I’m a utilitarian contemplating a career change.  I currently give all my income to international development (which is possible because my husband supports us both financially).  I don’t have any special gift for science, etc. that would help save the world, so I think donations are the best way I can help.

I’m 26 and halfway through social work school.  I enjoy social work and am reasonably good at it, but the most I’ll ever earn is probably $80K/year.  I’m now thinking more about the moral imperative to earn more and thus give more.

Most high-earning careers are not ones I think I would enjoy.  That means I would be fighting burnout for the rest of my career.  (I'm open to suggestions if you think otherwise.)  The exception is psychiatry, which I do think I would enjoy and be moderately good at.  But I would need about nine years of school and residency to become a psychiatrist.

If I go to medical school and become an average psychiatrist, I’d double my expected lifetime earnings compared to social work (even after paying for school).  I could give about 2 million dollars more, which GiveWell thinks turns into about 2,500 lives saved.  No amount of inconvenience on my part compares with that many lives.

So what I want to do is figure out whether I could be productive as a psychiatrist or some other profession, or whether there’s a good reason I should stay on my current course.

Some considerations:

I’m fairly smart but not competitive-natured.  I think this would make me bad at a lot of careers that pay well but don’t require extra school, because there’s more competition for those jobs.

I’m not sure about my academic capabilities.  I haven’t taken a real science course since high school.  It’s also been a long time since I had to do the kind of rote memorization that I believe is needed in law or medical school.  I’m worried that I would get into one of these and then find I wasn’t up to the work.

I have no interest in chemistry.  Also, I don’t do well when sleep-deprived.  Both of these might make me a terrible med student.

I’ve had bouts of depression in the past, but never ones that crippled my ability to study/work.  If I were busier, they might cripple me more.

I would need at least a year of postbac science classes before I could go to medical school.  This would bring the time to become a psychiatrist to nine years, plus at least a year to apply.  That seems like forever, though I know when I’m older it won’t seem as long as it does now.

Investing that time in more school has an opportunity cost.  If I stick with social work, I could start donating again in one year.  If I become a psychiatrist, it would be more like twelve years before I could donate again.  I don’t know what effect that delay would have.  Psychiatry earnings would overtake social work earnings about 18 years from now.

I know I should count my useless undergraduate major and one year of social work school as sunk costs.  But adding a lot more school on top of the eighteen years I’ve already done feels exhausting, and I think I’m more likely to fail now than I would have been if I’d started planning earlier.

Medical school would mean nine years of giving up many of the things I enjoy – spending time with my husband, cooking, gardening, reading.  This gives me an incentive to burn out, because it would mean I could do those things again.

I’m married.  I don’t want to believe it applies to us, but statistically, me going to medical school would increase our risk of divorce.  This study says 51% of married psychiatry students divorce during or after medical school (about double our current statistical risk).  I don’t think my marriage is more important than 2,500 people’s lives. But I do think seeing it die would make me much worse at school.  Even if we didn’t actually divorce, I would expect our relationship to be significantly stressed because I would be gone or busy so much of the time. 

If I quit or fail out of medical school, I’ve wasted a lot of time and money.

If my coworkers are high earners, convincing any of them to donate effectively would have a larger impact than convincing social workers to do the same.  However, I’ve had zero luck persuading anyone I know (except my husband), so this may be irrelevant.

The questions

Do you have advice on powering through an unpleasant experience for a good cause?  Is nine years too long to power through?  Are there other careers I should be considering?

Update, May 2012: I decided not to try medical school, because I thought I would hate it.  I finished social work school and am looking for jobs in psychiatric social work, which I was doing this last year and really enjoyed.

New to LessWrong?

New Comment
29 comments, sorted by Click to highlight new comments since: Today at 12:41 PM

Hi Julia,

I have done a lot of research on this topic working with Giving What We Can and Existential Risk Career Network folks. Eventually it is going on highimpactcareers.org, but I would be happy to discuss things with you, including more detailed analysis of medical school, and some alternatives with especially high returns for folk looking at things in a consequentialist light (including entrepreneurship, politics, and foundation/government work). Just email myfirstname.mylastname@post.harvard.edu.

I don't know your mind, but I would predict that in the average person, determination to donate ~100% of earnings to a good cause will not persist for 18 years. If you think there's a pretty good chance that you'll end up changing your mind about that, might as well give the money now while you're still a perfect utilitarian (for which I admire you a huge amount, by the way) rather than give nothing for years and years and end up not giving anything at all.

I'm currently in my last year of medical school pursuing a career in psychiatry. If you have any questions on the process, feel free to ask me by PM or email (scott@shireroth.org).

The determination has persisted more or less since I was twelve, so I expect it to stick around. Thanks for the offer to talk.

I doubt that becoming a psychiatrist is the way for you to do the most good. Some thoughts:

  1. Influencing a single young utilitarian-inclined person to become a psychiatrist in the immediate future who would not otherwise have would have the same expected impact as you yourself becoming one. (The situation would be different if you had already gone through the schooling and were deciding whether or not to keep doing it or to do something else).

  2. I think (but am not sure) that there's plausibly enough low-hanging opportunity for utilitarian networking and activism so that you could have at least the impact described in the above point by focusing on networking and activism. I have some ideas about this; PM me for more if you'd like.

  3. As Carl Shulman alluded to, there's the possibility of working at a foundation moving more money than you would make for the rest of your life. I have little sense for what qualifications are required to get such a position, but I would guess that they'd be significantly less than what it would take to become a psychiatrist. On the other hand you wouldn't have arbitrary flexibility over where the money went and so couldn't use it optimally; so there's some sort of trade off that would need to be made.

  1. My observation is that when utilitarian types (including myself) consider going through an unpleasant experience for a good cause, they tend to massively underestimate the probability that they'll burn out and underestimate the severity of burnout. See the second and third paragraphs of Carl's comment here. I don't completely identify with the framing but (sadly) have found that in my own experience making large personal sacrifices massively undermines my (ordinarily high) utilitarian motivations. Things can get very ugly when this happens (in the sense that it destroys my self-image and leads to long periods of self-loathing during which I doubt whether I was ever a good person).

  2. When causes vary in effectiveness by orders of magnitude, it's almost always more important to pin down the correct cause than it is to maximize one's donated income. If job related stress were to lead you to miss the best cause by an order of magnitude then your effort would have been in vain.

You have my admiration for itemizing so meticulously.

Keep in mind that not only would a divorce increase the probability of burnout, it would also reduce your ability to give. You'd have to pay all the living expenses currently covered by your husband's salary, and it would be advisable to build up savings since relying on only one income you would be more vulnerable to unexpected events (job loss, illness, ect.). Marriage gives you the flexibility to donate all your income now; I think it's reasonable to value it highly even from a purely utilitarian perspective.

As her husband, I would rather she didn't have a utilitarian incentive to either stay married or divorce. I should probably figure out some set of promises about how I would spend money in the event of a divorce so that the expected impact is closer to neutral from a utilitarian viewpoint.

Sometimes I think our relationship has too much game theory in it. But this one is probably a good idea.

All relationships are full of game theory. Be happy you have one that's more honest about that than most.

I’m not sure about my academic capabilities.

This makes me think you might benefit from taking a single part-time class after work. It lets you get your feet wet and see how you like it. If you crash and burn on that, you know school isn't viable. If you do awesome and feel like you could have done work + 2 classes

You might also benefit from talking to people in the field, and see how far in to your training you'd need to be before you can "tag along" as an intern/apprentice/observer (I don't know if psychiatrists do this? I know nurses and dentists do) - Again, something that lets you get a more hands-on feel without the full commitment.

If you're still in the market for third alternatives, you could also look in to making a second income off of a hobby - freelance writing, code video games for the iPhone, etc.. There's a wide variety of options out there, and you can generally teach yourself the relevant skills.

Lastly, keep in mind that changing your mind is allowed. If you do a year of school and find your marriage fraying, your grades dropping, you can step back, treat it as a sunk cost, and walk away if you need to. It's not ideal, but it's probably a worthwhile risk given the potential gains.

tl;dr: Get an idea of what it's like via easy routes, ease yourself in. If it works, awesome. If it doesn't, you haven't lost as much. Be aware of burnout, and be aware of how BAD the looming burnout might be.


My situation is not dissimilar-- 28 years old and halfway through a second bachelor's in nursing, which now seems not optimal. I'm currently applying to PA schools.

MD programs are also an option I've considered, and though I'm a little older than you I already have all my prereqs done because my first degree was in biochemistry, so we'd probably be about the same age when we finished up. I'm mainly hesitant because, as you say, it takes for fucking ever, and I suspect I'm going to want to have babies less than ten years from now.

PM me if you want to talk more; we could bounce ideas off each other.

ETA: Consider giving yourself the opportunity to fail cheaply: see how you do with your science prereqs, take the MCAT, shadow a psychiatrist to see if you actually want to do that, etc.


You seem to be overestimating social worker salary quite a bit. Social work is one of the worst paying careers.

Payscale.com indicates salaries are $27k to $58k after acquiring 10 to 19 years of experience. More than 20 years of experience places the possibility of 80k you mentioned closer to your reach, but it's worth noting that becoming an MD will actually probably at least triple, and possibly quadruple or even quintuple your lifetime earnings, not double as you estimate.

Do you have advice on powering through an unpleasant experience for a good cause?

Keep pictures and bios of people whose lives you're saving in your wallet/purse/backpack, to refer to when you feel like giving up?

I like your thought process and where you're heading. Good luck.

Looking at glassdoor, the highest social work salaries are in the $90Ks and most are in the $35K-$60K range. Looking back, my estimate for psychiatry was low, so your point is probably still right.

The pictures are a good idea. I have some, but no where I see them all the time.

I sadly don't have any advice for you, but I do want to say that I find you inspiring.

This got me thinking about end of life planning. Should I strive to go into retirement with very little money left, having donated it all to charity, and so avoid the exhorbitant costs of life support at the end?

I don't see why that's necessary. Just write a living will that discusses what treatments you refuse (or the value you place on your final time), and possibly have a suicide mechanism in place in case you think people will force treatment onto you. If you have insurance and very few assets, lots of money could still be wasted on keeping you alive when you don't want to be, and so I don't see how having less assets helps with this plan.

Good on you!

My only comment is that learning things (particularly but definitely not limited to rote learning) is significantly easier with judicious use of spaced repetition software such as Anki.

If you're seriously considering becoming a psychiatrist & taking on 9 more years of education & training- there are a couple more things to consider. One is, do you plan to have children and how do they fit into that. The 2nd is, while you have the potential to earn much more money, you would first have to take on debt to pay for medical school. Also, you may have to relocate to attend medical school and a residency, which would have an impact on your marriage and husband's career. Boy do I sound like a traditionalist, but they are things to consider.

I think, though, it should come down to whether you really like social work. If you like it and you're good at it, you'll make a difference in your work and give away what you can. If you're not sure if you do, that's another issue and you should explore your options. The training you've had in grad. school could serve you well in psychiatry.

I did include med school debt in my figuring. Yes, relocating would make things a lot less pleasant for both of us. And the difficulty of fitting children into a really busy next decade makes me sad. But not 2,500 lives worth of sad.

I think even if I become a great social worker (I think I can become quite good, but not great), the impact of my work won't be as large as the impact of my earnings.

It sounds like you've pretty much made up your mind.

I'm clear that there are ways I can have more impact than by being only a social worker. I'm not as clear about which other option I should take - whether that's a non-social work career of some kind, or combining social work with other work (such as philanthropy outreach).

We need good, smart social workers- there's a shortage going into the profession. Please stick with it. If you want to focus on saving lives as a social worker, you can go into development, start new programs, expand existing programs.

I've been on the administrative side of agencies. I can tell you that 1- having good people makes a huge difference in what they accomplish and 2- while they might advertise that a $100 donation will pay for so many vaccines- it doesn't really mean that if you give $100 that many lives will be saved. It's not that simple. There is overhead, program planning. Getting a little more money isn't going to allow them to expand into another city to start giving vaccines to a new population and they aren't spending every dime they take in right away, they need to keep reserves on hand. In other words, you can't really know that you are saving all those lives by giving that much money. You will know what your impact is as a social worker, though. I'd be happy to talk to you more about social work, send me a message if you want to arrange a phone chat.

We need good, smart social workers - there's a shortage going into the profession.

That may be, but what opportunity cost is it worth?

I can tell you that 1- having good people makes a huge difference in what they accomplish

How huge? In order to make comparisons one needs quantitative data.

while they might advertise that a $100 donation will pay for so many vaccines- it doesn't really mean that if you give $100 that many lives will be saved. It's not that simple. There is overhead, program planning.

The $1000/life GiveWell cost-effectiveness calculations take this into account.

Getting a little more money isn't going to allow them to expand into another city to start giving vaccines to a new population and they aren't spending every dime they take in right away, they need to keep reserves on hand. In other words, you can't really know that you are saving all those lives by giving that much money. You will know what your impact is as a social worker, though.

Donating saves an expected life. Yes, one's donation probably won't result in an extra life saved but it has a small probability of tipping the balance toward allowing them to expand into another city which would result in lots of lives saved. See circular altruism.

I believe the $2M = 2500 lives saved number that julia is using comes from the givewell.org evaluation of village reach:


It's a pretty thorough review of the charity, and givewell understands that spending $100 on vaccinating N children does not mean N lives saved. They write:

"These assumptions yield an estimate of one additional child fully immunized for every ~$41 of VillageReach's expenses ... this would imply that VillageReach is averting a child death for every ~$545 it spends"

Julia's calculation appears to be using $800 per life saved, which is even more conservative.


If you have enough doubt in your mind that it even seems like a faintly good idea to ask for advice before setting out on this path... in my opinion, that constitutes strong evidence that it's the wrong path for you, and the best time to cancel is before you start.

Yes, I have major doubts. But with thousands of lives on the line, obviously I want to be really sure. Relying only on my own ideas has not always worked well, and I'm excited to have found a community of people who can think about this stuff beyond "Wow, that's really intense, I could never do that."

It seems to me that you have boxed yourself into thinking along the common career paths only.

It happens occasionally that I hear a person asking something along the lines of "I want to help humanity, and, in my estimation, is the one with the most potential to do so, how do I best learn it to start realizing my dream?" The occupation in question I hear about is usually physics, nanotech or something along those lines. My first question usually is "are you any good at it?". The answer, more often than not, is "I don't really like physics that much, but I'm willing to make a sacrifice to achieve my ultimate goal, so I will work hard".

At this point I have little choice but to rain on one's parade. If you are not naturally good at something, you can still do well enough to get maybe into top 10% (I'm being generous here) in the field through hard work and dedication only, while hating your life along the way. If you find what you are best at (better than anyone you know personally is a good starting measure), and put all this hard work in, you are much more likely to be in the top 1% or better, while having fun along the way.

My point is that being one of the best in any field gives you more leverage than being one of many in a specific field. Do you have an area where you naturally blow everyone else out of the water without even trying? If nothing comes to mind, maybe you need to look harder and think out of the proverbial box. For example, maybe you can be the best mother in the world and contribute to humanity through raising the best children possible. Or maybe you have a writing talent that you don't give the time of day because it is not likely to provide the income you want. Maybe you are an excellent sharpshooter, but are repulsed by the idea of aiming your gun at people and so discard the possibility of it being used for good, not evil. Maybe public speaking is what you are best at.

Here is one example: I know a person in a country with huge corruption issues who accidentally became a realtor and a really good one. Just by dealing honestly, against rather grim odds, she probably improved (and likely saved) more lives than she would have in any other career. And guess what, she now has the disposable income to donate to causes she likes.

So, what are you really really really good at? Because nothing else is worth considering.

I'm really good at homemaking. I don't think anyone believes that me being really good at that is worth 2,500 lives.

Well, I know next to nothing about homemaking, but a quick search shows that it transfers well to, say, organizational aspects of international relief and development agencies and NGOs. But I suspect you have already considered and rejected that option.