Do Helping Professions Help More?

A student told me the other day he wanted to be a doctor, so he could help people.  I thought, "What, as opposed to the rest of us who hurt people?"  Contrary to the smug self-righteousness assumptions of those in "helping" professions, like child care, teaching, counseling, or emergency services, it is far from obvious that these professions are any more helpful than the rest. 

Yes, if you choose to be a doctor, you will spend your time providing services that people perceive to have value, sometimes enormous value.   However, you cannot take full credit for this value:

  1. You charge a price for your services, so the help they receive is the difference between the value they gain and the price you charge.  The more you charge the less help is gained, and doctors charge a lot.
  2. If there are a fixed number of slots in medical school, you would just displace someone else.   You then have to ask how much better are your services than that person’s.  And beware of overconfidence. 
  3. If there are not a fixed number of slots, then by becoming a doctor you induce between zero and one more doctor’s worth of patients to be treated.   But these are marginal, not average, cases; these patients thought their case so mild that they were right on the borderline of not going to a doctor at all.   So you only get to take credit for the value these marginal patients get, not the average patient.
  4. Customers might overestimate the value they get from your services.  Yes, your colleagues might say that people tend to underestimate the value of your service, but they are probably biased.  In fact, the marginal patient seems to get zero health value from medical services.   
  5. Part of the value you provide may be relative social status.   By teaching, you might help some students look better to employers than others.   By doctoring, you may help some show they care about their family more than others.   If so, you are helping some by hurting others.  Shame on you. 
  6. You may really want a helping job so that you can feel and look morally superior to those in non-helping professions.  If so, you gain value at the expense of others who look worse; shame on you again.

By participating in a society we all help each other.   The amount you are paid is a (low) estimate of the value others place on your services.  This estimate may have biases, but beware of too quickly assuming you know what that bias is.

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  • Grant Gould

    The phrase “so I can help people” seems simply to mean, “so I can see the people I help.” Interpreted that way, it is natural that people go into medicine or teaching or what-have-you “so they can help people.” These are people willing to pay a (sometimes small, sometimes large) premium to come face-to-face with the people who avail themselves of their help.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Grant, do you think people would be just as likely to say they wanted to become cashiers, waiters, or janitors “so I can help people”?

    • Signify

      It is folly to respond to a 6-year old essay and comments. However, I do think that people in the positions you describe are in a better position to help people, make them feel welcome, safe, happy, than many in the “helping professions.”

      As you stated so long ago – the rest of us aren’t here to “hurt” people, are we? Everyone in every occupation who honors their work regardless of what it is, and, therefore, honors themselves, and honors others, is helping, and even healing. And, in my experience, most know it. (And, I have done most all these jobs – as real jobs – not a fantasy trip to “the other side).

      Unfortunately, it’s far easier to spot people in those professional occupations who both detest their job and rather seem to loathe human interaction, (at least with you), than stated “helping professionals.” And, they, at least, do not prescribe medication or order tests. How many destructive social workers, teachers, guidance counselors and the like, does one encounter? Quite a few.

      And volunteers. Save us from “volunteers.” Save us from their self-righteousness – those who are not humble enough and honest enough to know full well the huge benefits they derive from volunteering.

      We need to save ourselves from this dishonesty as well. We might better serve our time on the planet either staying away from public interaction where we have an iota of power, or serving by being happy doing something a ‘meaningless’ as — well, I can’t think of anything. But, (and I say this to myself), deluding oneself as to motivation, or thinking you are not serving humanity by not “serving humanity,” may be the great gift one can give.

      PS To Nick, who should be in residency by now — you don’t need to go off to third world countries to find that kind of service or population right here in the U.S.A.

  • Perry E. Metzger

    I suspect that many students who say they want to be doctors “so they can help people” do so because it is socially more acceptable to say that than “because I want a good career and being a lawyer seems boring to me”, or some such. “So I can help people” is a fine socially acceptable platitude — so much so that I suspect many people won’t admit their real reasons even to themselves.

  • http://jewishatheist.blogspot.com JewishAtheist

    You charge a price for your services, so the help they receive is the difference between the value they gain and the price you charge.

    Only an economist could say that. By your logic, making a depressed person non-depressed (say 6 doctor’s visits and $300 dollars of medicine) is worth less than a used car. Removing a tumor early, saving a child’s life, is worth less than a new one. In reality, monetary exchange simply does not capture all kinds of “value.”

    When all you have is a hammer, everything looks like a nail. More than any kind of academic, economists appear to be completely blind to everything which doesn’t translate perfectly into dollars and cents. Moreover, your religious faith in the market is absurd.

    Is breast augmentation really worth more than removing the child’s tumor? In dollars, yes. In any important sense of “worth,” of course not.

    Finally, many doctors purposely go into underpaid specialties, areas in which they will make less but help more, and/or volunteer a lot of their time for free.

  • Paul Gowder

    #3 increases the supply of doctors, which could either reduce #1 or lower the wait time (etc.) for infra-marginal procedures in addition to providing marginal procedures.

    #1 might be easy for doctors, but what about teachers? And as JewishAtheist aptly pointed out, medical services, like educational services, might have a worth that is qualitatively different from, and incommensurable with, money.

    Also, there are surely professions that are paid equivalently but are less helpful to others. For example, consider the profession of “dishonest advertising executive.” You’d agree, I assume, that an advertising executive who produces manipulative ads designed to induce irrational behavior (biases, even) causes a harm to the victims of those ads? Now compare that individual to a doctor.

  • http://profile.typekey.com/bayesian/ Peter McCluskey

    Robin, I agree with some of what you say, but several of your claims sound wrong.
    You say: “If there are not a fixed number of slots, then by becoming a doctor you induce between zero and one more doctor’s worth of patients to be treated.”
    I don’t think that’s the only possibility. Maybe existing doctors are overworked, and would be better off if he takes away some business from them, and he would provide more thoughtful and conveniently timed treatment to existing patients.
    You say: “By participating in a society we all help each other.”
    This sounds wildly optimistic. Mancur Olson (in Power and Prosperity) mentions a study that showed “only 8 percent of the East German workers were producing goods whose value in international markets covered even the variable costs of producing these products”. There are nontrivial numbers U.S. jobs for which I see no obvious forces causing them to be more productive than was the case in East Germany (e.g. jobs where employers face little competition and don’t have good measures of results). Olson cites the study as Akerlof, G., Rose, A., Yellin, J. and Hessinus, H., “East Germany in from the cold: the economic aftermath of currency union” Brookings Papers on Economic Activity 1:1-87 (1991).
    And for all I can tell, your student’s original statement might have been intended to communicate his skills rather than the value of an average person becoming a doctor.

  • http://www.hedweb.com/bgcharlton Bruce G Charlton

    This Robin Hanson guy must be treated with caution.

    This posting is like the ‘morgul knife’ in Lord of the Rings, whose tip breaks off and digs its way toward the heart – infecting the victim with a demoralizing chill.

    In the UK we call the ‘helping’ professions the ‘caring’ professions – which is even worse (because implying that other kinds of people ‘don’t care’).

    As a (now non-practicing) MD, I recognize the phenomenon described here. I also recognize exactly the kind of self-deception RH describes, and the egotism of being deferred-to as a helper/ carer.

  • Madrone

    Re: JewishAtheist,

    You are not factoring in the full economic benefits of things like removing a childs tumor, only the cost for the patient to do so.

    If removing a childs tumor enables that child to succeed in life, live longer, have a life etc, than that value is very much compared to not removing the tumor, and either dying, or living a life with increased medical costs, and decreased opportunities.

    Often doctors do procedures that will have immense benefits for the patient, these would hence be very “helpful” but for procedures where the cost is a similiar, or more then the actual benefit, then the economic value of the help is closer or less then zero.

    At least thats how I understood the point

  • Lee

    “Helping” people in the last six months of their lives is how doctors help the transfer of wealth from heirs to helpers.

  • http://economicliberty.net/ liberty

    I think it was a joke, but you cannot use the marginal case as a literal measure of value for the next doctor. Obviously, if I become a doctor today, I won’t spend the rest of my career seeing only the patients that would not have bothered to go to a doctor except that I joined the ranks. Even if I am an “extra” doctor, because there was an equilibrium before (and that would be ignoring the steady need for new doctors to replace those who retire, die and so forth and would ignore the fact that I am part of the equilibrium, reponding to demand, not surplus supply) this would only change the total supply by a small margin meaning that the percent of patients in total who are seeing a doctor even though they only marginally require one will hardly shift at all due to the additional supply. Hence, I will be as “useful” a doctor as those that currently practice.

  • jp

    Lee — GREAT comment!

  • http://www.janegalt.net Jane Galt

    Surely we can recognize that there are “non-helping” professions: violent criminals, for example, or class action lawyers; telemarketers for sure. A desire to help people is a perfectly legitimate reason to avoid these professions in favour of medicine.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Jane, I don’t think people are bragging about not being violent criminals when they say they pick a helping profession.

    Liberty, the question is your effect on total care, not who exactly you care for.

    JewishA, I didn’t say that price equals value.

    Paul, yes there is a supply price effect, but I don’t follow your “incommensurable” comment. We can agree a dishonest ad exec isn’t as helpful, just as a dishonest surgeon is not as helpful.

    Peter, yes, there might be an effect on average workload. This isn’t E. Germany.

  • http://www.inferiorgood.blogspot.com Whit Stevens

    JewishAtheist:

    Mr. Hanson is not arguing that the price of a service is equal to the value of the service (it seems to me that’s how you understood him). Rather, he is saying that the benefit of a service is equal to the difference between the price charged and the value received.

    You state: “By your logic, making a depressed person non-depressed (say 6 doctor’s visits and $300 dollars of medicine) is worth less than a used car.”

    Mr. Hanson makes no such value judgment, he simply explains how such a judgment would be calculated. To see which service is more valuable, you’d need to compare a) the difference between the value derived from becoming “non-depressed” and $300 with b) the difference between value derived from owning a used car and the cost of said used car.

    Let’s say the value of becoming “nondepressed” for a given patient is $30,000. Then $30,000 – $300 gives us a benefit of $27,000.

    Let’s say the value of a given used car to a given customer is $350. If that customer paid 300 for the car, then the benefit provided by the car salesperson would be $50.

    In my arbitrary example, the doctor has provided more benefit than the car salesperson, even though the doctor charged the same as the used car salesperson. Certainly, the situation could be reversed. It’s possible to get a really, really good deal on a used car. It’s also possible to have such mild depression that becoming “non-depressed” doesn’t really provide all that much value to a given person.

    The point is that value provided needs to be compared with the price charged for that value. And in Mr. Hanson’s opinion, doctors don’t necessarily provide more benefit per $ charged than other occupations.

  • http://economicliberty.net/ liberty

    “Liberty, the question is your effect on total care, not who exactly you care for.”

    Sure, but that doesn’t change the outcome. It would have to be a zero sum society for my effect on total care to only affect the marginal cases. People would not be able to change their behavior in terms of having children due to more readily available childcare; new medicines would have to not be created though demand has risen for them now that health has improved; you’d have to believe that now that there is no way to change or improve medical care or increase real demand (as opposed to marginally necessary demand) now that medical care is cheaper due to greater supply. Sorry, I don’t buy it.

  • http://www.sparkgrass.com Garrett

    At least he didn’t say, “I want to be an economist, so I can belittle professional workers with my ninja math skills.”

  • Scoop

    Point three doesn’t quite hold. It is true that no seriously ill patients would go untreated if any one doctor had never gone into medicine, but you cannot automatically assign any given doctor’s worth as the marginal value of the last doctor because any given doctor can devise a revolutionary life saving procedure — one that would otherwise go undiscovered. Most doctors, obviously, will never do anything like this, but you cannot identify the superstars in advance.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Scoop, yes you can also take credit for the innovation that an average person is expected to produce. That is a gain for the field you choose, and a loss for the fields you did not choose.

  • Ben M

    From the would-be doctor’s perspective, the “I want to help people” statement is equivalent to “I think I’ll provide service more valuable than what I charge”. They view themselves as getting paid “market rate” for their time, their overhead costs, and some sort of baseline level of workmanlike service. Then they view themselves, perhaps without economic justification, as giving “something extra”.

    First, they view the “improvement in the patient’s lives” as an un-paid-for boon to society—there is a mixture of truth and untruth to this idea. Consider an imaginary back-pain-alleviating procedure that costs $1000. People at different income and activity levels will value this procedure differently; a low-income desk-worker might be willing to pay $500, while a low-income manual laborer might be willing to pay $1000; a rich marathon runner would value it at $50,000. Now, who shows up at the doctor’s office? The laborer and the marathoner. The laborer gets what he paid for. The marathoner walks away with $49,000 worth of unpaid-for quality-of-life, and profusely thanks the doctor. That’s when the doctor feels like he or she is “helping people”. (The doctor never meets the desk-worker fellow on the other end of the demand curve, and doesn’t feel guilty about *refusing* to give this person $500 worth of free services … ) Now, in principle this is true for all fixed-price, variable-utility goods—isn’t a cereal manufacturer “helping people” when they sell a $4 box of cereal to someone who values it at $10? Well, yes, but I suspect that the cereal price/demand curve drops off pretty fast. For lifesaving medical care, the demand probably remains high even when the price approaches peoples’ entire net worth. So that’s the “so I can see the people I help” thing, although it doesn’t stand up to the I-displace-another-equivalent-doctor logic.

    Anyway, that’s probably a roundabout way of stating some simple Econ 101 principle, but I’ve never taken Econ 101. Perhaps it’s as simple as “Medical care is not priced either a) to maximize revenue or b) to clear the market, but rather on a cost-plus basis”.

    On another side, probably entirely correctly, doctors view their *bedside manner* and sympathy as pure benevolence. This is probably pretty much true in medicine—I’ve never heard of friendlier doctors commanding different insurance payouts, so being kind to your patients is economically selfless but tremendously valuable. (Except in the ultra-rude case where you drive away patients and can’t fill your appointment book. Certainly it has a “payoff” in terms of making the doctor feel good, but this is true of most normal kindness, so let’s leave it at that.) The same is probably *not* true of, e.g., baristas, wait staff, or hairdressers, who might view banter-and-a-friendly-ear as a paid-for element of their service. It is probably true for, e.g., beat cops, or postal workers, or flight attendants, whose pay and advancement may not be affected by rudeness or politeness; for them, friendliness, if delivered, is delivered for free. Is the doctor’s sympathy *particularly* valuable, more so than that of the bartender or hairdresser? If so (and I believe it), “I want to help people” is entirely true in the sense of “I want to be in a position where my sympathy, though always free, is of maximum utility”; this is a boon to society even at the margin, since it’s a value which is created when a sympathetic person chooses medicine (sympathy delivered often and to great effect) rather than cereal-marketing (sympathy dashed on the bleak walls of a cubicle), and when a sympathetic doctor displaces a non-sympathetic doctor at the same price.

  • Ben M

    Aha, Whit Stevens addressed my point while I wasn’t watching. The car/medicine/cereal distinction (I think) comes down to: take the function N(p), the number of consumers who gain value p from a given service. For a product priced at p0, the integral of N(p)*(p – p0) dp, from p0 to infinity, gives the extra value of the service. Evaluate this function for all professions, and the one with the highest value is the one that helps people the most! Voila!

    Evaluating the function is left as an exercise for the reader. (It’s not implausible that doctors win on this measure, Robin.)

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Ben M, as far as banter goes, I’d have to say that doctor banter is among the least valuable banter I get. Same for sympathy.

  • http://www.hedweb.com/bgcharlton Bruce G Charlton

    Robin –

    If you are correct, and the helping-profession-tag self- and other-respect draws people into medicine, then wouldn’t this tend to depress wages? (Because people are being paid partly in non monetary ways).

    We would not see the full effect due to restrictions on licensing, but shouldn’t there still be an observable effect – maybe there is?

  • http://www.nicademia.blogspot.com/ Nick

    Some thoughts from a med student.

    I have recognized from day one that the answer “because I want to help people.” to the question “why be a doctor?” is insufficient. In fact, most medschools would agree; you get asked that question about a billion times while applying and a lame answer like that would get you a quick denial letter, not much else. As some have pointed out, simply being a doctor does nothing but displace someone else. Charging for all services rendered makes a physican no different than any other service provider.

    However, perhaps being a physician makes it *easier* to help people. There are tons of things a physican can do, from working in free clinics on the weekends to travelling to 3rd world countries to help out (those are two of the best things I’ve seen). When a physician does these things, in my eyes they have moved from a service provider to being someone that truely “helps people”.

    My definition of “helping people” is engaging in action that benefits others at a cost to self. As we are all interested in economics apparently, we might also consider that there is the factor of efficiency at stake. I’ll make up a simple term right now: a “coefficient of altruism”. This would be defined as the amount of benefit one can confer to others divided by the cost to self. The higher the coefficient, the more productive the altruistic act. A person genuinely concerned with helping others would obviously be very concerned that they are being most efficient with their charity…

    It goes that anyone can “help others”, but it isn’t always terribly efficient. For example, a lawyer could go out and work at a soup kitchen on a Saturday morning. This action does confer benefits to others, but relative to the cost to the lawyer the net coefficient is probably less than 1 (speaking from a dollar standpoint). In other words the lawyer would be better off just working and donating the money, at which point the coefficient is equal to 1. Maybe (pay attention to point one, coming up).

    Physicians are in a unique position because their potential altruistic coefficient is extremely high. Consider a physician who works at a free clinic on a Saturday morning and examines dozens of people that lack health insurance. The net benefit to others is potentially tens, maybe hundreds of thousands of dollars, while only costing a few hours of the physician’s time. This high coefficient mainly comes from three factors:

    1. Simply working more hours and donating the extra money to charities is inherently less efficient for a physician because a physician can already contribute directly, whereas an average person who contributes to charities must also fund the charity infrastructure, employees, and god forbid corruption. Even then, not all charities are good ones; some are quite ineffective in their overall mission, whatever that might be.

    2. A physician can see more patients at a free clinic per hour than would be possible in a regular clinic. I will concede that this is a debatable point, since quality of care might go down slightly; still, I dont think it would drop below sufficient levels to get the job done. After all, a paying customer is going to demand to sit and chat with the physician and will have extra paperwork regarding insurance, et cetera than a nonpaying customer at a free clinic. Thus the coefficient of altruism for a physician goes up.

    3. This is the most important point. Preventative care; in other words catching something early, is by far cheaper than it would be for last minute care. In other words, if the patient sees nobody until its time to go to the ER because their leg is falling off, its going to cost a lot more than a couple pills of cephalosporin would have. Incidentally, this is a pretty good reason to make sure everyone has health insurance, but thats another issue entirely…

    Or what of going to Africa and treating a child who might survive to adulthood, to one day do something great? You can’t put a price on something like that; the cost to the physician might only be a few thousand dollars, however. The final thing about being a doctor is that the transition to altruism might be easier and more natural, since so many social and health problems are part of the physician’s everyday experience.

    It would be a complete mistake, of course, to suggest that only physicians are capable of helping others in an efficient way. After all, if businessmen like Bill Gates or Warren Buffet had become physicians, we’d be a lot worse off today! Anyone can do great good in the world, no matter what field they are in. It’s always going to take dedication, creativity, and a sense of obligation. Traits that seem to be a rarity in all fields, medicine included….

  • paco mcdooby

    jp says: Surely we can recognize that there are “non-helping” professions…class action lawyers; telemarketers for sure.

    That’s a terribly foolish comment. Both provide services that people are willing and able to pay for. Example: Class action lawyers (among other things) mitigate the incentives large orgnaizations, for instance, have to screw lots of people by small amounts.

  • Bill

    As a physician, I find articles like this helpful. They serve to marginally reduce the oversupply of smugness in our profession, which one can view as sort of an unmarketable emissions by-product of the services we provide. Keep up the good work.

    Bill Hocter M.D.

  • Bernard Yomtov

    Why is the marginal patient assumed to be one whose illness is mild? That is far fom the only consideration in deciding to go to the doctor. Others might include cost, convenience of location or scheduling, etc. In addition, a marginal patient who doesn’t go because his illness is mild may easily be mistaken.

    I do agree that smug self-righteousness is to be guarded against.

  • http://profile.typekey.com/bayesian/ Peter McCluskey

    Robin, I think your attitude toward doctors is unusual enough that the value of a doctor’s sympathy to you says little about the value of a doctor’s sympathy to the average person.
    I’ve tried to introspect about what professions would be most likely to make me believe I’m helping people, and my conclusion is that part of what’s happening is that directness of interaction with beneficiaries affects my beliefs. When I evaluate the help I provide as a stock market speculator, I need to use a very abstract part of my mind, which bypasses any emotional effects. Whereas when I made a living writing software, I would occasionally meet a customer who thanked me for the quality of my software, and this feedback consisted largely of sharing emotion.
    I suspect I overweigh the emotional feedback and underweigh the abstract rational analysis of the help I’m providing (even though my skills and opportunities have led me away from jobs with emotional feedback). I think I’ve also seen effects of this same phenomenon cause some companies to bias their development toward putting effort into benefiting one customer by a conspicuous amount over benefiting many customers by a less noticeable amount (I’ve seen instances in software development that don’t appear explainable by profit motives).
    Part of the reason that people are less likely to boast of wanting to be a waiter or cashier in order to help people is the expectation that salaries indicate the value of the help provided.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Ben M, you are saying you help people more when you work in an industry with a low elasticity of demand. So people who sell oil should be especially proud of helping others?

    Nick, I don’t see why donating time versus money should be considered more helpful. And the data usually doesn’t find the benefits of prevention you hope for.

    Peter, why would salaries indicate value more for waiters than doctors?

  • http://profile.typekey.com/bayesian/ Peter McCluskey

    Robin, I’m unsure how you interpreted my remark about salaries. What I meant was that people treat higher salaries as evidence of higher value help. It isn’t desirable for them to ignore the contrary evidence that you’ve mentioned.
    They also ignore point #1 from your original post, and I don’t know whether that’s a problem. My intuition suggests that the difference between value provided and price charged may be positively correlated with price, but I can’t think of a good reason for that intuition.

  • Twisted Chicken

    Robin I think you make a rather unfavorable category error in your comparison between cereal price/demand curve to that of lifesaving medical care, as doctors have a definitional monopoly on the latter. Food providers taken as a category would have the same if not flatter price/demand curve, as do doctors.

    Your next 60 days supply of food is worth as much as your next 60 days of lifesaving medical care.

    Also what about all those other contributors to lifesaving medical care besides the doctors? You don’t think your whole fee goes right into his pocket. From the nurse to the pharmacists to the claims processor and to the janitor that sanitized the room there were an army of contributions made to that care as well as the creation of the physical equipment that provided it. The doctor is an irreplaceable contributor of health care but not the only one. He the quarterback that gets the girl. He is worth what he can get on the open market and not a penny more.

  • son2

    This seems like a classic example of economics-gone-wrong. Reducing a doctor’s actions to the sources of his income or the cost of the services provided to a median customer/patient is overly simplistic. Even a child can see that doctors help people in ways that economists, janitors, teachers, and class-action lawyers can’t.

    1. Although the median health patient might be a rich white twit like you or me (exchanging money for a probably useless physical exam), we aren’t the only types of patients physicians see. Daily, they counsel the most diseased and injured elements of society. Individuals with debilitating or life-threatening disease, people crippled from birth, victims of catastrophic injuries, all of mankind’s most pathetic sufferers (emotionally and physically) come to doctors. And doctors, nurses, and paramedics lay their hands on these people to heal them. They can’t turn away from people’s misery or disfigured bodies, but they have to help them.

    Are you a teacher? In contrast, who do you deal with every day? College students? Gosh, it must take a lot of courage and emotional fortitude to go to your office every day and face those miserable and disfigured coeds. There’s a difference between the way doctors help people and the way you help people.

    2. Secondly, doctors, nurses, paramedics (and many other ‘helping professionals’) face death on a daily basis. When was the last time you talked to someone who was about to die? Health professionals have opportunities daily to help the terminally ill and their families cope with that pain.

    Does a janitor have that opportunity? Does a judge? A business owner and employer? No, no, and no, which is why your student is right that she can help people as a doctor. The opposite of helping isn’t hurting, janitors, judges, and entrepreneurs are all great. But saying that “by participating in a society we all help each other,” implies that kids don’t need to cultivate that part of their Characters that is willing to care for the sick and dying…that’s just shameful. You should be ashamed.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Twisted, it was not me who talked about cereal.

    Son2, janitors risk death more than doctors, as they have a higher death rate. And doctors seem much better compensated than janitors for any discomfort they might feel in having to deal with ichy things.

  • tirta

    robin,

    doctors help more than other professions simply because their consumers (patients) subjectively think so. when you’re sick and at your weakest, all cognitive and emotional biases come into play, so anyone with normal mental faculties would have the tendency to value medical help more than any other help in their daily lives. i thought economists these days agree that even healthy people aren’t as rational as economics would like them to be, let alone when sick. only rational economists and robots can think about the six arguments you made when seeing their doctors. economists only, i should say, for robots don’t get sick.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Tirta, usually we economists are accused of claiming there is value in any product any fool is tricked into buying. But here you accuse us of not accepting at face value the fact that patients often think they are being helped more.

  • tirta

    robin,

    didn’t you imply that in your argument? i guess i have a problem in seeing how your analysis can be applied, and in which world if not this one. i agree that by participating in a society we do help each other, and that your analysis has its own validity. but taking this too far — without factoring in personal interaction, emotional bias, and the condition of being sick — wouldn’t that be absurd, given the current knowledge of how our mental faculties work?

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Tirta, the question is *how*, if at all, to factor in considerations of emotional bias and being sick. You seem to claim that helping people with sickness is “more” help than helping them with other issues. What is the basis for this claim?

  • tirta

    i’m not making that claim, robin, for ‘help’ to me is perhaps as problematic as it is for you. i only claimed that people seem to perceive medical help as more helpful than other kinds of help, because people are less rational when being sick (or perhaps because they do value health above all else, i’m not sure). yet i have to admit that i’m not aware of any direct psychological study showing this phenomenon empirically — although i strongly suspect that one would find such effect. i’ll let you know when i encounter one, or a similar one.

    i agree that the question is ‘how’. but the fact that there is still a lack of ways in which to factor those cognitive-affective variables — which existence you seem to agree on — should not be taken as a green light for a cold, rational analysis to go through unchecked.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    Tirta, even if we do analysis with our best available tools, we expect our descendants will have better tools. I don’t yet see how my analysis is invalidated by the fact that people have emotions, but I will leave uncertainty in my conclusions to account for all possible ways future analysis might show current analysis to be naive.

  • Carol

    Clearly, you are unflappable and nothing anyone says (whether it’s more logical or not) will change your opinion or your argument.

    As someone working toward a CASAC degree in the “helping profession” I’d like to comment.

    I agree that the helping profession is a more direct, face to face interaction. We get to see the change we make in the world in person, as we work with people day to day.

    I don’t think asserting the desire to help people is a bad thing. Perhaps it is egotistical to proclaim it from the rooftops, but the sentiment behind it is more altruistic in the end. I think it’s fair to say that a lot of people get into the helping profession to help people, to make a difference in the world one person at a time (particularly those at the more shallow end of the helping pool: social services workers, substance abuse counselors, etc.). We don’t get paid much, but the job is rewarding.

    Other professions may provide necessary services, and may in fact change lives and help people, but it’s far less measurable. You can say a movie changed your life, or a particularly nice waiter made your day. These may help a person once in awhile, but helping professionals do it every day; it’s the driving intention of the profession to help.

    Living in a society bent on the value of a dollar takes the focus off the importance of personal relationships; the helping profession puts the focus back on to them.

  • http://www.hopeanon.typepad.com Hopefully Anonymous

    “If so, you are helping some by hurting others. Shame on you.”

    Why is the latter sentence in a Robin Hanson overcoming bias piece? It seems to me you’re riding widespread bias here, not making it transparent. Shame on you Robin Hanson, for hurting my persistence odds by helping yourself to the enjoyment of a little snark. :_^(

  • http://retiredurologist.com retired urologist

    Regarding doctors, in my experience, the “helping” motivation is strongest at the pre-med level, present but less strong in med school, and usually absent by the end of residency. There seems to be an inverse relationship between “desire to help” and “number of patients seen”. Another consideration is that during this time, the individual in question changes from a teen-ager to a person frequently in the mid-thirties, reminiscent of the quote often inaccurately attributed to Churchill regarding age, liberals, and conservatives. Yes, there are many practicing doctors who volunteer their time to clinics, but it is a small percentage, and it is difficult to say whether the motivation is “helping” or “status” or “guilt assuagement” or “marketing” or “control” in each case.

    Most of my colleagues chose a guild offering exclusive (but limited) benefits and guaranteed economic survival, the same as all successful guilds. The remuneration in that guild seldom is set by the doctor, and only so in practices dealing with purely elective and/or cosmetic concerns. When I was at the top of my surgical game, my per-procedure fee scale was one fourth what it was when I began practice for Medicare patients (65 and over, or disabled), and one half for privately insured patients. Free market concepts apparently do not apply, as even the wealthiest patients would not pay more for better service.

    It is an obvious source of jealousy that the average doctor has a higher income and a better public image than the average economist, regardless of the actual value of the services. Hanson may be consoled that in medicine, like economics, it is not necessarily the “best and brightest” who are compensated the most.

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  • Chunga

    I think there are people who believe their existence on the planet is more valuable or more important than other peoples based on a range of group and individual differences, whether it is the type of job they do or their wealth, or their good looks or their membership of a social/cultural grouping of kind. Of course their are helping professionals driven by ego and needing to compensate their issues about how much they matter. There are always people in all occupations and in all broad social groups who towards deep insecurities and narcissism as there are “helping professionals” or members of any broad grouping of people who tend towards other personality types. Such a sweeping generalization before the argument even begins seems to reduce tue meaningfulness of the debate.

  • JChav

    Do people who sit around all day, don’t work, and eat bon bons help others?

    • Signify

      They are, at least, doing no harm to anyone other than, perhaps, themselves, and maybe even not then.

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  • KC

    I’m a nurse and chose to be one when I was too young to even know what my salary would be or what people thought about nurses. And before I became a licensed nurse, one of my duties at work was to change old peoples diapers- and I did that for years while making terrible money! You should have seen the looks of disgust on people’s faces when I told them what I did for work. But I enjoyed the job very much and I had at least one good laugh EVERY DAY I went to work. Now tell me health care workers are just in it for the money, status, etc.! Almost every coworker I’ve ever had has a HUGE heart. Some people may quite possibly never understand that you can give and not expect anything in return, and you do it because it makes everyone involved feel good- including yourself once in awhile! It’s not wrong to gain some satisfaction from what you chose as your profession! As for the taking someone’s place in school or at the workplace, “If not me, who? And if not now, When?” -Gorbachev

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  • Dues

    I think that “I want to help people.” has more top do with how a job feels from the inside than anything else. When I was a nurse, all of the patients who I worked with relief on me, and if I dropped the ball then they would be screwed. As a programmer, if I.drop the ball, we loose a day off work.

    So in that context “I want to help people.” Sounds like the polite form of: “I want other people’s lives top depend on my actions.” So helpful people are attracted to jobs like doctors and police officers and the military and politics. Those kinds of jobs put you in power over other people so you can signal that you aren’t going to take advantage of them.

  • http://juridicalcoherence.blogspot.com/ Stephen Diamond

    Old post, but the argument is egregious–at two levels.

    By participating in a society we all help each other. The amount you are paid is a (low) estimate of the value others place on your services. This estimate may have biases, but beware of too quickly assuming you know what that bias is.

    A hapless student told Robin he wanted to become a doctor to “help people.” Robin is insulted (for himself and the rest of us); what are we doing, hurting people? Robin delivers the ultimate Randite argument: your services are worth approximately what you’re paid!

    Two small problems:

    1. If judged by their pay, doctors’ services are helpful indeed.

    2. How helpful society views an occupation is (like pay) an “estimate” of how much the services are worth. Sure there are gross exceptions, but so too with pay. (Consider a rich hit man.)

    By
    participating in a society we all help each other. The amount you are
    paid is a (low) estimate of the value others place on your services.
    This estimate may have biases, but beware of too quickly assuming you
    know what that bias is. – See more at:
    http://www.overcomingbias.com/2006/12/do_helping_prof.html#sthash.uf0dVoUr.dpuf
    By
    participating in a society we all help each other. The amount you are
    paid is a (low) estimate of the value others place on your services.
    This estimate may have biases, but beware of too quickly assuming you
    know what that bias is. – See more at:
    http://www.overcomingbias.com/2006/12/do_helping_prof.html#sthash.uf0dVoUr.dpuf

    • Sieben

      There might be a couple of multi-millionaire hitmen who kill babies. But surely this is not characteristic of how the economy is structured.

      Do you have a real example of a rich person who provides no value to society?

      • http://juridicalcoherence.blogspot.com/ Stephen Diamond

        The easiest way to generate example is to pick occupations involved purely in the interested allocation of resources.

        A large-scale hitman type example would be military arms manufacturers, munitions makers. The benefit they provide one set of humans is offset by the costs they impose on rivals. As Robin would say, it’s a pure of war. Insofar are there still is a “military-industrial complex,” there presumably are rich and powerful munitions manufacturers.

      • Sieben

        Large parts of society believe the MIC is good and are happy to write them a blank check. I do not personally believe this, but it adds an unnecessary layer of complexity to the analysis.

        I thought you were trying to give an uncontroversial example of someone who gets paid a lot but does no good. Something that is a “gross exception” to “how helpful society views an occupation”. Like the kind of hitman you implied, and not the metaphorical hitman you’re backpedaling to.

        My issue is that I don’t think that you can systematically get rich in society without doing (or being perceived as doing) something really beneficial.

        Maybe if you did something for bureaucrats that *they* needed, but was bad for society as a whole, and the whole arrangement was hidden from public view. Hmm…

      • http://juridicalcoherence.blogspot.com/ Stephen Diamond

        Large parts of one society think MIC is a good, but larger parts of other societies think the MIC of the first society is a bad. For the sum of military endeavors, it’s a sheer waste.

        Part of the problem seems to be an equivocation on “society.” Does it mean human society or one particular society? Since the discussion was about “helping people” I think the first is the correct context.

        Many people would disagree that MIC is a waste. Chances are, they’d calculate from that standpoint of their own society, which is cheating.

        Does the same possibility exist for making money when it does no good for one particular country? There’s where an unnecessary level of complexity is introduced. Do wealthy civil lawyers, for example, make a contribution to society where they’re involved in a sheer tug of war? The question is controversial because you have to take into account the externalities provided by a development of the law. But the MIC example seems to me a precise example of where people get enriched without doing good. The fact that they can get many to believe they are doing good shouldn’t confuse.

      • truth_machine

        “Do you have a real example of a rich person who provides no value to society?”

        Paris Hilton. And she’s just one of a very large number of that sort who are less well known.

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