scenarios that you'd need anywhere close to that many.

With that out of the way, I'm honestly intrigued by the AP idea. Having basically mainlined CMOing for the last couple of months, I can safely say that having an appointed second in command isn't an unattractive idea, especially on solo-command rounds. Nothing like trying to watch sensors, negotiate with mercs, keep station panic to a minimum, and try to coordinate your department, all while outside of it and probably having to help with Sec efforts. So, having someone whose entire job is to run shit when your gone can be helpful. It can also serve as a 'CMO-lite' option, so someone else can train to share that pain. And, its faster and much more streamlined than appointing an interim CMO while you take acting captaincy, because, do you really think you have the time or headspace to think of that when the round is bad enough the DOCTOR has to be captain? Nope. With this, just say 'You're up Chuck,' and Chuck should immediately be able to step into those shoes, maybe with a quick stop to throw a command headset at him.

Admittedly, this can backfire, since if the CMO is really on their game, forgets about the AP, or not a lot is happening, the AP has to sit and spin the entire time. And, it could lead to issues of authority again, but, instead of surgeon vs. physician, its AP vs CMO. Unlike the Warden, the AP wouldn't even have the option of Camera Duty, since everyone burns their eyes out staring at sensors anyway.

But, on the whole, I think its a decent addition, at least in principle, similar to our other 'command-lite' roles, and would fit in with our expansion of them going into NBT.

Right, that's my lot, not apologizing for the wall of text, ejecting from here biyeeee.

[Boggle08]

20 hours ago, Peppermint said:

I maintain that the removal of the previous alt titles was a mistake, as they allowed a lot more character growth.

To be blunt, if I want to play ss13 medical to do mechanics, I'll play CM or paradise or something similar where you just have to worry about said mechanics. Removing RP and character flavour on an RP server is not a good move imo, and just letting staff know if a surgeon is overstepping and being an asshole is a much better idea. Further removing medical flavour is not the best plan, and all the issues will still exist -seems a department certain people love to feel superior over anyway (med students, admittedly, as it tends to be) and they'll manage to figure it out. 

Surgeon overstaying their lane? Let staff know instead imo.

Our current culture and roster of medical does a very good job of regulating physicians and surgeons who overstep into becoming super-doctors. A part of this is because medical's modus operandi has much more clarity than it used to. I got into medical a month or so before we ironed out the surgery chart and stripped out the alt titles, and during that time, everyone had a different idea of what a physician was supposed to do, what kind of surgeries they could perform, and if that changed depending on which alt title they picked.

I think what is important to consider when thinking about alt-title reinstatement is that it is an inherently misleading system; especially if you are new to medical. People will usually assume that the alt title radically changes the function of their job. Expectations and job knowledge need to be the same across alt titles, and it needs to be clear enough to the point where there's no confusion whatsoever. A Nurse that thinks it can't do any surgery is just as bad as a trauma physician that thinks it can do everything. I'm not inherently against the idea(I remember being pissed when they took the engineering titles), I just think we have to consider ways to mitigate it's pitfalls in order to implement it.

The idea that all facets of gameplay should always concede to RP is kind of self destructive in my view, however. HRP is not consistent at all, as we often go through player droughts and RP doldrums. SS13 has a precedent for complex, involving systems. Integrating such into our gameplay gives people something to tinker with, something to collaborate on, or can even give context and meaning for their actions.

[Faye <3]

On 25/02/2022 at 13:22, Boggle08 said:

The second thing is that I don't want to have these nerds have any kind of inherent managerial authority in medical. Medical sans the CMO manages just fine with each role doing what it's supposed to do; we don't need two Quartermasters. It's a recipe for bitchfighting, and takes away focus from what the Primary physician is supposed to replace.

i agree w/this very strongly. any authority that isn't the CMO's in medical is a bad idea. it's unnecessary and not needed. If the CMO, for whatever reason, needs someone to hold down the fort while they're away, they can already say "hey, x is in charge while I'm gone/unavalible/busy". This would just be a mini-CMO when there isn't a CMO, which would be real bad.

Edited February 27, 2022 by Faye <3

[nonno_anselmo]

Hi gamers, i read this thread and got curious. Do bear in mind that I have not played in about a year so my """"""""""""""""""contribution"""""""""""""""""" to this discussion will be that of historical memory and some background info on the current state of the art for each role.

In the past there was a lot of overlap with what a physician and a surgeon do, the heavy cordoning of the physician role from all surgery-related procedures took a long journey and some deep consideration from anyone who was playing the medical bay roles at the time. One of the main reasons that such heavy stops were placed on the physician role was to make it so that physicians would rely on their roleplay-focused knowledge of chemical treatments to fix any problem one might have. 

The main reason, however, for physicians stepping into surgery and surgeons into the GTR/ICU was due to the fact that the array of chemicals physicians had in their arsenal was limited to the choices we have today. It revolved around Bicaridine - Dermaline - [median painkiller I forgot the name of] - Dexalin+ - Peridaxon - Alky.

Most of these chemicals did not have the drawbacks introduced by Kermit Chems updates thus had no discernible skill component to the administration of these medicaments which made the physician role gameplay function revolve around a sleight of hands with mixing them in your hypospray and effectively cutting the downtime of the patient inactivity as when someone is on a roller bed they are functionally useless to whatever commotion is going on; this barebones treatment combined with the ability for anyone roleplay-wise to administer these easy to acquire chems resulted in people "taking matters into their own hands" and functionally making a physician a medibot with speech options. This has been sort of patched with unintuitive yet not-overbearing nooks and crannies to the chemical codex by implementing OD effects (see buthazoline) and proper administration mechanism (see: Alkysine [it has a chance to cause brain damage if you give it at above 2u] which is more functional if administered through an IV). This resulted in physician players being capable of using the given tinctured to their full extent thanks to being well versed in all matters chemical (aside from their production), making their role much more delicate and increasing their skills ceiling by many magnitudes (although i must admit that going from 1 to 3 is a 200% increase so do take this with a grain of salt).

 

Likewise surgeons had most surgeries given exclusively to them after the acknowledgement that all of their exclusive surgeries are solely for quality of life from a functional standpoint (e.g.: fractures can be ignored with a splint and over-the-counter painkiller) that can be slowly albeit just as effectively fixed through the proper and informed work of your average physician. Of course this still result in surgeons administering all advanced treatment chemicals because "i am in the power of doing it so this means it is right" but that's another story. 

 

As for alt titles I will have to sadly say that they have been largely ineffective in the past (see: trauma physician attending the GTR and physician attending the ICU) as well as an alt title like attending physician will result (once again) in the creation of a role which blurs the line between physician and surgeon like old unregulated surgeons did, taking away from the gameplay and ALSO roleplay (remember that in medbay a lot of roleplay comes from the convalescence and interactive treatment of the patient [assuming they are not critical but baymed already makes people so resilient to crit and death that it is hard to not bring someone back]) when the current situation results in a low influx of injured players and when the situation causes a large influx there will be too many patients for there to be any interaction as medbay must engage factory medbay mode.

I still play to this day on mrp and lrp when i have the chance, namely /tg/, and they have a unified medical doctor role. This works there because for obvious reasons i won't state there is a constant influx of injured players but already when going from lrp to mrp where the influx has a lower ramp up in players and a higher concentration of metagangs  the cracks can be seen with people actively fighting and scorn rising through the players as few who are more efficient and abrasive take advantage of the unified role to simply take over the entirety of the patient haul. While this is benefician from a gameplay standpoint for everyone who gets healed quickly and is able to return to their shenainigans, it is disheartnening for anyone out of the loop. Yes, /tg/ manuel has a medbay metaclique problem and it makes the job nigh impossible to play when faced against a squadron of highly trained and highly efficient players coordinating to keep everyone alive without involving any unfamiliar faces, yes this is and was facilitated by the unified role. Do remember that role identity is also character identity to some degree.

 

edit: i do not think aurora has this problem nowadays as the heavy stops placed on each role permit a properly fledged character and role identity, forcing a healthier mood through interaction, roleplay and a cooperative reliance between the roles. now delete paramedic and berets.

Edited March 1, 2022 by nonno_anselmo

[KingOfThePing]

Reviving this because of the No More Surgeons PR (hijacked by Gem).

 

Discuss the change of removing the surgeon job, physicians now can do everything (and should also do everything), subsequential reducing the number of 4 physicians + 2 surgeons = total 6 down to 4 physicians. Personally I am not for or against it, only indifferent. It lays to rest many Surgery Chart Memes and while it is somewhat unrealistic and will need some character retcons it is probably for the best in the long run.

[Roostercat]

Given gem's new PR, I am going to drop my opinion here.

 

Removal of the surgeon is a bad idea for multiple reasons. For one thing, everyone in medical having the same job now is going to be a trainwreck. We used to have four surgeon slots, and it always ended up with two surgeons actually using the ORs and the other two not doing anything. You can say "well they can just do GTR work then" but if we do that then we just have the exact same setup as we do now with way less flavour. Two ORs, two people for surgery. 

Having surgeons and Physicians as being distinct offers a lot more character growth, as most players do think about this distinction when making their medical char. Just blending everything together makes it all samey and boring. Nobody has their special thing, with physicians being great at general care and surgeons being great at, well ,surgery. 

Saying this gets rid of the chart is not a very great argument either because the chart nowadays boils down to physicians not being allowed to do anything with organs. That's it. If people cannot understand that, they should not be playing medical. 

Overall this change just takes away and doesn't really do anything for the game but make medical into a moshpit of six people fighting for the same job. It's a bad idea. -1

[MattAtlas]

7 minutes ago, Roostercat said:

We used to have four surgeon slots, and it always ended up with two surgeons actually using the ORs and the other two not doing anything. You can say "well they can just do GTR work then" but if we do that then we just have the exact same setup as we do now with way less flavour. Two ORs, two people for surgery. 

I don't think this point is very valid to be fair as people that wanted to do surgery used to intentionally pick the Surgeon alt title to do it, but with this change there would be an active expectation that you are a) not the sole surgeon b) expected to do GTR work as well and c) have no right to a monopoly of the ORs.

 

[Roostercat]

8 minutes ago, MattAtlas said:

I don't think this point is very valid to be fair as people that wanted to do surgery used to intentionally pick the Surgeon alt title to do it, but with this change there would be an active expectation that you are a) not the sole surgeon b) expected to do GTR work as well and c) have no right to a monopoly of the ORs.

 

This will just result in six slots fighting to do the same thing, or people going behind one another's back to take the patients. 

[KingOfThePing]

There are no six slots. There are only four now.

[Roostercat]

Then there are four people fighting for it, same issue

[Sparky_hotdog]

I'll drop my two cents on the issue.

As far as I can see, the surgeon/physician debate that has existed for as long as I've been active on Aurora (Now 2+ years) stems from a mechanical issue, no matter how much we talk about it as being an IC or RP issue. Fundamentally, the medical system as is doesn't have enough complexity to it to justify the level of stratification we have tried to have for so long. This isn't a complaint about the system btw, as while I've pondered how to change it to fix this issue, medical is already viewed by most (I believe) as one of the most complex departments, and it doesn't need to be any more so. But as it stands physician is just a jack of all trades role which offers very little to a department which thrives on niches. In my observation, there just aren't enough cases staying in the GTR/ICU to justify physician as is.

I'm not going to say that this is a perfect solution to the complaints of physician players, but we've spent the last 2 and a half years (Or however long it's been since the surgeon split) juggling permissions, access and surgery charts, with very little effect. Things are slightly better than it was when I started playing medical a year ago, but they're still a long way from being settled. And thus I think this is a valid attempt at trying a new approach. Maybe it won't work; That's what test merges are for.

1 hour ago, Roostercat said:

This will just result in six slots fighting to do the same thing, or people going behind one another's back to take the patients. 

On this note, I feel this is a rather cynical view of the department. I'd rather trust the player base to be respectful, rather than have an entire role dedicated to expecting the worst of people.

[Roostercat]

2 minutes ago, Sparky_hotdog said:

 

On this note, I feel this is a rather cynical view of the department. I'd rather trust the player base to be respectful, rather than have an entire role dedicated to expecting the worst of people.

it's not that I expect the worst of people, its that surgeons are there to do surgery, and physicians do general care. If you remove that boundary, now everyone does the same thing and people either have to butt in or get butted out. There's no lanes anymore. 

[MrGodZilla]

I strongly support removing surgeon. I'll explain why from a gameplay perspective.

There are three stages to treating someone in medical, First Response, General Care, and Surgery. Not all patients go through all three, but each medical role (First Responder, Physician, Surgeon) is theoretically meant to excel at their respective stage. Physicians, however, are in a weird grey zone because the stage they're meant to excel at is something that can be accomplished equally as well by all three of these roles. In contrast, first response is exclusively done and prepared for by first responders, and only surgeons can do the full spectrum of surgery, which they have dibs on anyway. This creates the situation where first responders will often do first response and general care followed by surgeons doing surgery if it's necessary. Physicians have to basically force themselves to fit in this equation.

One of the first solutions that come to mind is "why don't we limit the general care the first responders are capable of?" Firstly, there isn't really much general care that would make sense to remove from first responder qualifications. Most of general care is hooking up IVs, EPP, administering chemicals, using the body scanner and sleepers, ect. This is all stuff that a first responder absolutely should have in-universe knowledge of.

The second solution is "why don't we have a CMO establish that the first responder's job ends once the patient is in the GTR? At that point, the patient is in the physician's hands." Sure, I've seen a CMO try this before in the interests of everyone getting their share of medical gameplay, however, have you considered why first responders are inclined to do general care in the first place? It's because they establish first contact with wounded, they're the first to access the situation, how bad it is, and ultimately, what needs to be done. In a department where seconds are the difference between somebodies round getting ended, FRs do not always have the time to call out everything that's wrong with an inbound patient, nor do they have the time to explain it to a physician once that patient is in the GTR. That first responder knows what's going on, they've done field diagnostics and (hopefully) already started the process of stabilizing the patient. If we apply this solution, that patient gets thrown onto the physician, where we need to either spend time explaining to them what's wrong with the patient, or the physician has to spend time diagnosing the patient, seeing what the issue is, seeing what's already been done to stabilize them, ect, ect. That kind of delay wastes time and lowers the chance that a critical patient will survive. Beyond that, there are times where I just do not trust handing off patients, especially critical, to physicians, even more so if it's a new face and I haven't assessed how good at brainmed they are.

With that all in mind, there just simply is no room for a role that is meant to, at least theoretically, solely excel at general care. Physician is a role that, even in the presence of a just one surgeon, immediately depreciates in value because these two roles can do the exact same thing, but one is qualified to do a little bit more. If we axe the surgeon role, we'll have a good balance where First Responders will occupy the first response and half of the general care stage, and Physicians will occupy the other half of general care along with surgery.

As for slots fighting each other, some players like the GTR aspect of medical more, and some enjoy surgery more. Let people pick and choose, I highly doubt you're going to see actual fights over who gets to click on someone with 10 second delays for 5 minutes. If it really comes down to that, the physician who steps up and assigns themselves to assisting in general care of the patient should also do the patient's surgery, because, as I argued earlier, they weren't sitting in an OR waiting for a patient and a piece of paper to magically appear, they were actually assessing the patient and visualizing what needs to happen in advance for faster results. If this suggestion forces people who otherwise only wanted to do surgery and nothing else to actually learn brainmed, all the better.

 

TL;DR, Physician, as of now, has no room to work with. Having just FRs and Physicians establishes a perfect balance in duties. If there are slot wars, of which I've basically never seen in medical, people will just have to perform other aspects of medical whilst waiting their turn.

Edited August 17, 2022 by MrGodZilla