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Living in Spain and Working in the US

Now that I got this locum tenens gig in the US I feel a lot more positive about my future chances of finding similar gigs. The income was good and the work has been relatively easy. This means that living in Spain and working in the US as a clinician is a feasible method of surviving abroad.

So this got me thinking about regular locums work in the US. As in, making it a regular gig to fly out to the US for some locum tenens work in order to provide me enough income to run my household in Spain.

Living in Spain and Working in the US

At this stage of my life, I’m gravitating towards living in Spain. I’ve lived there on and off since the end of 2017. But I’m not married to the idea of living in Spain, it’s just a lovely place at this stage in my life.

In Spain I’m enjoying a very relaxed lifestyle, a slow pace of life, and I’ve made good friends there.

In my city, Santiago de Compostela, you can live on a small income and don’t need a car to get around. The weather is similar to that of the Pacific Northwest and the air quality is incredible.

I love the greenery everywhere. The air is fresh every day and I like walking around the city, rain or shine.

Living in Barcelona or Madrid of course would be different. There is more air pollution and a ton of tourists. Still, those are beautiful cities with warm and mellow people.

I prefer this smaller city feel. Having lived in LA, SD, and Portland, I don’t gravitate towards big city living. And if I ever miss it, I will always have my Portland condo.

Socializing has been easy in SDC. There are many opportunities to get together with friends to have wine or take an art class, on the cheap.

The city has a good number of artists. From those who make custom fashion to painters and jewelry makers.

Housing is relatively cheap in Spain, too. In SDC I can rent a nice place for 400 euros per month. For 600 I would get something quite fancy in the more modern part of the city.

Working in the US

The advantage of working in the US is the high income. The money I earn in one day in a clinic here is enough to pay for 1 month of living expenses.

But it’s not all fuzzy kittens and baby butts, working in the US as a physician is scary as fuck. Look at the drama I’ve had to deal with in regards to the medical board.

There is always the fear of a lawsuit or some bad outcome. Something I don’t think physicians in Spain worry about as much.

Locum Tenens

A locum tenens gig for 2 months could earn me somewhere around $30,000. And I wouldn’t have to work 100-hour weeks, either.

Some locums groups will pay for the majority of travel expenses. But even without that. It’s possible to live on the cheap if you have time to plan ahead.

For physicians with relatively clean professional records and all the proper state licenses, living in Spain and working in the US through locums is incredibly simple.

Travel Expenses

I’ve managed to pay less than $1,000 for a round-trip ticket to the US from Spain.

I chose the wrong AirBnb for this current locums gig I’m working here in Los Angeles. For $2,000/month, I should have been able to find a place where I can prepare my own meals.


As other readers on this website have commented, locum tenens is very tax efficient. If you know what you’re doing you can write a lot of your expenses off against your income.

Even as a per diem physician I have paid only 15% in taxes over the past few years. It’s far more tax-efficient than being a physician employee.

Time Away

I thought I would be heartbroken being away from Spain for this long. But it’s been wonderful. I have made great friends in Los Angeles and reconnected with old buddies.

2 months away while working in the US isn’t too bad but it requires some planning.

If you’re super productive you can also rent out your place in Spain on Airbnb while away.


Then again, flying back for locum tenens work isn’t the only option for earning money in Spain as a physician. I can be a digital nomad physician and earn my income remotely.

I can do telemedicine while abroad. I created a course for physicians who want to live abroad and earn US dollars as physicians from US companies.

The idea of spending all of that jet fuel to fly from one continent to another doesn’t exactly give me a chubby. Telemedicine seems like the more sustainable way of practicing my trade.

Healthcare Consulting

Finally, another great way to earn a solid income as a physician is to use my clinical knowledge as a healthcare consultant. It’s a great way to live in Spain and earn income from the US.

I created a course for that as well, teaching physicians how to find a topic of interest and how to recruit their first set of clients.

You can consult for a medical device company, a pharmaceutical company, or a healthcare startup. Your knowledge in your specialty is very valuable.

Healthcare consultants charge anywhere from $75 to $500 per hour of work. I’m charging $150 and haven’t had trouble finding clients, as long as I put in the work to find those clients.

Working in the US, Remotely

Finally, there are other ways of earning a location independent income from the US while living in Spain. I think some creativity will go a long way.

Online teaching is another way, which I did when working for a local community college. No reason you can’t do that while away in Spain.

You can sell courses, as I do on this website. Or you can do individual consulting for physicians if you have a certain skill-set that you can market.

8 replies on “Living in Spain and Working in the US”

But all of those religious trail zombies! Do they take over the city? We’re starting our exploration of Spain in two days for a month. Right now leaning toward Southern France but Spain is cheaper and perhaps easier to migrate to. We’ll see what we think of Andalusia, but I don’t like lots of tourists and my wife hates extreme heat so I do think we’d migrate north as you did. Just not sure about that PDX weather in that part of Galicia. I have to think hard before I commit to oppressive cloud cover over me for 5-6 months again.

Thanks for the update. Will watch a your Spain vid on youtube tonight.


Lol, dude, I had to look up what a trail zombie is – hilarious.
Excited for you guys to travel. If you are in my neck of the woods I’ll join you for some coffee or wine.
I agree that Spain can be cheaper but I have heard that Southern France can be cheap too, really depends on how you do it, right? There are/is Michelin restaurant(s) in Santiago de Compostela,too. Along with 500 euro hotels. But why do that when we have the best of the best luxury here in the US – that’s my working theory.

I get asked about the Galician weather a lot – like how can you stand it? I figure that I would rather have my base in Spain in a green and safe and relatively inexpensive place like SDC. I can always take a train down to Seville or Cadiz or Barthelona if the weather wears me out.
I also think I’m not as sensitive to the clouds for some reason. But that could change, sure. I just didn’t prosper as well in the heavy tourist cities in the south.

I thought you had no interest in clinical medicine anymore. Yet you are bending over backwards to find clinical jobs…..

I love clinical medicine, I don’t like the career of medicine. It hasn’t been an easy conflict to resolve but the important things in life are worth battling over. I’m not in a rush to resolve it and don’t feel any pressure to be on one side of the fence or the other. It’s easy to burn the ships and not look back but that could leave us with feelings of regrets. So it’s better to bend over backwards, if that’s what it takes, to explore your feelings towards your career before making a rash decision. I do think there is a point at which you’ll just have to rip the bandaid – not sure I’m there yet, but getting close.
A good friend of mine also said that you should never leave a sure thing for something uncertain. The career of medicine is still a very sure thing, all my non-career interests are ideas which I’m still developing. I’m happy that I’ve been able to step out of clinical medicine as much as I have so far, that wasn’t easy to do.

I left a very lucrative STRESSFUL job with a well-respected hospital 6 months ago and joined a virtual primary care company as a contractor. The money is not enough and will not be enough until I can get up to a panel of 150-200 patients which will take probably another 4-6 months. Due to that and that I need benefits, have been toying with going back, but not full-time. My problem is that I don’t WANT to do that. I love the flexibility and really like this current start-up I’m with. My quality of life has been 100% better since I left. Have 3 kids-one in college, and one soon to be in college, so need to be smart(er) about next move.

If I may, I’d recommend trusting your instinct. You don’t want to go back to something that stressful or risk another hospital affiliated practice which might turn out to be the same. I have never met anyone who has found life satisfaction and joy through money, unless money was a side effect of something they liked doing.
It might be worthwhile to stick it out and keep building your practice. Set small goals and assess how you’re doing with reaching your ramp-up metrics; make adjustments as needed. You’re on the forefront of healthcare because virtual primary care is the future, no matter how little faith we have in it.
Get as creative as possible to maintain this lifestyle – cut out spending, do some other telemedicine on the side, whatever it takes …. enjoy it because such opportunities come up infrequently and you’ll always be able to go back to a back-breaking job.

I’ve been doing the living abroad/working locums fake digital nomad thing for almost a year now and have had serious consideration of moving to Spain as well, looks like you’ve actually made the incredible leap! How have you navigated the taxes? My understanding is that after 183 days in Spain you are a resident there and that worldwide income as a Spanish resident is taxed per the US-Spain tax treaty circa 1990 as independent services. Have you had to pay Spanish taxes?


This year will be the first year that I’ll have spent the majority of my time in Spain but up until now I have been paying my taxes in the US. I am not too concerned about taxes, lots of expats live abroad and earn their money in the US. And from what I understand paying taxes in Spain is relatively easy. Wish I had more information for you … actually, this might help, I have a friend who has been living in Spain for some time and makes most of his money from real estate investments in the UK even though he’s from the US and he hasn’t paid taxes in the US nor Spain … not something I would advise but he just hasn’t set off any radars because his income is relatively small, enough to live off of … again, 100% advise against this strategy but I don’t think any tax police will come after you … most countries tend to be a rather lenient when it comes to figuring out taxes for expats. I’ll post my taxes once I do them.

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