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[Loud Whispers]

If you disable or reduce skill rust, then embarking with a well-rounded doctor is a good long-term investment. If you keep him alive until you start getting sieges and actual wounded patients, you can "burrow" him into the hospital to get fast treatment.

How is this done exactly? Skill rust is a very good reason not to start with a doctor. Those skills are likely to rust away anyway so why bother. In every fort I end up replacing the starting doctor because he eventually becomes a peasant. I'm not interested in injuring dwarves just for doctor practice.

Don't slate it till you try it.

[runhidesurvive]

i usally start with a doctor considering i always seem to lose a high master miner to collapses and my dwarfs seem to think "fun" is locking they're selves in rooms and dying of thirst and hunger

[Sutremaine]

How is this done exactly? Skill rust is a very good reason not to start with a doctor. Those skills are likely to rust away anyway so why bother. In every fort I end up replacing the starting doctor because he eventually becomes a peasant. I'm not interested in injuring dwarves just for doctor practice.

Don't slate it till you try it.

I think they'd like to know how... Here are the settings I use.

[SKILL_RATES:100:16:32:64]
[SKILL_RATE:DIAGNOSE:100:0:0:0]
[SKILL_RATE:SURGERY:100:0:0:0]
[SKILL_RATE:SUTURE:100:0:0:0]
[SKILL_RATE:DRESS_WOUNDS:100:0:0:0]
[SKILL_RATE:SET_BONE:100:0:0:0]

What this does is change the global skill gain / rust from the default 100:8:16:16 and then changes the medical skills specifically to 100:0:0:0. I also have strand extraction set to 200:0:0:0 and physical / mental attribute rust switched off.

[Nan]

Soap does not replace a legendary doctor. Or even a novice. Doctors > Soap by far.

Well, the soap is applied by dabbling doctors, I don't expect the soap to do the work all by itself . My experience with building nice hospitals, with a dedicated cistern, full supplies and doctors on call 24/7 (at least 3 doctors to prevent on-break breakdowns, bedrooms next to the hospital, possibly burrowed) is that injured dwarves quickly get up and walking again, even if treated by dabblers. I deliberately injure lots of dwarves, and I'm darn impressed how quickly and reliably my medical trainees have them back in the Very Dangerous Room (in fact I'm so impressed, I'll probably cease my doctor-training programs, your garden variety peasant seems to be just as effective a doctor as he would be a mason or cook)
With this in mind, investing points in doctors becomes extremely dubious. I mean yes, getting some immigrant bone doctor is nice and may as well put her to work, but why spend points on medical skills if it doesn't improve survival rates, which AFAICT it doesn't at all, and since recovery is fast even with dabbling doctors?

The other thing, is that "prevention is better than cure". At the moment all injuries are player-caused or highly preventable except those to military dwarves. There are no accidents, a mason wont crush his hand, a miner wont put his pick through his foot, a wood-cutter wont get hit by a widow-maker. And cave-in injuries are 100% preventable.
So when I figured out, the only reason I had a doctor was to treat my elite military, I figured it'd be smarter to have a military which is better at not getting injured. Prevention is after all, better than cure. So I replaced the starting doctor with a starting military dwarf with skills in Shield User, Armor User or Dodger, and a weapon skill since "the best defense is a good offense" (the quicker you kill the enemy, the less injury they can inflict).

So even if there's something I'm missing about medical skill, such as masterwork bones that are 2x superior to the original, I think that embarking with military skill (and putting it to work ASAP) is just plain smarter than embarking with medical skill.

[Psieye]

Every hauler does doctor work in my forts. When a siege has just lifted and the casualties are brought to beds, I give the haulers some time to get the medical work done before I start unforbidding the spoils of war. Some skills just aren't worth deliberately training up specialists for when 50+ dabblers can do the job faster than one legendary.

[Loud Whispers]

Nan, I agree, but going so far as to get rid of them completely means that one Titan syndrome, unlucky axe hit or long fall could kill your legendary axedwarf when a doctor could so easily save them. No doubts about it.

[Azure]

Use this model for a drop shaft to train medical dwarves.
Roof
Bridge (you'll want 4 deep 3 wide or longer so dwarves go onto the bridge instead of chilling outside the door.)
Open Space
Floor

Set up a squad for useless immigrants. Give them metal or better armor. Helmets and chest protection is a MUST. Your uneducated idiots will do a header or backflop once every 30 or 40 times. Have Nurse dwarves or the wounded can easily starve/dehydrate.

This method has a injury success rate of around 80% The wounds are then broken down into a broken bone or two and multiple shattered bones.

Safe Way:
Put (# of doctors -1 to 2) in the squad. Station them on the bridge and pull the lever. Check the injured for any remaining "smashed open" wounds before sending them back to the drop shaft. Doing this will get your non-disease susceptible dwarves a lifespan of 5-15+. Mine frequently make it over 7 years before infection will get them. And that's after near-constant injuries.  Use dwarves with increased healing and disease resistance traits.

Assembly Line:
If infection doesn't concern you, feel free to set the lever to repeat and add more dwarves to the squad. You'll lose maybe 1-2 a year once infections get set in but migrants will outweigh this pretty well. This is good for training a large staff. and keeping dwarf pop low. Use useless bastards. Put dwarves with quality traits into the recruit squads instead.

I haven't used a danger room for creating injuries instead of training but it sounds far riskier with far less injuries.

To the guy asking why training is needed:
  For skills like surgery, low skill causes a higher infection rate.
  Longer wait times for treatment means higher infection risk. Gotta love Urist Mc5000kills dying cause his stubbed toe wasn't treated in time.
  If your fighting something durable like a titan made out of steel or adamantium for months, the higher skills mean your hobos will get back to the fight that much sooner.
    I had an ambassador made out of slate arrive during a goblin siege before i had any kind of decent military. By the time we had high enough skills for lopping off limbs it had Legendary+5 dodge. A month and a half later, multiple dead dwarves, around 30 dwarves with broken bones in the hospital we excavated the barracks we were fighting it in and collapsed the roof on it. The survivors from the militia had all taken multiple trips to the hospital for treatment before getting back to it.

[Loud Whispers]

I'm just going to stick to ~2 level drops, I'm not going to give my useless immigrants metal armour D:<

(Unless you have a ton of tetrahedrite, in which case this is plausible.)

Alternatively, an 8~ drop onto animals will ensure the dwarf definitely does not die, as well as having wicked injuries.
[The dwarf has to land on the animals, or will asplode spektakulzay]

[khearn]

I'm just going to stick to ~2 level drops, I'm not going to give my useless immigrants metal armour D:<

(Unless you have a ton of tetrahedrite, in which case this is plausible.)

Alternatively, an 8~ drop onto animals will ensure the dwarf definitely does not die, as well as having wicked injuries.
[The dwarf has to land on the animals, or will asplode spektakulzay]

They still get injuries if they land on the animals? I thought they just got stunned. Or is this height dependent?

[Loud Whispers]

I'm just going to stick to ~2 level drops, I'm not going to give my useless immigrants metal armour D:<

(Unless you have a ton of tetrahedrite, in which case this is plausible.)

Alternatively, an 8~ drop onto animals will ensure the dwarf definitely does not die, as well as having wicked injuries.
[The dwarf has to land on the animals, or will asplode spektakulzay]

They still get injuries if they land on the animals? I thought they just got stunned. Or is this height dependent?

Height dependant, water also slows down falls somehow (not sure how the game mechanic works for that though).

[Jake]

I've always thought it was better to have a doctor and not need him than the other way around, even if I seldom need a medical dwarf until the first ambush; losing anyone in the first year or two is a pain, if only for the hassle of getting a coffin made and placed somewhere and the personal effects tidied away when you've only got a dozen dwarves and a to-do list a foot long.
I usually give mine a couple of points in fishing and leave him to get on with that until he's needed; he must be the world's happiest on-call GP.

[Loud Whispers]

I've always thought it was better to have a doctor and not need him than the other way around, even if I seldom need a medical dwarf until the first ambush; losing anyone in the first year or two is a pain, if only for the hassle of getting a coffin made and placed somewhere and the personal effects tidied away when you've only got a dozen dwarves and a to-do list a foot long.
I usually give mine a couple of points in fishing and leave him to get on with that until he's needed; he must be the world's happiest on-call GP.

When I'm feeling particularly mad, I give my chief medical dwarf legendary bedrooms, dining rooms, closets the size of my mayor's/equivalent bedroom, a farm tended by serfs and serf bedrooms, along with the actual hospital itself. Burrowed to his awesumz rooms, he's always prepared to conduct his work, and is always ecstatic £:

[khearn]

I'm just going to stick to ~2 level drops, I'm not going to give my useless immigrants metal armour D:<

(Unless you have a ton of tetrahedrite, in which case this is plausible.)

Alternatively, an 8~ drop onto animals will ensure the dwarf definitely does not die, as well as having wicked injuries.
[The dwarf has to land on the animals, or will asplode spektakulzay]

They still get injuries if they land on the animals? I thought they just got stunned. Or is this height dependent?

Height dependant, water also slows down falls somehow (not sure how the game mechanic works for that though).

What I've read (but not tested) about water is that water basically doesn't add to the fall height. So 5 levels of air and 5 levels of water does the same as 5 levels of just air, or 5 levels of air and 20 levels of water.

Hmmm, sounds like a good science project. I did a fort a while ago to test falling damage, this shouldn't be much different, I just need to arrange the test chamber so that I can fill it with the desired depth of water.

I'm finding that I have the most fun with DF when I'm doing science to figure out how things work. Forts without a science project tend to die from boredom.

[Nan]

I've always thought it was better to have a doctor and not need him than the other way around, even if I seldom need a medical dwarf until the first ambush;

The thing is, you don't need a doctor in order to treat a sick dwarf, you need a hospital in order to treat a sick dwarf. If you really want to invest points to medical stuff at embark, just bring spider silk thread and cloth, gypsum plaster bags, lye and logs. Butcher one of the pack animals, render the fat and turn it into soap - do this early on before you need it. Now if you get an injury before you've built a hospital, just assign a temporary hospital over his sick bed (throw down some coffers or bags) and assign a couple of dwarves to all medical skills (burrow them in the hospital, or turn off their other skills). Build a heap of buckets and a few splints and crutches. Your medical temps will successfully treat the injured dwarf.
Be warned; if you don't have soap for your hospital, a badly injured dwarf will probably die of infection. Keep it hygienic and survival rate will be dramatically improved.

[Loud Whispers]

I've always thought it was better to have a doctor and not need him than the other way around, even if I seldom need a medical dwarf until the first ambush;

The thing is, you don't need a doctor in order to treat a sick dwarf, you need a hospital in order to treat a sick dwarf. If you really want to invest points to medical stuff at embark, just bring spider silk thread and cloth, gypsum plaster bags, lye and logs. Butcher one of the pack animals, render the fat and turn it into soap - do this early on before you need it. Now if you get an injury before you've built a hospital, just assign a temporary hospital over his sick bed (throw down some coffers or bags) and assign a couple of dwarves to all medical skills (burrow them in the hospital, or turn off their other skills). Build a heap of buckets and a few splints and crutches. Your medical temps will successfully treat the injured dwarf.
Be warned; if you don't have soap for your hospital, a badly injured dwarf will probably die of infection. Keep it hygienic and survival rate will be dramatically improved.

I've not had a single Dwarf die in hospital yet and I'm proud of it. And most of the time soap wasn't even used/in production. Dwarves have a secret cleanliness value, frequent baths and soapy baths lowers the chance of death by infection.