What's a Doctor to Do?
By David Henderson
Over at Marginal Revolution, Tyler Cowen posted a question asked by a 3rd-year medical student who’s a regular reader of MR. Here’s the question:
I am a 3rd year medical student, and for the purposes of this question, let’s assume I have equal interest and ability in the various medical specialties. In order to create the greatest good for the greatest number of people through my work in medicine (i.e., the highest return to society), what specialty should I pursue? I should add that, although I intend to practice in the U.S., I am open to devoting as much of my free time/vacation as possible to pro bono medical activities, and further, that I wish to do the interventions myself (instead, for example, or just making lots of money and then donating the proceeds to some other charitable activity). In attempting to answer this question, I’ve been looking at DALYs and QALYs associated with various medical interventions (e.g., cataract surgery). Am I going about answering this question the right way? Any thoughts?
I thought Tyler gave a thoughtful answer. I won’t repeat it here because you can check for yourself.
A lot of commenters chimed in, of course. One who comments a lot on Tyler and whom I won’t name because I don’t want to encourage him, looked for the bad and, at least in his evaluation, found it.
But many other commenters had very thoughtful comments. Here were the three that I particularly liked:
1. You could help with the nurse to near-doctor pathway. That might be the best thing for social good if you can figure out how to scale that.
My [DRH] comment: Of course, whether this makes sense will depend on this particular person’s skills. But I agree with the commenter that the payoff could be huge.
2. If you actually wanted to do the most good, you’d simply become an orthopedic surgeon and donate your excess earnings to a givewell.org charity.
That doesn’t feel right, huh? That’s because altruism is suspect. You’re always serving yourself just under different timeframes and signalling patterns. It’s not that you want to do the most good per se, because nobody actually wants that. You probably want to see people benefit at your hands. There’s nothing wrong with that, but it’s important to acknowledge to properly assess what’s the best move for you.
You should try to figure out what it is about helping others that really drives you. Do you like exposure to danger, travelling to third world countries and the camaraderie of do-gooder doctors? Then maybe doctors without borders is for you. Do you like being in small town america helping Americans deal with debilitating obesity? Then maybe you should be a family doctor. Do you like a lab setting and quantitative analysis? Then research is probably right for you.
I think once you’re honest about the fact that you’re actual motivation is serving yourself, you’ll do a better job of serving yourself and the world.
DRH comment: I think the person making this comment could be a good career counsellor.
3. My GP does Doctors without Borders for a third of the year. So 1) she’s a GP which is the most needed kind of doctor in the US and 2) she does DWB which lets her do humanitarian work and travel. Plus, when I travel out of the country somewhere exotic she knows exactly what shots I need.
I’m really shocked only one other person has said general practice. You KNOW it’s what we need. It’s hard, it pays the least, and it’s the actual boots on the ground for people here and everywhere. You don’t even need to do DWB. Go set up a clinic in rural America if you want to do real aid work.
I would add one more thought. Given that the questioner reads MR regularly, he/she should apply some of the basics he/she has learned in economics and:
1. Oppose government regulation of medical care, including regulation of health insurance, restrictions on supply (licensure, CON laws, etc.), FDA restrictions that keep drugs off the market, etc.
2. Not become a nanny stater who tries to get the government to regulate our lives on sizes of soda bottles, packaging of cigarettes, etc.