For whatever reason I got obsessed with the idea of working remotely as a physician as soon as I realized that it was a possibility through telemedicine. My first attempt to cut the cord was in 2017 and it worked out beautifully. I was earning $10k/month living in a relatively cheap place, Barcelona, Spain.

Fortunately I had enough foresight to realize that I shouldn’t solely depend on my medical license as a way to earn income as a digital nomad physician. I started incorporating a few other income sources and made another trip abroad to Seville, Spain in 2018. By this time I was earning money as a healthcare consultant as well.

This is my third time abroad and this time I have even more location independent physician income sources – 8 in total. I have enough income diversification that it’s unlikely for me to hit a financial dryspell. In this post I’ll discuss the logistics of earning money as a location independent physician from clinical and non-clinical sources.

Santiago de Compostela, Spain

I decided to leave the US once again in late March, 2019. I got my airline ticket ($1,100)  reserved to Madrid early April and I was going to figure out the rest of the trip later. It’s only April 9th as I’m writing this post and I’ve been in Santiago de Compostela not even a week.

Cheap Living

I settled on this city because it was the cheapest AirBnb I could find. I wanted to settle down in San Sebastian but it’s a very expensive city. Coffee there costs nearly 2 euro, beer 2.25. No, no, no. I wasn’t about to live in another LA or San Diego.

I scrolled left on the AirBnb map. Scrolled some more, and some more, and came across a gorgeous AirBnb for $750/month and reserved it for 4 months. Here is my apartment tour if you want to check out where I’m living.

Selection Criteria

Whenever I go to stay in a new city anywhere in the world I have strict criteria which have served me well so far. I’ll share in another post or one of my podcast episodes. My criteria help me save money on living expenses and make sure that I am living somewhere safe.

This is a very cute city. Small footprint with friendly faces. Great cafes. Cheap rent and cheap flats for sale. I can get to a beach in under 40 minutes with the train. Or I can take it south to wine country.

Location Independent Physician Income

In the past I was dependent on telemedicine income. But it has gotten harder and harder to earn money as a physician. If it’s not the insurance, it’s the red tape of the job, or it’s the medical boards. The conglomeration of medicine has made it an industry, an economic sector which is no longer in the hands of the physician.

With the backbone of medicine having become prescribing and performing procedures, I have decided to branch out. My last per diem gig as a telemedicine physician ended just 2 weeks ago. I was doing telemedicine work for Oscar and was informed that I couldn’t be board certified through NBPAS. I had to be board certified through the ABMS.

Below are the 8 ways I’ve been earning money here in Spain. It’s always a work in progress because I’m less worried about the total income. Instead, I like to find something to do which I enjoy doing every single day. So far it seems that it’s not just one thing but a combination of different gigs.

1. Healthcare Consulting

My main source of income right now is through healthcare consulting. I just received my paycheck for the months of January, February, and March to the tune of $15,000.

For anyone interested in getting started in healthcare consulting, it’s something you can do on the side with just a couple of hours of work per week. I have created a superb online course to get you started in healthcare consulting as a medical professional.

2. Individual Consulting

My next location independent physician income source is from answering the questions of readers of this website. I have been earning a few hundred dollars every month answering your guys’s questions through my clarity.fm profile.

I get questions about careers at Kaiser Permanente. I also get telemedicine related questions. I’ve had PA’s, podiatrists, oncologists, orthopedists, anesthesiologists, and ER doctors all reach out to me and pay me to hear my opinion on a certain topic.

3. Private Telemedicine

I have built my own telemedicine platform using VSee’s comprehensive telemedicine software. I am initially advertising to my friends who are small business owners. They have employees whom they cannot afford to cover with health insurance. But they can afford to pay me to offer healthcare to their employees.

I’ll write more about this in the future. Think of it as Direct Primary Care with a virtual twist. Nobody cares if I’m board certified or not. Nobody cares if I was investigated by the medical board.

4. Medical Expert Platform

My next income source is building my own medical forum for patients. I have started a brand called MHC – Medical Health Coach. I have hired a social media person to help me brand it and grow it. Over the next few years I will have my own patients through this portal and won’t depend on anyone else for patient leads.

The most important aspect of this is that I am not going to turn this into a clinical brand. I want to be a medical expert without having to practice medicine. Take my medical license away and I can still dish out general health advice to a group of patients.

5. Just Answer

I have been doing Just Answer work for several years. It’s not a telemedicine site. Instead people ask you health related questions. You get questions from news reporters, from scientific minded individuals, parents, patients, and other medical professionals.

There are a lot of customers on there and plenty of room for more physicians to get on there. If you’re interested then I highly recommend it. And, of course, I have created a tutorial for that as well which you can purchase from my shop. As with everything I sell, you have a 100% money back guarantee. Take the course and if it’s not what you expected then return it for a 100% refund with no questions asked.

On JA you don’t make any diagnoses, you don’t order any medications, nor any tests. You simply are a topic expert which makes the work very easy and rather lucrative. You can make a lot of money with just a couple of hours of work a day on JA. I get questions such as:

• which OTC meds to use for acne
• does Keto really work for weight loss
• can the person take an extra birth control pill if they are having heavy periods
• someone from India wants to know how to manage their blood pressure without meds
• a writer wants to know if an eye really pops out of socket during trauma

6. Product Sales

Each of us has something we’re an expert in. You might be an expert in a specific procedure as a surgeon. Or maybe you’re a successful day-trader. Maybe you’re a real estate investor. You might restore old cars and flip them. Perhaps you own a pizza shop.

What we have in common is that we are clinicians or other healthcare professionals. I would much rather learn how to flip homes from another physician than from a realtor – like this guy. I trust you more if you’re a doctor. We likely have something in common which means I’m likely to succeed if I follow your methodology.

That’s why I sell products on my own website. Right now they are tutorials and courses. They are priced in the $100-$200 range. My goals is to keep adding more products to my online shop.

7. Rental Income

I am renting out my Portland studio condo to a friend of a friend for $1,200/month. It’s a short-term rental which means that either party can give a 7-day notice to other to cancel the contract. She’s reliable, single, and she’ll check my mail for me and water my plants.

In the past I have rented my studio out on AirBnb for $2,200/month. It was rather easy dealing with AirBnb and if I needed the extra income then I will revert back to AirBnb in the future.

8. Investment Income

I have $200,000 invested in VTSAX which is similar to the VTI fund I have written about in the past. The investments earn 2% dividends every 3 months, approximately $4,000 per year or $300/month.

I am invested very conservatively and am not really investing for an income flow. If I was then I might go even more aggressively into small-cap funds and lower my bond fund allocation.

Living Expenses in Spain

In this previous post I shared my living expenses in Seville, Spain. It was a more expensive city to live in. Santiago de Compostela’s housing is a lot cheaper and food prices are quite fair if you don’t go to the English cafe’s.

Spending Trifecta

Housing, food, and transportation – the spending trifecta, comprises 75% of the average US household budget. Here in Santiago de Compostela I have the following spending categories:

• Housing – $750
• Food – $350
• Healthcare – $65
• Exercise – $50

$750 gets me a 3-bedroom with WiFi and all utilities included. The pantry is full and I don’t have to buy any linen or furniture. I agree that it’s a little expensive for Spain but for everything I am getting it’s a worthwhile expense.

I don’t have any transportation expenses because I can hoof it everywhere. There are buses but I live near the city center. If I need to go further I’ll buy a bicycle.

Food is cheap and I don’t eat out. There are fruiterias and grocery stores everywhere. Tons of fresh fruits and veggies and beans. Baguettes are 0.50 euro.

The only reason I have health insurance is because I want to eventually get my permanent residency in Spain so it’s a criteria to have a Cadillac plan health insurance. Otherwise it’s free for anyone who lives here. Even if you pay cash for everything, it’s super cheap.

I also am addicted to bouldering so I pay $50/month for my climbing gym membership.

I have a cell phone but still don’t have cell service, even here in Spain. With abundant WiFi I simply haven’t needed it. I priced some out, just in case, and it seem that 7 GB will cost me 10 euros. This is a prepaid plan which expires in 4 weeks, not bad. Or I could get 3 GB for 7 euros.

Telemedicine in Spain

If you’re trying to keep things simple then you can sign up with a telemedicine company and do your telemedicine calls from Spain. If you follow my instructions on my International Telemedicine Course then you can make money doing telemedicine while living anywhere in the world, as long as you have an internet connection.

You can either see patients for US based telemedicine companies or you can build your own telemedicine platform as I discussed in this previous post. It’s not hard to recruit patients. Think of all the private practices out there who don’t have the bandwidth to also offer telemedicine for their patients. Think of the DPC’s, naturopaths, functional medicine doctors, and even the nutritionists.

As for making calls from Spain – it’s free. I have discussed this in numerous posts before. With Google Voice you can make and receive free calls from US phone numbers.

Just yesterday I was at home and received a text message from Dial Care that there was an Oregon telemedicine patient waiting. I replied to the text and accepted the consult. I made a phone call and pocketed the money.