making of an MD, or Why I Think Bones was a Boy Genius ;)
Several commenters have asked for a brief primer to accompany No Dead End In Sight, on the process of acquiring an MD, Leonard McCoy's documented medical achievements in canon, his likely qualifications that would have been needed to make those achievements, and why those things don't add up without creative contortions. Hence, here is my rationale for my choices telling that story. Dates for McCoy's achievements are courtesy of Memory Alpha.*
Medical school, the foundation every doctor acquires before choosing a specialty, takes four years, and requires a four-year bachelor's as prerequisite, either in a formal "pre-med" program or other bachelor's degree including appropriate coursework in biology and chemistry. This is not, however, sufficient to be a practicing physician. A residency of at minimum a year for general practice, and 4-5 years for a surgeon or even 8 for a demanding subspecialty like neurosurgery or vascular surgery, is required before a doctor can be board-certified to practice in that area.
- Item: McCoy was leading a vaccination program on Dramia in 2251 (TAS) It's really, really highly unlikely he was doing this before he was licensed to practice medicine. If he was a standard admission at 18 and completed med school at 26, it would be 2253. Also, it's unlikely that he would be involved in a program like this without some sort of public health background, something that at THIS point anyway, there really isn't an established undergraduate degree program for. So he would have had to be doing it concurrently with his medical school background. Emory has a joint MD/Master's in public health, which would conveniently be a very useful skill set for a Federation starship's chief medical officer, who would in addition to having to manage a fair-sized community's health on board, would also be expected to provide assistance in the case of disaster/epidemics on worlds his ship is visiting.
- Item: McCoy has developed a brain grafting technique by 2253 (TOS/TNG canon). This is NOT something he could have gotten institutional support for or a go-ahead to practice on patients without being well into his residency; even at that it would require an AMAZING amount of documentation for A) his hospital's institutional review board, which evaluates 1)whether a proposed experimental treatment is safe and intellectually sound, and 2) the education materials for patients allow them or their representative to give proper informed consent that they understand the risks and benefits of the proposed treatment and their other options if they don't want to be in a trial, and B) a grant to fund the initial models not in humans. This is a peer-reviewed process and no matter how brilliant McCoy is, he'd have to demonstrate his experience, credentials and rationale VERY thoroughly before anyone would give him money to research it, let alone actually let him poke around in peoples' brains. I'm STILL stretching credibility by having him able to do this as a trauma surgeon (a 5 year residency), and he's probably partnering with an actual neurosurgeon (an 8 year residency) in order to get his technique reviewed.
-Item: Returning to the issue of McCoy's serving as Chief Medical Officer of the Enterprise--or more specifically, keeping that post once Jim Kirk has been formally made Captain--it seems really unlikely that the qualifications for that post wouldn't include at least a general surgeon's knowledge. He's specifically working with a peacekeeping force; it could reasonably be expected that there will be injuries requiring surgical intervention. Similarly, in exploration of unknown and possible hostile environments, injuries requiring rapid triage and stabilization would reasonably occur. While a starship the size of Enterprise would no doubt have several physicians on staff to cover potential need and be able to take care of day-to-day health issues, it seems reasonable to assume that the CMO would be the first in line to identify needed interventions and to be able to assess the appropriateness with which his staff deliver them. It seems logical to assume that it's a responsibility roughly equivalent to an ER (A&E for my Brits) chief attending. A trauma surgeon is a specialty roughly on the level of a general surgeon or cardiothoracic, containing elements of both and focusing on repair in an immediate crisis situation. McCoy's dossier at the movie site also mentions high marks in anatomic and forensic pathology: useful aptitudes for someone who is dealing with injuries by surgical intervention. This is a five-year residency in most programs; it's reasonable to conclude that he'd completed it before the events on board the Enterprise, and going back to the previous item, the neurosurgical grafting technique, it's very possible he'd in fact completed it by the time he enlisted. Which would make him (especially with the public health expertise) actually qualified to be someone's CMO upon his graduation from Academy to properly familiarize himself with the chain of command and structure he's working within.
-Item: organizing the astrophobic's conference--another useful skill set for a Chief Medical Officer, given that they'll be called upon to do personality testing and possibly assessing for PTSD/other mental health problems in his/her isolated community on at least an emergent basis until s/he can triage them to another more qualified practitioner, would be a basic knowledge of xenopsychology if not a full psychiatrist's certification. Doing this (canon per the movie site) could be construed as taking an active interest in managing his own issue to go into the black; it's also reason to suppose that he's fully aware of the potential problems and needs of other cadets and/or servicepeople.
Canon does not give any fixed dates for McCoy's academic achievements; he is established at Ole Miss for undergrad in the "mid-2240s" and having met/had a liason with Emony Dax in ST:DS9 (again, per Memory Alpha). It is also confirmed that he started medical school "in or before 2245" and was board-certified to practice medicine (no specialty noted at that time) by 2253. So it does not violate any terms of canon for McCoy to have had an accelerated academic career. It in fact makes a lot more sense that he did, unless the entire institution of medical school has changed beyond recognizability by 2245, when he would have entered college at the currently-standard 18. Always a possibility, but I think an unlikely one given how much broader the scope of medicine becomes with the introduction of more sentient species, that acquiring a medical degree would become LESS rigorous.
I have borrowed a little bit from the Pocket novels re: his friendship with the captain of the Manhattan and later the Lexington, Mark Rousseau (see listing at Memory Beta, although I had them meet at Ole Miss rather than in elementary school). The exact date of McCoy's father's death from pyrrhoneuritis is also not established in canon, other than at some time before he knew Jim and Spock well enough to talk to them about it; in TOS this is guessed to have been in the 2260s, but as it is not definitively fixed in time, I have used it as the catalyst that broke up his marriage. Joanna's date of birth is established in canon as 2249. Eleanora McCoy's death is not established in formal show canon, but per Memory Alpha there are canon references to Joanna staying with McCoy's aunt, which seems somewhat strange if his mother is still able to care for a child.
*Note: I am using TOS McCoy's achievements because AOS McCoy has been confirmed to have the same date of birth, and unlike James T. Kirk there are no official events given to suggest that his aptitudes and attitudes would be different than his TOS counterpart.
Medical school, the foundation every doctor acquires before choosing a specialty, takes four years, and requires a four-year bachelor's as prerequisite, either in a formal "pre-med" program or other bachelor's degree including appropriate coursework in biology and chemistry. This is not, however, sufficient to be a practicing physician. A residency of at minimum a year for general practice, and 4-5 years for a surgeon or even 8 for a demanding subspecialty like neurosurgery or vascular surgery, is required before a doctor can be board-certified to practice in that area.
- Item: McCoy was leading a vaccination program on Dramia in 2251 (TAS) It's really, really highly unlikely he was doing this before he was licensed to practice medicine. If he was a standard admission at 18 and completed med school at 26, it would be 2253. Also, it's unlikely that he would be involved in a program like this without some sort of public health background, something that at THIS point anyway, there really isn't an established undergraduate degree program for. So he would have had to be doing it concurrently with his medical school background. Emory has a joint MD/Master's in public health, which would conveniently be a very useful skill set for a Federation starship's chief medical officer, who would in addition to having to manage a fair-sized community's health on board, would also be expected to provide assistance in the case of disaster/epidemics on worlds his ship is visiting.
- Item: McCoy has developed a brain grafting technique by 2253 (TOS/TNG canon). This is NOT something he could have gotten institutional support for or a go-ahead to practice on patients without being well into his residency; even at that it would require an AMAZING amount of documentation for A) his hospital's institutional review board, which evaluates 1)whether a proposed experimental treatment is safe and intellectually sound, and 2) the education materials for patients allow them or their representative to give proper informed consent that they understand the risks and benefits of the proposed treatment and their other options if they don't want to be in a trial, and B) a grant to fund the initial models not in humans. This is a peer-reviewed process and no matter how brilliant McCoy is, he'd have to demonstrate his experience, credentials and rationale VERY thoroughly before anyone would give him money to research it, let alone actually let him poke around in peoples' brains. I'm STILL stretching credibility by having him able to do this as a trauma surgeon (a 5 year residency), and he's probably partnering with an actual neurosurgeon (an 8 year residency) in order to get his technique reviewed.
-Item: Returning to the issue of McCoy's serving as Chief Medical Officer of the Enterprise--or more specifically, keeping that post once Jim Kirk has been formally made Captain--it seems really unlikely that the qualifications for that post wouldn't include at least a general surgeon's knowledge. He's specifically working with a peacekeeping force; it could reasonably be expected that there will be injuries requiring surgical intervention. Similarly, in exploration of unknown and possible hostile environments, injuries requiring rapid triage and stabilization would reasonably occur. While a starship the size of Enterprise would no doubt have several physicians on staff to cover potential need and be able to take care of day-to-day health issues, it seems reasonable to assume that the CMO would be the first in line to identify needed interventions and to be able to assess the appropriateness with which his staff deliver them. It seems logical to assume that it's a responsibility roughly equivalent to an ER (A&E for my Brits) chief attending. A trauma surgeon is a specialty roughly on the level of a general surgeon or cardiothoracic, containing elements of both and focusing on repair in an immediate crisis situation. McCoy's dossier at the movie site also mentions high marks in anatomic and forensic pathology: useful aptitudes for someone who is dealing with injuries by surgical intervention. This is a five-year residency in most programs; it's reasonable to conclude that he'd completed it before the events on board the Enterprise, and going back to the previous item, the neurosurgical grafting technique, it's very possible he'd in fact completed it by the time he enlisted. Which would make him (especially with the public health expertise) actually qualified to be someone's CMO upon his graduation from Academy to properly familiarize himself with the chain of command and structure he's working within.
-Item: organizing the astrophobic's conference--another useful skill set for a Chief Medical Officer, given that they'll be called upon to do personality testing and possibly assessing for PTSD/other mental health problems in his/her isolated community on at least an emergent basis until s/he can triage them to another more qualified practitioner, would be a basic knowledge of xenopsychology if not a full psychiatrist's certification. Doing this (canon per the movie site) could be construed as taking an active interest in managing his own issue to go into the black; it's also reason to suppose that he's fully aware of the potential problems and needs of other cadets and/or servicepeople.
Canon does not give any fixed dates for McCoy's academic achievements; he is established at Ole Miss for undergrad in the "mid-2240s" and having met/had a liason with Emony Dax in ST:DS9 (again, per Memory Alpha). It is also confirmed that he started medical school "in or before 2245" and was board-certified to practice medicine (no specialty noted at that time) by 2253. So it does not violate any terms of canon for McCoy to have had an accelerated academic career. It in fact makes a lot more sense that he did, unless the entire institution of medical school has changed beyond recognizability by 2245, when he would have entered college at the currently-standard 18. Always a possibility, but I think an unlikely one given how much broader the scope of medicine becomes with the introduction of more sentient species, that acquiring a medical degree would become LESS rigorous.
I have borrowed a little bit from the Pocket novels re: his friendship with the captain of the Manhattan and later the Lexington, Mark Rousseau (see listing at Memory Beta, although I had them meet at Ole Miss rather than in elementary school). The exact date of McCoy's father's death from pyrrhoneuritis is also not established in canon, other than at some time before he knew Jim and Spock well enough to talk to them about it; in TOS this is guessed to have been in the 2260s, but as it is not definitively fixed in time, I have used it as the catalyst that broke up his marriage. Joanna's date of birth is established in canon as 2249. Eleanora McCoy's death is not established in formal show canon, but per Memory Alpha there are canon references to Joanna staying with McCoy's aunt, which seems somewhat strange if his mother is still able to care for a child.
*Note: I am using TOS McCoy's achievements because AOS McCoy has been confirmed to have the same date of birth, and unlike James T. Kirk there are no official events given to suggest that his aptitudes and attitudes would be different than his TOS counterpart.