The Expat Life for Physicians

What is an expat? It’s short for expatriate, referring to a citizen of a country who is living outside of that country while maintaining their citizenship in their country of origin. The expat life abroad is a good option to consider for physicians who want to either live on less in another country or who want to live the traveling lifestyle.

The Expat Business

In retirement circles, it refers to someone who retires in another country while often keeping some ties to their country of citizenship. In the workforce, it can also refer to a person who is sent by their employer to work and live in another country.

There are many US immigrants who have been living here for decades and are, in fact, expatriates – expats. In the medical field, we encounter quite a few such individuals.

Countries are businesses and protect their borders because that’s how they keep bad people out and good money in. As you can imagine, it would be bad business for a country to see all their retirees leaving for other countries which can offer the same quality of life at a lower price.

This post is a cursory overview of what factors to consider when deciding on an expat life and how to overcome the common obstacles.

Solving the Banking Problem

I’ll mention this a few times in this post. Your bank can close your account if they suspect you are no longer a US resident, even if you remain a US citizen. It’s a rare thing to happen but I know friends who have dealt with this.

There might be a couple of banks that will look the other way or ignore the fact that you are no longer a US resident.

Charles Schwab seems to be the only legit bank that caters to expats. They are comfortable with you living abroad and will continue to service your accounts.

If you earn your money in the US and need it transferred to a bank overseas, then the best thing is to skip the US banking system altogether. Either you’ll need your client/employer to pay you through a system such as PayPal or have them mail you physical checks.

I’ll mention a Wise account in this article as well. Though there are many such quasi-banks that can be used while living the expat life.

Your Mailing Address

I think this is the simplest topic to address. If you decide to spend a few consecutive years abroad, whether for a job or as a retiree, your mailing address suddenly becomes an important topic.

As a US citizen, you will always owe taxes to the United States, no matter where you live. Some of your income will be deducted for this if you are paying taxes to the country you are living in, but anything above that, you will owe taxes to the US.

Many virtual mailbox services are available and as long as we continue with snail mail I recommend having one. Traveling Mailbox is such an example.

Credit Cards

Your credit card company can cancel your credit cards if you are overseas for a long time or if they believe you are no longer a US resident.

It’s a smaller problem for US physicians since we generally have more money flowing through our accounts.

Most credit card companies will likely continue to service your account. But it’s worthwhile to seek out credit card companies that are more expat life friendly.

Your Brokerage House

My research shows that some brokerage houses will let you have accounts with them if you are an expat, but the information on this was muddy. Seems that Charles Schwab and Fidelity are somewhat okay with this.

Vanguard has a reputation for being the lowest cost and most transparent of the large brokerage houses.

Charles Schwab, mentioned above, is another good brokerage option for those physicians living the expat life.

Remember, if you’re not a resident of the country where you opened your bank, they can close your account.

Physical Mail Solutions

I know it seems silly, but if you follow the conversations online regarding the ‘physical address’ problem, you’ll see that finding feasible solutions is necessary.

1. Pay for a Physical Address

One option is to pay for a physical address which is what all permanent RVers do, which is what traveling nurses and some traveling doctors do.

Great mail-forwarding companies provide you with a physical address for a set monthly fee. They scan all incoming envelopes and have you decide whether you want to toss them, have them open them and scan the contents, or mail them directly to wherever you are in the world.

You can’t just have a PO address. Most banks and financial institutions won’t accept that. If you give them a physical address, then they are happy. Some companies, such as SBI, understand this and offer you a physical address.

2. Use a Friend or Family Address

Forward your mail to the house of a friend or family member. But this is no easy task because you would have to trust them, and they would have to trust you.

It would still be a lot of work for this person to scan your letters and look through them, not lose them, forward them to you or reply to them on your behalf.

3. Maintain a Home in the US

I think this is the least feasible option, but it would involve keeping a physical address in the states while enjoying your expat life.

You leave your home empty or buy a small condo and make it your main address. There are other advantages to this that I won’t get into here.

Perhaps if you bought in a state with zero income tax – that might be an option. If you have to pay taxes from overseas income, the state income tax portion savings alone might cover the mortgage payment in a zero-tax State.

Visa And Residency

With the ubiquitous 90-day visa rule, it’s hard to stay in one place long enough to make it an actual home. Living the expat life for physicians might require you to stay in one place long enough to feel settled in.

Especially if you are a digital nomad physician and building your own virtual practice, moving around a lot can add stress.

Applying for long-term residency can be done through any of the following means listed below. They are for a minimum of 12 months with the option to renew several times:

• investment visa (you literally buy the visa by investing a grip overseas)
• work visa (need a job sponsor)
• entrepreneur visa (you earn your income through your own business)
• student visa (usually you have to be <35 years old)
• retirement visa (you need a pension and often have to be over >50 years old)
• intellectual visa (for those who give lectures/are involved in research)

After a few years of residency, you can be considered a “permanent resident”. A few years after that and you could become eligible for citizenship.

Tax Obligations for Expat Physicians

If you are an expat then, by definition, you still have your US citizenship, meaning you will continue to pay taxes to the US. If you decide to settle down full-time in the destination nation, you would have to give up your US citizenship to escape double taxation.

That said, the US is somewhat fair in this regard. Your earnings abroad are excluded up to a certain amount – assuming you are paying taxes on them to the country you reside in. This amount is in the $100,000 range per year.

Earnings above $100k would be taxed by the US. Most countries you reside in will also require you to pay income taxes to them on that sum. Hence, double taxation.

Your Primary Residence Back Home

Most expats sell their primary residence since managing a rental property from far away can be a headache. Others choose a management company to run the rental for them. Few will keep it sitting empty.

Even if you are a resident in another country, you’d have to continue paying property taxes to the US on your home on US soil.

All Modes of Communication

Letters, boxes, emails, phone calls, and text messages are the various forms of communication that many of us will want to maintain. I have addressed the mail system above.

As for digital communication, it’s much easier than I thought. With Google Voice and Skype, you can have a US phone number if you desire. This allows you to make VoIP calls without incurring a long-distance fee.

Prepaid plans are easy to get in the rest of the world. You pay around $10-20/month and get 5-10 gigabytes of data that can be used for your VoIP communication. All you need is a SIM card from a local service provider.

Housing Considerations for the Expat Life

Moving overseas means that you have to arrange housing. Hotels and hostels might do fine for a few days, but eventually, you want to feel more settled in.

I recommend Airbnb and Facebook groups for finding housing overseas. Each destination will have a Facebook group where you can post your request or see places listed for rent.

I highly recommend getting a furnished unit with electricity and internet already paid for when you start out. Getting such services started can be a pain in the ass if you aren’t familiar with your new destination.

3-6 months is a good amount of time to feel settled before venturing out to find a cheaper and more permanent housing situation.

When it comes to buying a home, note that most countries won’t allow you to own a house if you aren’t a citizen. This isn’t the case with Spain, where I’m residing, but quite common otherwise.

Health Insurance

Health insurance is cheap everywhere else in the world so this isn’t really a big issue. You can purchase international insurance that covers you for several countries or just choose one location – these are often customizable.

The price will be quite cheap if the US isn’t included in one of those countries.

In most countries, you would be able to partake in the national healthcare system as long as you pay taxes. For some countries, paying a tad extra to get supplemental private health insurance is better. Expat forums are a great resource for this sort of information.

Socializing as an Expat Physician

I decided to put all the other topics under socializing. This includes learning the language, making friends, learning customs, and figuring out how shit gets done.

Learning the Language

Damn nearly every country will have language classes for adults who want to learn the native language. Many are free through social organizations. Some are paid, and you sign up through local colleges. Others are private through language schools.

I pay 100 euros a year in Santiago de Compostela and get great classes at La Escuela de Idioma.

If you avoid speaking English with English speakers, you’ll see words repeated so often that they will stick.

My preferred method is to start with basic things like restaurant menus and business signage. I take pictures and sit there with my Google Translate app and decipher them.

I have also had good luck buying a used children’s book and making notecards out of some harder-to-remember words.

Making Local Friends

Shop owners are my go-to for making friends. They appreciate my business and are often happy to humor me as I pathetically try my Spanish on them. One lady, Lucy, even forces me to have full-on conversations with her and will not let me out of it until I have understood what she said.

When you frequent establishments, you get to know the owners and their patrons. One conversation leads to another, and connections are made. Phone numbers are exchanged, and you are now a social butterfly.

Meetup.com

I’ve always had good luck with meetup and other social websites which advertise get-togethers. Even though you might feel that you’re the only one who feels out of sorts – everyone feels the same, but some are better had to mask it.

Sports

This is my favorite way to make new connections. Either yoga, tennis, rock climbing, or ping pong. There is an automatic connection made, and if you have fun, people are inclined to think that you’re probably not a creep.

Frequenting a gym is a good way to run into the same people over and over. Eventually, you can strike up conversations and go from there.

Earning an Income While Abroad

Well, if you’re a healthcare professional, you can apply for licensure at your new destination, or you have to take on odd jobs while living your expat life.

I would advise starting with online work first, if possible. If you decide to work legally in another country, you must have a work permit.

Online work can be done without much headache. Though it’s technically not allowed (unless you have a work visa), nobody gives a shit. I have done telemedicine in Barcelona without ending up in jail.

There are plenty of jobs you can get where the client won’t care if you have a work permit or not because they are going to pay you cash. I would again direct you to Facebook groups for this. This probably would be like being a nanny, doing customer service for English-speaking clients, or being wait staff.