Joseph Pusey

Doctor @ National Health Service
188 karmaJoined Apr 2022Working (0-5 years)



I currently work as a doctor near Manchester, England. Right now, I'm working on completing my Foundation training and deciding what I want to do with the rest of my career. Possible candidates, outside of continuing in clinical medicine, are jobs in operations or research at EA-aligned Global Health and Wellbeing organisations, and I'm excited about opportunities in these fields.

I've been involved with EA through volunteering and working for One for the World, attending EAG 2022, the Cause Innovation Bootcamp, the Hi-Med fellowship, and (most importantly) my GWWC pledge to GiveDirectly. 

How others can help me

I'm looking for flexible, part-time opportunities to test my fit for research or operations roles in Global Health and Development. 


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Enormous +1 for FocusMate, which transformed my (limited) ability to do cognitive work and improved my mental health a bunch.

DOI: A doctor who sucks at research.

My answer to both of these questions is that doctoring has a fairly low ceiling in terms of how much impact one can have. 

The way that healthcare systems in the developed world work means that "making a diagnosis" is a fairly small part of the day-to-day work of what doctors do. Once a certain level of experience is reached, diagnostic ability probably plateaus; some doctors might be better than others, but even if they are the impact of that discrepancy probably isn't that great. I've never (disclaimer- not been practicing very long) seen a "House MD" type situation where someone is desperately unwell because no one can make a diagnosis until some rogue genius comes along. Ready access to sophisticated investigations and interventions mean that clinical reasoning in that traditional style is probably less important than it was in the past. 

You're quite right that the average biomedical researcher probably doesn't have a massive social impact; the difference is that it is possible to be 10x or 100x (1000x?) better at research than a colleague, in a way that it's not really possible to a 10x better doctor than the average. 

This leads to a much more "long tail" distribution of impact in biomedical research, where a few researchers have massive impact, some have significant impact, and many have little impact. Presumably, when effective altruists suggest that research is more impactful than clinical practice, they mean that a) you might end up in that small group of very impactful researchers and b) given that possibility, and the impact if you did, the "expected value" of becoming a researcher is higher than that of becoming a doctor. 

If you were asking to compare impact between the median researcher (minimal impact) and the median doctor, the impact might be much closer. 

+1 on Rory Stewart- as well as being the President of GD, he was the Secretary of State for International Development in the UK, has started and run his own charity (I believe with his wife) in the developing world, has mentioned EA previously, is known to be an enjoyable person to listen to (judging by the success of his podcast), and has just released a book- and therefore might be more likely than usual to engage with popular media.

I think I disagree with this quite strongly. As well as excellent posts (for example, by CE) that summarise information from lots of projects, I found this description of one individual's experience of starting a charity really useful. I don't think the author claims at any point that their conclusions apply universally, and I certainly didn't read it in that way.

I think the post you're asking for would be great but probably not practicable, particularly for someone who sounds like they have quite limited time; I'm grateful that they wrote this post rather than no post at all, and in general I hope that people are willing to write even broadly about their jobs rather than worrying that they have to give an exhaustive and highly nuanced account.

This is super exciting, interesting work. I'd love to know what kind of stuff already exists in this space because it seems such a great way forward I'm surprised that we aren't more aware of it.

Do you think this mapping tool was only possible because of the in-depth local knowledge of Uganda the two of you bring? Or is this something that you could scale to other countries? Or could be done by desk-based researchers elsewhere?

I have also done some NGO/charitable/public sector mapping in Uganda and just remember it being an absolute nightmare driving around trying to work out which places were still open, had ever existed, or were open to our user base. Huge props to you guys for doing this work and I'm interested to follow its progress when you start talking to other orgs :)

I couldn’t find any data on bean soaking habits in Uganda or Sub-Saharan Africa in general but I have heard anecdotally that it is common in some countries, perhaps Zimbabwe? (insider knowledge appreciated).

I happen to have a friend from Zimbabwe staying with me- he says that he is aware of people who soak their beans (his sister, for example), but that it's done pretty much purely for economic reasons and still not common- likely less than 10%.

As in, paying UK undergrads ~£50/hr (assuming they work 15 hours all year round, including in the very lengthy university holidays)? (!) Or am I missing something here?

This is a terrific distillation Akhil- very readable and it's updated me strongly on the scale and neglectedness of the problem. Is there any source you're aware of that explains the relative import of human, animal, and environmental overuse? I'd be interested to know the rough orders of magnitude of how much resistance they each contribute.

I agree with this, and I think this might be a case where the largest donors, median donors, and beneficiaries might have very different intuitions.

Agreed that this seems very possible. Who should we listen to most closely if it is the case?

Hi Michael. Thanks for your thoughtful comment.

You've highlighted an issue I agree with- that this is something of a grey area where one's personal position on complex moral issues can make a big difference to how effective you think this problem area might be.

I am not clear from your explanation on whether health impacts are talking about the effect on the mother or the effect on the stillborn child.

In the article, I'm defining the health impacts of a stillbirth as the years of health, or healthy life, lost to the child who is stillborn- this, as you point out, is very hard to define. Any health impacts on the mother (not related to economic or wellbeing impacts) were not described particularly fully in the readings I found, although there may be more research that I haven't seen; I suspect they would be hard to entangle from the health problems which may have contributed to, rather than caused, a stillbirth.

It seems to me that you have to accept one of these or the other.

If I was smarter, I'd have a better impression on where I fell on this issue. What I hope to point out in the article is that taking either position to an extreme results in a position that clashes with my, and I suspect many people's, moral intuition. Probably further thought on this is required by people who have more experience with time discounting/health economics/actuarial sciences than me.

If you are considering the effect on the stillborn child, it seems that you should consider increasing reproduction as approximately as good as decreasing stillbirths.

Presumably, some people do think this. I think for me to have a strong position on it I'd have to have strong positions on other, more fundamental moral questions that I haven't come to good answers for.

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