Doctors as changemakers
Career paths that can multiply your impact on the world’s biggest health problems
You went into medicine because you wanted to help people. But somewhere between the wards, the busy clinics, the long nights, and the relentless pace of training, a bigger question started to surface: am I actually making the difference I hoped to make? And, are there ways I could do more?
If you've found yourself asking these questions, you're not alone. Medicine is an important and impactful profession, in which you can have a profound effect in individuals’ lives. In spite of this, many doctors are looking for ways to have an outsized positive impact on the world’s big problems. We believe that medical training and experience provide unique positioning to achieve this. But finding that pathway to greater impact requires careful thinking about where, and how, to direct your skills and energy.
What do we mean by 'impact'?
Doctors get the incredible opportunity to help save and improve people’s lives. How many lives will you save as a doctor during your career working in the NHS (or another health system in a high income country) that would not have been saved without you there? That’s really difficult to calculate accurately, because:
Mortality data have only rarely been analysed to address this question,
It’s hard to separate your effect as an individual doctor from the efforts of the healthcare team that you work with, and
If you weren’t there as a doctor, there would almost certainly be another doctor there doing the work instead of you (but see below about countries with a shortage of doctors).
Taking all this into account, the average number of lives saved by an individual doctor during a career in the NHS is almost certainly less than a hundred, and may be less than 10, especially if you just consider the number of lives you are saving that wouldn’t have been saved if you’d been replaced by another doctor (see Gregory Lewis 2023 for a full discussion).
Doctors in clinical practice make a genuinely meaningful contribution to saving and improving lives. But if you are finding that the clinical career path is not a great fit for you, or if you seek to have much greater impact in saving and improving lives, there are many career paths through which you can potentially multiply your impact several times over. Some people have even found ways to save thousands of lives.
Where to start?
A good place to start is by identifying the pressing problems that need to be solved. A simple framework helps to identify some of the most promising opportunities for career impact:
Importance: How serious and large-scale is the problem? Diseases causing millions of deaths globally, or pandemic risks that could destabilise civilisation, rank higher than problems affecting smaller populations or patient groups.
Tractability: Can the problem actually be solved, or meaningfully reduced? Are there interventions that work?
Neglectedness: Is the problem already receiving sufficient attention and resources? If a problem is neglected, your contribution makes a bigger difference.
Applying this framework leads to some striking conclusions. For example, global health in low-income countries is vastly under-resourced relative to the burden of disease. Programmes providing insecticide-treated bed nets for malaria prevention, or vitamin A supplementation, save one life for approximately every £2,300-£3,800 ($3,000–$5,000) spent on the programme. Compare this to the health economists’ estimate that marginal NHS spending generates health gains at roughly £13,000–£30,000 per quality-adjusted life year (which roughly translates to hundreds of thousands of pounds to save a life).
Another example of a promising high impact field is biosecurity and pandemic preparedness. Organisations in this field work to detect, prevent, and manage biological threats - from naturally occurring pandemics to the risk of engineered pathogens. For example, Blueprint Biosecurity is a nonprofit aiming to prevent pandemics by guiding the development of technologies and policies to minimise the spread of airborne disease. The COVID-19 pandemic quickly showed how infectious disease can unravel economies and health systems, and fundamentally change billions of lives. Yet biosecurity remains deeply neglected by policymakers, funders and the medical and scientific communities.
Careers in clinical medicine have important value that should not be minimised. There are also career paths available to you that could multiply your impact many times over. There’s no guarantee of course - the elements of a successfully impactful career are inherently unpredictable - but your medical training is a great head start in many of these pathways.
Career Paths Worth Considering
If you want to pivot towards a high impact career addressing one of the world’s important, tractable and neglected health problems, there are many career paths from which to choose. You may want to stay in medicine with part of your time spent in clinical care, or to pivot out of medicine altogether, or to construct a portfolio career from several different part-time or freelance activities. Some examples are outlined below.
Academic research
Develop new knowledge to improve the prevention, diagnosis, treatment or outcomes of a disease.
Impact in a research career is unpredictable. The likelihood of significant impact is increased by relentless focus on relevant questions about diseases with high global burden or high level of future biosecurity risk, that receive disproportionately little funding.
Examples include studying cost-effective implementation of proven but underutilised treatments for common diseases with high mortality, mitigation of antimicrobial resistance, and improving pandemic preparedness.
Government policy
Shaping national and international policy frameworks that may affect millions of people, whether working in government, think tanks or with multilateral organisations like the World Health Organization.
Public Health
Focused on improving and protecting the health of the population, through preventative interventions, policy, environmental interventions, health promotion, and organised societal efforts rather than treating individual patients.
Roles in public health span academic research, designing and leading the implementation of health programmes, government advisory roles, health communications, etc.
Non-profit organisations (NPOs)
Bring a medic’s broad skill mix to work in, to lead, or to found health-focused NPOs.
NPOs that prioritise proven interventions, cost-effectiveness and target the right problems can prevent hundreds of thousands of cases of disease or death.
Founding a highly effective charity that successfully tackles an important and neglected problem is a highly impactful career path (e.g. see the work of the >50 charities incubated through the Charity Entrepreneurship Program).
Grant-making
Bring medical- and research-informed insights to evaluating programmes for funding by grant-making organisations (e.g. Wellcome Trust, Gates Foundation). The impact of these roles can be even higher in organisations that focus on evaluating the cost-effectiveness of charities, e.g GiveWell or Coefficient Giving.
Effective giving
Work in clinical medicine and donate a proportion of your salary each year - this can be highly impactful.
A salary > £45,000 ($60,000) annually puts your income in the top 1% globally. Doctors in high income countries may earn 2-4 (or more) times this threshold.
For example, a UK consultant earning £130,000 donating 10% of their income to highly effective charities can save an additional 4-5 lives each year through these donations alone.
Giving What We Can provides an easy-to-use platform to organise your effective giving.
Clinical practice in underserved regions
Each additional doctor has a much larger impact in a region with a doctor shortage. The counterfactual impact of a doctor in an underserved country can be 10x higher than in a high income country.
For example, the number of doctors per 100,000 population is 4 in Niger, 29 in Kenya, and 72 in Bangladesh, compared to 330 in the UK.
Practical next steps
It can be difficult to identify the best first steps to direct your career towards having a bigger impact on one of the world’s big health problems. Here are four concrete actions you can take, whatever your stage of training or career:
1. Invest time in career exploration
Deliberately explore your options before committing to a path.
Read widely, listen to podcasts featuring doctors who've taken non-traditional routes, and reflect honestly on where your skills and interests lie.
Sign up for an impact-focused career planning course or one-to-one advice, like those offered online by High Impact Medicine. This structured programme is designed specifically for doctors and medical students who want to increase their career impact.
2. Build your network
Join communities of like-minded doctors and students. From people in your local network and university groups, to regional, national and international organisations, there are many communities focused on global health, biosecurity and other impactful areas.
Reach out to experts and people who are following a path that interests you, to ask for a 20-minute “coffee chat” about your career. You’ll be surprised how willing people are to give advice, and how helpful that advice can be.
High Impact Medicine hosts a growing network across the UK and globally, sharing peer connections, information and occasional online events.
3. Test the water and build your skills
Volunteering, internships, student placements (e.g. electives or summer positions) provide direct experience in areas that interest you, grow your understanding of potential career paths, and build your skills, your CV and your network.
Identify the relevant gaps in your skills and training that are important for your future impactful career path. Do you need better data literacy and basic (or advanced) statistical competency, stronger writing or communication skills, or management and leadership skills? Do you need to understand global health, the policy cycle, or health economics more deeply?
Each career path has its own requirements. Through medical training, you acquire many transferable skills across the domains of, for example, the UK’s framework of Good Clinical Practice, Europe’s UEMS European Training Requirements, USA’s ACGME Milestones, and Canada’s CanMEDS. Make sure any educational courses in which you enrol add significant value beyond that level of medical training.
Many excellent online courses are available for free or at low cost. For deeper education, you may want to consider a Masters or (especially for academic career paths) a PhD. If so, explore the options very carefully to ensure your time and money are well spent - talk to current students, visit on open days, connect with faculty.
4. Apply strategically
If you’re directing your career within medicine to a more highly impactful role (e.g. as a clinician scientist, or into public health), ensure that the opportunities you are pursuing truly enable you to have a big impact. Remember that many research publications and reports remain unread and uncited - your impact arises from your daily decisions to stay on course, not just your job title.
If you’re pivoting to a career outside of medicine, use job boards that specialise in highly impactful roles and organisations in global health, biosecurity and other areas (e.g. job boards run by 80,000 Hours and Probably Good). Small organisations can often benefit from the broad skill-set that you bring from your medical background. If your dream job is with a larger organisation, applying initially to smaller ones can provide a good stepping stone to your goal.
The scale of what's possible
Dr. Donald Henderson used his medical training to lead the global eradication of smallpox — a campaign estimated to have saved between 150 and 200 million lives.
More recently, Dr. Paul Farmer founded Partners in Health, transforming access to care for millions of patients in some of the world's poorest countries. Dr Agnes Binagwaho helped rebuild Rwanda’s national health system after the genocide, leading reforms that dramatically improved access to HIV treatment, vaccination and maternal care for millions of people.
Right now, highly effective start-up charities are being led by young founders Dr Lucia Coulter (Lead Exposure Elimination Project) to prevent lead poisoning, Dr. Keyur Doolabh (Healthy Futures Global) to prevent deaths and disability from congenital syphilis, and Dr Jun Young (Charlie) Jeong (Clear Solutions) to prevent childhood deaths from acute diarrhea. Each of these charities already impacts thousands of lives.
These examples illustrate the extraordinary leverage available to a medic who thinks carefully about where to direct their energy.
You don't need to eradicate a disease to have an outsized impact. Helping to shape a public health policy, funding a life-saving intervention through strategic giving, or founding an organisation that prevents tens of thousands of cases of childhood disease — these are all within reach for motivated doctors and medical students who are willing to think outside the box about their careers.
Acknowledgements
This article is based on a previous document co-authored by High Impact Medicine and Probably Good. In producing this path profile, we were fortunate to receive help and feedback from a number of medics, medical students, and area experts. Not all views expressed in this profile are necessarily endorsed by any of them, and all mistakes are our own. For their help, we would like to thank Akhil Bansal, Bal Dhital, Elina Christian, Greg Lewis, Hunter Lau, Joe Pusey, Lucia Coulter and Peter McIntyre.