Think of a surgeon performing a life-saving operation. An undeniably impressive act, but it also prompts a deeper question: would the patient have died without this specific surgeon?

The answer is not as simple as you might think. Consider: in wealthy countries, there are most likely many more qualified surgeons. And, if you dig even deeper, there are even more people who would have liked to become surgeons, but couldn’t due to the limited number of training spots in medical school.

This touches on a key idea that is often overlooked by ambitious idealists: often (and fortunately!), there are many others who want to make the world a better place. This means that even in the most impactful jobs, if there are ten people that are willing and able to replace you, your added value could remain limited.

For those driven by moral ambition, the lesson is clear: seek out opportunities where your contribution is irreplaceable. The most impactful work is the work that which would otherwise be left undone—if you don’t do it, no one will.

VORP

To understand this concept better, we need to take a trip to a field where the added value of every employee is calculated precisely: the baseball field.

In 2004, statistician Keith Woolner came to the remarkable conclusion that scouts and coaches were consistently misjudging baseball players. Experts were primarily looking at output metrics like how many home runs a player scored, but according to Woolner, that was the wrong question. What he wanted to know was how many more home runs a player scored, than the player who would have replaced him if he had been sick that day. After all, average baseball players come cheap—it’s the real superstars that teams compete for and are willing to spend big on. For Woolner, this meant that what truly mattered was the way a player performed in comparison to their average replacement at that position.

‍Woolner developed a method to express this ‘added value,’ a score he called ‘value over replacement player’ (VORP). While the concept of VORP works a bit differently outside the world of sports—in sports, your performance always comes at the expense of the opponent—the core question is relevant beyond baseball: What are you adding, compared to the next person in line?

Lucia Coulter

In the summer of 2020, a young doctor named Lucia Coulter asked herself this exact question. She had recently graduated and had started her work as a doctor in London, so she certainly wasn't lacking in moral ambition.

And yet, something gnawed at Lucia. She loved her work as a doctor, but when she looked at her career through the VORP lens, she felt she could do more. What Lucia really wanted was a position for which there was no ‘replacement player.’ Eventually, this search would lead her to one of the most neglected health issues of our time: lead poisoning.

Lead poisoning is one of those issues you’ve probably never heard of, even though it affects hundreds of millions of people. According to the World Health Organization, each year 1 million people die and millions of healthy life years are lost, due to the harmful effects of lead entering people's bodies through sources such as paint and polluted drinking water.

Lucia was not the first to try and tackle lead poisoning—but people weren’t exactly lining up to do so, either. In 2021, only 6 to 10 million dollars was spent globally by a small handful of NGOs to combat lead poisoning. And even today, only 48 percent of countries have legislation that limits the spread of lead paint, meaning that in the poorest parts of the world, paint still often contains dangerous amounts of lead.

Samantha Power, US Administrator of the United States Agency for International Development (USAID), summarizes the issue as follows:

“Never in my career have I seen an opportunity like the one we are about to discuss—to deliver such a powerful blow to such an invisible killer for such a relatively small amount of funding. (...) The world can make a really substantial dent in lead exposure for less than it costs to make the last movie you saw.”

Lucia quickly got to work. With the organization she founded—the Lead Exposure Elimination Project (LEEP)—she managed to convince the government of Malawi to more strictly regulate the lead content in paint. According to LEEP's calculations, this success alone would result in 43,000 additional healthy life years and better health for 215,000 children. In short, LEEP hit a home run in the fight against lead poisoning—and that would have never happened without Lucia.

Where is your talent needed?

What makes Lucia a role model of moral ambition is not just the remarkable success of her organization, but her choice to do something no one else was doing.

Or, as she mentioned in an interview with the Giving What We Can foundation:

“When you're part of a health system and you're working as a doctor the most you can do is make sure things go how they're supposed to go. Whereas when you're starting something new, they're going in a way where they wouldn't have otherwise gone.”

Of course, the world would definitely not be better off if all doctors quit their jobs. But at the moment, certain professions attract a disproportionate number of talented people, while other causes—like the fight against lead poisoning—remain completely neglected.

You might encounter some raised eyebrows, when you tell people at a birthday party that you quit your stable job as a doctor to become a lead poisoning eradicator in Malawi. But that might be precisely the point: those who do what others won’t, can make the biggest difference.