Dear colleagues,
Here is a synopsis of a poster presentation I have been given the opportunity to present at the Australian and New Zealand Rheumatological Association meeting in Auckland in about one weeks time. (I am pretty sure this is a first for this type of presentation at an international meeting.)
WHAT WOULD IT TAKE TO DOUBLE YOUR IMPACT AS A MEDICAL PRACTITIONER? (to be “twice the doctor”)
The answer is reasoned below and might surprise you. It certainly surprised me!
I thought long about this while the Twice the Doctor foundation was being established and I came up with $12,000 per annum – that being the average wage of a doctor in Sub- Saharan Africa. However a much more sophisticated analysis has been done by Dr Gregory Lewis. He came to the conclusion that at very best the average doctor in the western world might avert about 10- 15 DALYS per year.
(https://80000hours.org/author/gregory-lewis/)
A DALY is a disability adjusted life year and costing DALYs averted is probably the best way we have to assess the cost effectiveness of a medical programme, treatment or service.
As a western society we accept a cost of $50,00 to $150,000 or so to prevent a DALY. So if a drug costs $20,000 per annum such as biologics used for Rheumatoid Arthritis and it improves a person’s medical quality of life by 20% it tends to be funded by the PBS as the price to avoid one DALY by use of this drug would be about $100,000. Biologics are the number one best selling drugs by far in Australia and generally in the western world and we pay about $100,000 per DALY averted for them.
The numbers in the developing world are vastly different. For example the cost to prevent a DALY for trachoma surgery in Ethiopia is about $27!!
This is not really so surprising as the procedure prevents permanent blindness, (that is a lot of DALYs) and the “surgeon” once trained, gets paid about $1 per surgery.
So back to how much it would cost for you to double your impact as a doctor working in the western world by supporting an activity in the developing world such as a programme to provide trachoma surgery:
Western doctors average DALY prevention per annum……………15 multiplied by cost to prevent a DALY in Ethiopia with trachoma surgery……$27 i.e 15 x 27=. ………$ 405.
SO ….FOR ABOUT $400 A YEAR YOU COULD EFFECTIVELY DOUBLE YOUR MEDICAL IMPACT ON THIS PLANET.
IS THIS REALLY POSSIBLE?
When you consider:
- African countries have an annual health budget of as low as $16 per person.
- About 1.2 billion people live on $1.25 a day
- Ethiopia has 1 doctor/ 40,000 people, Australia has 1/250 people
… IT IS ENTIRELY POSSIBLE!
So this means that even if these figures are out by a 100- 300% (highly unlikely), a senior doctor in Australia can donate the proceeds of a SINGLE DAYS WORK ONCE A YEAR and double their impact on patient outcomes.
That’s a real opportunity!
Please consider this carefully. This year Doctors Day In May is the 24th of May. Your contribution to the highly effective and efficient “DALY-preventing” programmes we help fund would be greatly appreciated not just by us but by patients greatest in need on this planet.
Regards to all
Rob Baume
(on behalf of the Directors of TTD)