This article draws heavily from 80,000 Hours (see their up-to-date entry here).

Introduction

It’s easy to feel like one person can’t make a difference. The world has so many big problems, and they often seem impossible to solve.

This is reminiscent of Esther who was tasked with to saving an entire nation. At first, she hesitated, feeling the weight of the risk, but she ultimately realised that she had been placed in her position by God “for such a time as this.” Her faith and unconventional approach saved the Jewish people.

Likewise we have learned at CFI that while many common ways to do good (such as becoming a doctor) have less impact than you might first think, others have allowed certain people to achieve an extraordinary impact.

In other words, like Esther, one person can make a difference — but you might have to do something a little unconventional.

How much impact do doctors have?

Many people who want to help others become doctors. Dr Greg Lewis, did exactly that. “I want to study medicine because of a desire I have to help others,” he wrote on his university application, “and so the chance of spending a career doing something worthwhile I can’t resist.”

How much difference does becoming a doctor really make? 80,000 Hours teamed up with Greg to find out.

Since a doctor’s primary purpose is to improve health, 80,000 Hours tried to figure out how much extra “health” one doctor actually adds to humanity. 80,000 Hours found that, over the course of their career, an average doctor in the UK will enable their patients to live about an extra combined 100 years of healthy life, either by extending their lifespans or by improving their overall health. There is, of course, a huge amount of uncertainty in this figure, but the real figure is unlikely to be more than 10 times higher.

Using a standard conversion rate (used by the World Bank, among other institutions) of 30 extra years of healthy life to one “life saved,” 100 years of healthy life is equivalent to about three lives saved. This is clearly a significant impact; however, it’s less of an impact than many people expect doctors to have over their entire career.

There are three main reasons this impact is lower than you might expect:

Researchers largely agree that medicine has only increased average life expectancy by a few years. Most gains in life expectancy over the last 100 years have instead occurred due to better nutrition, improved sanitation, increased wealth, and other factors.
Doctors are only one part of the medical system, which also relies on nurses and hospital staff, as well as overhead and equipment. The impact of medical interventions is shared between all of these elements.
Most importantly, there are already a lot of doctors in the developed world, so if you don’t become a doctor, someone else will be available to perform the most critical procedures. Additional doctors therefore only enable us to carry out procedures that deliver less significant and less certain results.

This last point is illustrated by the chart below, which compares the impact of doctors in different countries. The y-axis shows the amount of ill health in the population, measured in disability-adjusted life years (DALYs) per 100,000 people, where one DALY equals one year of life lost due to ill health. The x-axis shows the number of doctors per 100,000 people.

You can see that the curve goes nearly flat once you have more than 150 doctors per 100,000 people. After this point (which almost all developed countries meet), additional doctors only achieve a small impact on average.

So if you become a doctor in a rich country like the US or UK, you may well do more good than you would in many other jobs, and if you are an exceptional doctor, then you’ll have a bigger impact than these averages. But it probably won’t be a huge impact.

These findings motivated Greg to switch from clinical medicine into biosecurity, for reasons we’ll explain over the rest of the guide.

Who were the highest-impact people in history?

Despite this uninspiring statistic about how many lives a doctor saves, some doctors have had much more impact than this. Let’s look at some examples of the highest-impact careers in history, and see what we might learn from them. First, let’s turn to medical research.

By 1968, it had been shown that a solution of glucose and salt, administered via feeding tube or intravenous drip, could prevent death due to cholera. But millions of people were still dying every year from the disease. While working in a refugee camp on the border of Bangladesh and Burma, Dr David Nalin sought to turn this insight into a therapy that could be used in poor rural areas. He showed in a study that simply drinking a solution made at the right concentration and consumed at the right rate could be almost as effective as delivery via feeding tube or IV.

This meant the treatment could be delivered with no equipment, and using extremely cheap and widely available ingredients.

Since then, this astonishingly simple treatment has been used all over the world, and the annual rate of child deaths from diarrhoea has plummeted from around 5 million to 1.5 million. Researchers estimate that the therapy has saved over 50 million lives to date, mostly children’s.

If Dr Nalin had not been around, someone else would, no doubt, have discovered this treatment eventually. However, even if we imagine that he sped up the roll-out of the treatment by only five months, his work alone would have saved about 500,000 lives. This is a very approximate estimate, but it makes his impact more than 100,000 times greater than that of an ordinary doctor:

But even just within medical research, Dr Nalin is far from the most extreme example of a high-impact career. For example, one estimate puts Karl Landsteiner’s discovery of blood groups as saving tens of millions of lives by enabling transfusions.

The Unknown Soviet Lieutenant Colonel Who Saved Your Life

Or consider the story of Stanislav Petrov, a Lieutenant Colonel in the Soviet Army during the Cold War. In 1983, Petrov was on duty in a Soviet missile base when early warning systems apparently detected an incoming missile strike from the United States. Protocol dictated that the Soviets order a return strike.

But Petrov didn’t push the button. He reasoned that the number of missiles was too small to warrant a counterattack, thereby disobeying protocol.

If he had ordered a strike, there’s at least a reasonable chance hundreds of millions would have died. The two countries may have even ended up engaged in an all-out nuclear war, leading to billions of deaths and, potentially, the end of civilisation. If we’re being conservative, we might quantify his impact by saying he saved a billion lives. But that’s almost certainly an underestimate, because a nuclear war would also have devastated scientific, artistic, economic, and all other forms of progress, leading to a huge loss of life and wellbeing over the long run.

Yet even with the lower estimate, Petrov’s impact likely dwarfs that of Nalin and Landsteiner.

What do these differences in impact mean for your career?

We’ve seen that some careers have had huge positive effects, and some have vastly more than others.

Some component of this is due to luck — the people mentioned above were in the right place at the right time, giving them the opportunity to have an impact that they might not have otherwise received. You can’t guarantee you’ll make an important medical discovery.

But it wasn’t all luck: Landsteiner and Nalin chose to use their medical knowledge to solve some of the most harmful health problems of their day, and it was foreseeable that someone high up in the Soviet military might have the opportunity to have a large impact by preventing conflict during the Cold War.

So, what does this mean for you?

People often wonder how they can “make a difference,” but if some careers can result in thousands of times more impact than others, this isn’t the right question. Two different career options can both “make a difference,” but one could be dramatically better than the other.

Instead, the key question is: What are some of the best ways to make a difference? In other words, what can you do to give yourself a chance of having one of the highest-impact careers? Because the highest-impact careers achieve so much, a small increase in your chances means a great deal.

The examples above also show that the highest-impact paths might not be the most obvious ones. Being an officer in the Soviet military doesn’t sound like the best career for a would-be altruist, but Petrov probably did more good than our most celebrated leaders, not to mention our most talented doctors. Having a big impact might require doing something a little unconventional.

But first, let’s clarify what we mean by “making a difference.” We’ve been talking about lives saved so far, but that’s not the only way to do good in the world.

What does it mean to “make a difference”?

Everyone talks about “making a difference” or “changing the world” or “doing good,” but few ever define what they mean.

So here’s a definition. We define “impact” or “kingdom impact” as:

A concrete change that conforms with God’s redemptive plans to renew our fallen world.

Examples of impact:

Justice for the poor
Faith in God
Peace on Earth

Read more about impact and kingdom impact here.

Impact is not the only thing that matters

CFI’s stance is not that impact is all that matters. We discourage any paths for impact that require lying, neglecting key relationships, breaking God’s law, or refusing to honour God.

Some other considerations for whether actions are good besides expected impact include:

Virtue, intentions and honesty.
Family, including your spouse and parents, or others that you may have special obligations to.
God’s commandments and glory.

CFI focuses on providing information on the impactfulness of career choices because there is much less guidance available for this compared to other considerations. We aim to glorify God by seeking the greatest possible impact for His kingdom.

Read here for more about our framework.

Summing Up

Medical careers may not have as much impact as expected, but unique choices can lead to extraordinary outcomes.
Impactful careers arise from faith in God, timing, and proactive choices to address pressing issues.
Social impact measures how many lives are improved and the lasting benefits of those improvements.
Like Esther in the Bible, individuals can maximize their impact by seizing unique opportunities for change.

Need help discerning your career? Sign up for our free one-on-one impact mentorship here.

To read more about it click here.

Do you have any career uncertainties? Click here to read our article on three big career uncertainties you can trust God with.

Can One Person Make A Difference?