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