I have heard and have experienced that much of the PvE content is far too easy for seasoned players. With the advent of the Elite setting, complete with damage debuffs, the level of challenge was raised somewhat. Of course, the real reason to play Elite is for the extra rewards.
I would like to propose another layer of realism to the Trek universe, tied in to the Doff system, specifically for even greater rewards and a more rewarding gameplay experience.
When Elite is selected and you die in a PvE mission, the usual Critical, Major, or Minor debuff is inflicted as per usual. But to clear it, you must run a coinciding Doff mission. The time of the mission to complete, different for each debuff, should be in line with canon. Transporter malfunction might take 4 hours to repair. Plasma leak, 20 hours.
However, this system isn't to grief the players. It is to justify much greater rewards for completing missions in Elite. Everybody and their mother shouldn't be doing elite. Elite means elite, and the rewards should match. Double all of the current rewards to balance out this new realism. And of course, it is selectable, so you don't have to participate if you don't want the greater rewards.
Just a thought for some better realism in a game that drives me nuts that I can't experience spaceflight and bridge command FROM THE BRIDGE.
While it would certainly add some immersion, all that would probably happen would be that the encounters would be filled with people fielding ships with dozens of injuries, even more so than they're doing now...