Back in the 2010s, EAs spent a long time dunking on doctors for not having such a high impact (I’m going off memory here, but I think “instead of becoming a doctor, why don’t you do X instead” was a common career pitch). I basically mostly unreflectively agreed with these opinions for a long time, and still think that doctors have less impact compared to stuff like x-risk reduction. But after having more personal experience dealing with the medical world (3 primary care doctors, ~10 specialist doctors, 2 psychiatrists, 2 naturopaths, 3 therapists, 2 nutritionists/dieticians, 2 coaching type people, all in the last 4 years (I counted some people under multiple categories)), I think a really agenty/knowledgeable/capable doctor or therapist can actually have a huge impact on the world (just going by intuition of how many even healthy-seeming people have a lot of health problems that bring down their productivity a lot, how crippling it is to have a mysterious health problem like mine, etc; I haven’t actually tried crunching numbers). I think such a person is not likely to look like a typical doctor working in a hospital system though… probably more like a writer/researcher who also happens to do consultations with people.
If I had to rewrite the EA pitch for people who wanted to become doctors it would be something like “First think very hard about why you want to become a doctor, and if what you want is not specific to working in healthcare then maybe consider [list of common EA cause areas]. If you really want to work in healthcare though, that’s great, but please consider becoming this weirder thing that’s not quite a doctor, where first you learn a bunch of rationality/math/programming and then you learn as much as you can about medical stuff and then try to help people.”
The model for dunking on doctors was something like: there is a limited number of doctor positions, so even if the hypothetical best doctor ever chooses a different career, it will not mean fewer doctors; it will just mean that the second best doctor will take their place instead. But the second best doctor ever is also a very good doctor, so the difference in the outcome will be very small.
Now, I am not sure if I remember the argument correctly. But if I do, it is obviously flawed. Because not only the previous job of doctor#1 is now taken by doctor#2, but also the previous job of doctor#2 is now taken by doctor#3, etc. Until we reach the hypothetical limit, and the previous job of doctor#N is now taken by a person who previously wouldn’t get the license, but now they will become doctor#N+1. So the overall change for the field of medicine is losing doctor#1 and getting doctor#N+1 (and shifting the remaining doctors). The difference between doctor#1 (the best doctor ever) and doctor#N+1 (who barely gets the license), multiplied by the length of their careers, could indeed mean a difference of many lives saved. It is just not really visible, because all those lives are not saved at the same place, but distributed along the chain.
The same reasoning also applies to the effective altruists, of course. It’s just, there is no guarantee that the hypothetical best doctor ever will become the most impactful effective altruist ever. They might as well become a mediocre one.
Back in the 2010s, EAs spent a long time dunking on doctors for not having such a high impact (I’m going off memory here, but I think “instead of becoming a doctor, why don’t you do X instead” was a common career pitch). I basically mostly unreflectively agreed with these opinions for a long time, and still think that doctors have less impact compared to stuff like x-risk reduction. But after having more personal experience dealing with the medical world (3 primary care doctors, ~10 specialist doctors, 2 psychiatrists, 2 naturopaths, 3 therapists, 2 nutritionists/dieticians, 2 coaching type people, all in the last 4 years (I counted some people under multiple categories)), I think a really agenty/knowledgeable/capable doctor or therapist can actually have a huge impact on the world (just going by intuition of how many even healthy-seeming people have a lot of health problems that bring down their productivity a lot, how crippling it is to have a mysterious health problem like mine, etc; I haven’t actually tried crunching numbers). I think such a person is not likely to look like a typical doctor working in a hospital system though… probably more like a writer/researcher who also happens to do consultations with people.
If I had to rewrite the EA pitch for people who wanted to become doctors it would be something like “First think very hard about why you want to become a doctor, and if what you want is not specific to working in healthcare then maybe consider [list of common EA cause areas]. If you really want to work in healthcare though, that’s great, but please consider becoming this weirder thing that’s not quite a doctor, where first you learn a bunch of rationality/math/programming and then you learn as much as you can about medical stuff and then try to help people.”
The model for dunking on doctors was something like: there is a limited number of doctor positions, so even if the hypothetical best doctor ever chooses a different career, it will not mean fewer doctors; it will just mean that the second best doctor will take their place instead. But the second best doctor ever is also a very good doctor, so the difference in the outcome will be very small.
Now, I am not sure if I remember the argument correctly. But if I do, it is obviously flawed. Because not only the previous job of doctor#1 is now taken by doctor#2, but also the previous job of doctor#2 is now taken by doctor#3, etc. Until we reach the hypothetical limit, and the previous job of doctor#N is now taken by a person who previously wouldn’t get the license, but now they will become doctor#N+1. So the overall change for the field of medicine is losing doctor#1 and getting doctor#N+1 (and shifting the remaining doctors). The difference between doctor#1 (the best doctor ever) and doctor#N+1 (who barely gets the license), multiplied by the length of their careers, could indeed mean a difference of many lives saved. It is just not really visible, because all those lives are not saved at the same place, but distributed along the chain.
The same reasoning also applies to the effective altruists, of course. It’s just, there is no guarantee that the hypothetical best doctor ever will become the most impactful effective altruist ever. They might as well become a mediocre one.