Best residency for Mars

[diogotty]

Imagine you decide to go to Mars with the first wave of settlers, possibly for life.
You'll probably be one of very few physicians, if not the only one.
Which residency would you choose to make the greatest impact on your fellow settlers' life expectancy and quality of living?

IMO it would have to be something hands-on that no other physician would be able to talk you through remotely: I'm thinking General Surgery or Ortho.
Your thoughts?

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[FiveRivers]

Very interesting thread. Should we, the human species expand our borders beyond our planet, out of necessity or scientific advancement, the physician that will be most needed is the general internist. No matter where we as a society move, our basic medical problems,( ex. HTN, Diabetes, bacterial infection, ect.) are going to be the primary cause of morbidity and mortality. Physicians that have the expertise to treat these conditions, as well as more critical cases that may arise, will be most in need. Internists fit this description the best.
The settlers that would be the first to migrate (in this case Mars), will need to be able to receive medical treatment for these problems to ensure their evolutionary success, as well as to enable them to pass their genetic code to future offspring. Not only will this ensure the health of the initial group of settlers, but promote future expansion of the population as well.

 

[foo]

You forgot Psychiatry, anyone taking a one way trip to Mars is probably nuts....

 

[diogotty]

http://www.openminds.tv/nearly-100000-people-sign-up-to-go-to-mars-1011/

You both make interesting points.
I was actually going to suggest psychiatry. Because although the candidates will most likely be screened for all kinds of mental illness, if someone goes postal there it could have a huge impact in mortality and morbility So including a psychiatry to keep tabs on them might be a good idea.

I also realized it'd be a bad idea to rely on remote consulting for healthcare, as communications can go down, so IM or one of it's subspecialties is definitively a must.

I'm also curious if Mars lower G could translate in higher incidence of bone fractures (osteoporosis) and other musculoskeletal disorders in the long run, which could justify bringing an ortho surgeon

 

[thefritz]

Imagine you decide to go to Mars with the first wave of settlers, possibly for life.
You'll probably be one of very few physicians, if not the only one.
Which residency would you choose to make the greatest impact on your fellow settlers' life expectancy and quality of living?

IMO it would have to be something hands-on that no other physician would be able to talk you through remotely: I'm thinking General Surgery or Ortho.
Your thoughts?

I'm gunning for spacederm. Lots of skin cancer when you have no ozone layer.

 

[colbgw02]

Aerospace medicine. Duh.

 

[DeadCactus]

General surgeon. Easier to consult resources or use telemedicine for the cerebral aspects of medicine especially in a pre-screened, largely healthy population. Hard to learn to do an appendectomy on the fly...

Family medicine would be a close second.

 

[Paddington]

They'd have to specially train the guy. Prolly military FM background, but they have would have to make him get extra training with surgeons (getting real surgical experience) to handle basic traumas, long bone fractures, appys, etc., but maybe also train them to be medical lab scientists, like the Star Trek doctors who are always investigating stuff.

 

[gutonc]

Pathologist. Because they're all gonna die!

 

[Dral]

Emergency Med by a long shot.

 

[Arcan57]

Emergency Med by a long shot.

You'd think that but we're not terribly good at life-saving on a long-term basis without a hospital to back us up. We can stabilize them, but they wouldn't survive the transport back home for definitive care. Although I guess you could make the argument that surgeons aren't much good without anesthesia but I'm guessing the first wave to Mars would be mostly ASA 1 patients so you could probably just take a CRNA or cross-train the hell out of a medic.

It would also lead to some interesting/ugly scenarios since any operations that required significant transfusions would be a no-go so you may be looking at cases where the technical skill exists but not the resources to pull it off. Most ortho stuff would have to be closed reduction/immobilization since I doubt you'd be able to bring any significant volume of the more specialized equipment due to weight restrictions. In general an acute care surgeon is probably your best bet with some significant cross-training in OB/GYN. There would also need to be the recognization that you've got a decent chance of dying from things that are easily curable because of inadequate resources. Of course, you don't have to exit the atmosphere to have that experience.

 

[diogotty]

They can't take off from mars because of all the fuel they'd need to escape Mars' gravity, but it could be possible to have unmanned spaceships dropping supplies (but probably the cost'd be prohibitive)

Also don't forget the settlers'll be quite frail when they arrive to mars, after 6 months in 0 gravity.

 

[Law2Doc]

Given how long it takes to travel to mars at present (almost a year with negligible payload), even taking into account marked improvements in propulsion technology, any settlers will be quite old by the time they get there. So I'm thinking urology and other geriatric heavy specialties will be most needed.

 

[Silent Cool]

Imagine you decide to go to Mars with the first wave of settlers, possibly for life.
You'll probably be one of very few physicians, if not the only one.
Which residency would you choose to make the greatest impact on your fellow settlers' life expectancy and quality of living?

IMO it would have to be something hands-on that no other physician would be able to talk you through remotely: I'm thinking General Surgery or Ortho.
Your thoughts?

I would say dermatology or gynecology

 

[wholeheartedly]

Was also going to say psychiatry. Even they aren't crazy when they leave, they will be after being stuck there for awhile.


My second answer would be OB/Gyn..... cuz you're going to have a lot of bored people with not a whole lot to do...

 

[qxrt]

No matter where we as a society move, our basic medical problems,( ex. HTN, Diabetes, bacterial infection, ect.) are going to be the primary cause of morbidity and mortality. Physicians that have the expertise to treat these conditions, as well as more critical cases that may arise, will be most in need. Internists fit this description the best.

I doubt this. Moving to a different planet introduces a potentially sterile environment with a different gravitational field and atmosphere from Earth that would alter any potential infections and physiological pathologies we would see. Considering that physicians tend to use their experience and evidence-based medicine to decide on treatment and management plans, and all such data comes from Earth, I can see these factors potentially becoming marginalized in a setting that no one has seen before.

And why aren't radiologists on the poll?

 

[Law2Doc]

...

My second answer would be OB/Gyn..... cuz you're going to have a lot of bored people with not a whole lot to do...

not only that, but it's going to be logistically easier to transport fewer people and just have them reproduce when they get there rather than try to ship a whole colony.

 

[Law2Doc]

...
And why aren't radiologists on the poll?

they are just going to beam back the studies to India to read more cheaply.

 

[colbgw02]

Humans reproduced successfully for thousands of years before OB/GYNs existed. I would think they would be the last specialty to take.

 

[Dral]

Humans reproduced successfully for thousands of years before OB/GYNs existed. I would think they would be the last specialty to take.

I'm guessing there was also considerably more M&M related to pregnancy and childbirth during that time.

 

[colbgw02]

I'm guessing there was also considerably more M&M related to pregnancy and childbirth during that time.

I never asserted anything to the contrary, but you've done an excellent job of completely missing the point.

 

[thesauce]

Where's radonc?

 

[FiveRivers]

deleted post

 

[Law2Doc]

Humans reproduced successfully for thousands of years before OB/GYNs existed. I would think they would be the last specialty to take.

Actually if you are going to spend multimillions sending people to space to be fruitful and multiply, you aren't going to want too many of them to die in childbirth. The thousands of years of humans multiplying here only worked because for the many hundreds of thousands that died of complications, there were hundreds of millions of others successfully breeding. The cost of losing a percentage wasn't as big a deal because you weren't paying to bring each person to another planet.

 

[thesauce]

Actually if you are going to spend multimillions sending people to space to be fruitful and multiply, you aren't going to want too many of them to die in childbirth. The thousands of years of humans multiplying here only worked because for the many hundreds of thousands that died of complications, there were hundreds of millions of others successfully breeding. The cost of losing a percentage wasn't as big a deal because you weren't paying to bring each person to another planet.

Agreed.

Since family medicine is trained in Ob and other procedures, I would think they would be near the top.

Also, I think sports medicine should have been included as the colony will need support for their team at the Intergalactic Olympic Games (IOG).

 

[colbgw02]

Actually if you are going to spend multimillions sending people to space to be fruitful and multiply, you aren't going to want too many of them to die in childbirth. The thousands of years of humans multiplying here only worked because for the many hundreds of thousands that died of complications, there were hundreds of millions of others successfully breeding. The cost of losing a percentage wasn't as big a deal because you weren't paying to bring each person to another planet.

Le sigh. You're making an argument for why OBs would be helpful, not why they would be more helpful than another field. The goal isn't to preserve the life of every child-bearing woman, but rather to maximize the colony's survival. If only one physician is available, then it's silly to have that person's expertise involve 1) half the population and 2) an activity that is routinely accomplished successfully without modern medical intervention.

Agreed.

Since family medicine is trained in Ob and other procedures, I would think they would be near the top.

Also, I think sports medicine should have been included as the colony will need support for their team at the Intergalactic Olympic Games (IOG).

This guy gets it.

 

[deleted87716]

Mars needs PCPs.

 

[evilbooyaa]

If anyone seriously answers anything besides Family medicine (seriously) then we're all doomed. Who does boonies-style rural medicine now? Family Med (or EM if there's a hospital). What will medicine on mars be like? Boonies-style rural medicine x 100. A woman having a baby while her first child might have pneumonia and her husband needs a refill on his HTN meds? One doctor.

I really want to hear the rationale for a CT surgeon on Mars.

 

[Arcan57]

If anyone seriously answers anything besides Family medicine (seriously) then we're all doomed. Who does boonies-style rural medicine now? Family Med (or EM if there's a hospital). What will medicine on mars be like? Boonies-style rural medicine x 100. A woman having a baby while her first child might have pneumonia and her husband needs a refill on his HTN meds? One doctor.

I really want to hear the rationale for a CT surgeon on Mars.

If you were talking about one of those mythical FM programs were in 3 years you'd become competent in surgery, OB, as well as acute and chronic care then yeah FM wins hands down. In reality, it's a lot easier to cross-train a surgeon to do deliveries and c-sections and pick up some basic peds than to try and get someone competent in surgeon coming from another discipline. Let's not pretend that the chronic care and less-time sensitive cognitive skills couldn't be picked up off of Martian Google or telemedicine.

But in reality, any medical SPECIALTY would require extensive cross-training.

 

[notdeadyet]

not only that, but it's going to be logistically easier to transport fewer people and just have them reproduce when they get there rather than try to ship a whole colony.

Cue dueling banjos...

 

[CDI]

they are just going to beam back the studies to India to read more cheaply.

 

[sylvanthus]

Some of the combined residencies would be useful. Med-Peds, EM/FM, EM/IM, EM/IM/CC, etc.

But ya agree with Rural FM with OB.

 

[qxrt]

If anyone seriously answers anything besides Family medicine (seriously) then we're all doomed. Who does boonies-style rural medicine now? Family Med (or EM if there's a hospital). What will medicine on mars be like? Boonies-style rural medicine x 100. A woman having a baby while her first child might have pneumonia and her husband needs a refill on his HTN meds? One doctor.

I really want to hear the rationale for a CT surgeon on Mars.

Eh...I would more trust a surgeon to be able to manage my hypertension and diabetes than trust a family practice doc to perform an appendectomy on me. Plus, moving to a new frontier like Mars would increase the likelihood of trauma and other situations where surgery may be necessary. So, I vote general surgeon. Ideally, a general surgeon with a critical care fellowship. Best of all worlds.

 

[AStark]

I agree that you'd need at least a fully trained surgeon. Ideally, you'd have an internist, anesthetist, general surgeon, and pediatrician (assuming there were kids), all with critical care training (for cross-coverage), and probably a psychiatrist too. Of course, you'd also want a 4-bed ICU and some floor beds, along with the nursing staff to cover them.

On the other hand, it would make more sense to invent a new kind of "space" residency combining extensive training in acute and critical care medicine and surgery, lasting at least 6 years and possibly more. They can look up stuff otherwise, I'd think, for chronic care issues. I'm sure they'd have access to UpToDate and the Cochrane database on Mars.

 

[deleted87716]

it would make more sense to invent a new kind of "space" residency combining extensive training in acute and critical care medicine and surgery

Yep.

Of course, even a "space doctor" has limitations.

 

[diogotty]

Of course, even a "space doctor" has limitations.

Doctor Who will save them

 

[Dejavu]

None of those surgeons that people are talking about will be able to do anything without an anesthesiologist.

And for the OB answers, female scientists are too smart to have a baby without an epidural.

I'm just saying...

 

[CDI]

None of those surgeons that people are talking about will be able to do anything without an anesthesiologist.

And for the OB answers, female scientists are too smart to have a baby without an epidural.

I'm just saying...

Its not like you can file a lawsuit up there.

 

[Winged Scapula]

None of those surgeons that people are talking about will be able to do anything without an anesthesiologist.

And for the OB answers, female scientists are too smart to have a baby without an epidural.

I'm just saying...

True for many things but having personally done several cases with LA only (Appendectomy, mastectomy, inguinal and umbilical hernias, etc.), I'd say that's not necessarily true. After all, surgery predated the invention of anesthesia.

I'm just sayin'.

 

[AStark]

None of those surgeons that people are talking about will be able to do anything without an anesthesiologist.

And for the OB answers, female scientists are too smart to have a baby without an epidural.

I'm just saying...

My hypothetical space residency would include considerable training in anesthesia.

 

[deleted87716]

My hypothetical space residency would include considerable training in anesthesia.

Dr. McCoy knows a little something about anesthesia...

 

[Raryn]

True for many things but having personally done several cases with LA only (Appendectomy, mastectomy, inguinal and umbilical hernias, etc.), I'd say that's not necessarily true. After all, surgery predated the invention of anesthesia.

I'm just sayin'.

"Surgery" may have, but there's a reason my specialty is called "internal medicine". Prior to the inventions of anesthesia and aseptic technique, you guys only operated on "external" organs (amputations, wound closures).

 

[Winged Scapula]

"Surgery" may have, but there's a reason my specialty is called "internal medicine". Prior to the inventions of anesthesia and aseptic technique, you guys only operated on "external" organs (amputations, wound closures).

While there is no doubt that the work of Semmelweis, Lister, Young Simpson and Morton greatly advanced the practice of surgery, and that the majority of surgery prior to 1846 was amputation, mastectomy and other superficial structures, intrathoracic and intraabdominal procedures were performed.

The ancient Greeks were fairly adept at percutaneous procedures, as they were known to drain blood and pus from the chest as well as to perform paracentesis, trepanation and drainage of liver and renal abscesses.

True "internal" surgery:

1580s - first recorded C-Section in which mother and baby survived (there are earlier reports of uncertain authenticity)
1735 - first appendectomy
Late 1700s/early 1800s - first ORIF of fractures
1809 - first oophorectomy for tumor (first elective successful laparotomy)

There is quite a rich and fascinating history of medicine, including intraabdominal and intrathoracic surgery, which predates any use of asepsis, anesthesia, or medications. Success in such endeavors was rather poor, although this was the case for much of medicine.

 

[thesauce]

I think they found evidence of brain surgery on ancient Egyptian mummies too

 

[Winged Scapula]

I think they found evidence of brain surgery on ancient Egyptian mummies too

You are correct. I mentioned that only in passing in my post above because I was responding to the comment that "internal" (assumed to mean thoracic and abdominal) surgery didn't occur until after the recognition of sepsis and the advent of anesthesia. Those two events I ushered in the era of Modern Surgery but there is evidence of thousands of years of procedures we would recognize today as surgical in nature, even including intracavitary ones.

 

[soonereng]

My hypothetical space residency would include considerable training in anesthesia.

I think your space residency should be named...... Rocket Surgery!

 

[Raryn]

While there is no doubt that the work of Semmelweis, Lister, Young Simpson and Morton greatly advanced the practice of surgery, and that the majority of surgery prior to 1846 was amputation, mastectomy and other superficial structures, intrathoracic and intraabdominal procedures were performed.

The ancient Greeks were fairly adept at percutaneous procedures, as they were known to drain blood and pus from the chest as well as to perform paracentesis, trepanation and drainage of liver and renal abscesses.

True "internal" surgery:

1580s - first recorded C-Section in which mother and baby survived (there are earlier reports of uncertain authenticity)
1735 - first appendectomy
Late 1700s/early 1800s - first ORIF of fractures
1809 - first oophorectomy for tumor (first elective successful laparotomy)

There is quite a rich and fascinating history of medicine, including intraabdominal and intrathoracic surgery, which predates any use of asepsis, anesthesia, or medications. Success in such endeavors was rather poor, although this was the case for much of medicine.

You got me. There's a number of counterexamples to the general bit I referenced above.

(In my defense, I was mostly getting it from Atul Gawande's great piece in NEJM about the history of surgery, but that one also spoke mostly in generalities.)

 

[AStark]

Never mind the advent of modern surgery, my dad was telling me about an arrest he attended to in the OR when he was a resident 30 years ago. The anesthesia resident had intubated the esophagus, and at the time neither continuous end-tidal CO2 nor pulse oximetry were standards!!

But rocket surgery? Not exactly brain surgery.

 

[pgg]

You forgot Psychiatry, anyone taking a one way trip to Mars is probably nuts....

Robinson's Red/Blue/Green Mars series of books had a number of chapters from the point of view of the psychiatrist who went with them. His job was hard. Essentially every single one of the first 100 settlers lied and lied and lied about their motivation for going because to tell the truth would've disqualified them as crazy.

Emergency Med by a long shot.

I thought all EM docs did was drink coffee and consult surgery/ortho/IM/etc?

Given how long it takes to travel to mars at present (almost a year with negligible payload), even taking into account marked improvements in propulsion technology, any settlers will be quite old by the time they get there. So I'm thinking urology and other geriatric heavy specialties will be most needed.

Mars isn't that far. Depending on the launch window, it's only months with current conventional technology (no exotic stuff like nuclear or antimatter propulsion). A bigger issue is that the people we sent would probably be old to begin with, because young people aren't going to be accomplished enough, educated enough, experienced enough to make the cut.



Lots of surgeons in the 3rd world do their own anesthesia. Spinal anesthesia is particularly easy to learn. Surely on Mars, the finer points of doing it well and perfectly safely are negotiable. A couple cc of bupivacaine and a reusable spit-shined needle is about the cheapest and most compact anesthetic imaginable. Just make sure you don't need any surgery above T4-6 or so, give or take.

We anesthesiologists can go in the second wave, after the lounge is constructed and has sufficient radiation shielding.

 

[Dejavu]

Robinson's Red/Blue/Green Mars series of books had a number of chapters from the point of view of the psychiatrist who went with them. His job was hard. Essentially every single one of the first 100 settlers lied and lied and lied about their motivation for going because to tell the truth would've disqualified them as crazy.



I thought all EM docs did was drink coffee and consult surgery/ortho/IM/etc?



Mars isn't that far. Depending on the launch window, it's only months with current conventional technology (no exotic stuff like nuclear or antimatter propulsion). A bigger issue is that the people we sent would probably be old to begin with, because young people aren't going to be accomplished enough, educated enough, experienced enough to make the cut.



Lots of surgeons in the 3rd world do their own anesthesia. Spinal anesthesia is particularly easy to learn. Surely on Mars, the finer points of doing it well and perfectly safely are negotiable. A couple cc of bupivacaine and a reusable spit-shined needle is about the cheapest and most compact anesthetic imaginable. Just make sure you don't need any surgery above T4-6 or so, give or take.

We anesthesiologists can go in the second wave, after the lounge is constructed and has sufficient radiation shielding.

Will we have to bring the doughnut machine, or will it already be in the lounge?