That's a bit reaching.. they learn schooling/academics just to get the privilege to begin to develop their doctor skills. Plus, they already made a change to how fast medicine can be gained in one of the earlier beta patches along with leadership.
It is a reach, because how it is currently also doesn't match up with any RL analogy. So, if we go with that 'RL' thinking, maybe make the 'surgeon' role only available or more advantageous after a certain X# skills in medicine (say 50 for arguments sake), but not give a hard lock or prevent the other members from gaining XP just because you clicked one to be the surgeon. They already have a soft lock by way of their skill/attributes/focus points anyways. Doesn't take away the fact the end-perks are OP, but at least it's not a one or none option as it is currently.
The options are already available and viable. The difference is you want it so that any and all builds can become a superman build and that you don't have to specialize your builds. I like how it's setup now it limits the player and forces him to be strategic about what kind of build he wants in order to access certain perks. It makes sense and it's more realistic. Besides the player has every advantage in the game anyways. Medicine is only difficult for some to level because the game is absurdly easy. That's not medicines fault that's the games fault. If there are some skills that are actually hard to level then they should be fixed. Medicine just isn't one of them.
They did away with that with the ability to reset perks (which I'm fine with). I'm not looking to make a superman build - and the way they do have it set-up, the only way for the player to be 'superman' is if they don't enable death/aging.
Medicine is only 'hard' if you're good at the game (ie less casualties), but also, if you're good at the game, does that mean the only feasible means to get medicine to 275+ is by 'foolishly sacrificing' units?
Really, the main issue I have is, how amalgamated they made the whole skill/roles/perks system. The party roles should've been their own 'skill/growth path', where each level of progression opens up perks that actually pertain/applicable at each stage for said role. Likewise, with governors (/caravans). I mean, pull out all the 'governor' perks as they have in all the current categories, and you can just make that its own skill path, only gainable/usable by an assigned governor after X amount of time or XP or however else (building completion, quest resolved).
Moreover, when suggestions do emerge purporting to make the game more challenging what is being suggested is invariably just to make the game take longer to complete through increasing or introducing more grinding. The game just does not need to be stretched out further.
I think most of the issues is the lack of challenge, as it's not tuned/timed/scaled well. The very beginning can be, but you very easily slingshot right past many elements to the end (painting map one color) which is the exact same grindiness whether you have 2 towns or 4+.
We're advocating to either add more (they won't) or at least extend the early stages of the game so it makes even getting a foot into the late-game more 'rewarding'. Before they realize how very lacking the late-game is; but then one can choose to continue or not from there.
Exaggerated example but, imagine playing an MMORPG, but you get x5 exp boost so they speedtrack you to the late game but there is no late-game element (like most MMORPGs would or should have; or side content).