Tl;dr—rent seeking is bad, m’kay?
This was a interesting read, but it’s rather narrowly focused. If Anne were a doctor, then the greater her skill at surgery, the less replaceable she would be. For any occupation, the more skilled a person, the less replaceable she becomes. Replace ability isn’t really the relevant metric. Rather, Dr. Anne may have the option to teach other people her surgical skill, increasing her replaceability and reducing theirs. But teaching people a useful skill is obviously altruistic; this doesn’t turn on replaceability. Likewise, doing a good job is more altruistic than doing a bad job (when there’s no reward). Hence, complex database Anne is less altruistic than friendly database Anne because she’s doing her job worse. The reason replaceability isn’t discussed is because I don’t think it really adds much, especially since one should, generally, act to become more skilled and thus less replaceable.
Being able to teach others is itself a useful skill that might increase Dr. Anne’s irreplacability at the same time. Maybe her role in the institution will change and she will do fewer surgeries & more teaching; maybe she will do fewer simple surgeries (because she has trained others to do them) while she takes on more challenging ones more suited to her because of her experience.