I moved to New Zealand AMA

[acleverpsychpun]

A year ago I moved with my young family to New Zealand and started working in the public health system here. Our reasons were a mix of wanting an adventure, better work life balance, and a healthier environment for our child. There have been ups and downs but in general we have loved it, and plan to stay. I’ve seen posts of people asking about overseas options, so I’d be happy to provide my perspective to anyone interested. My department also has a few vacancies so…some shameless recruiting.

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[WisNeuro]

Have you met Brett and Jemaine yet?

 

[wolfvgang22]

What are the biggest differences between living in the U.S. and living in NZ? What do you miss about living in the U.S.?

What is better about practicing in NZ versus the U.S.? What is worse?

What is your workload like? What is your compensation? Will you keep U.S. citizenship? What are taxes like?

Thank you!

 

[Celexa]

How easy/difficult was the credentialing process?

Major cultural differences in practice patterns?

Is your place of employment open to, say, a six month gig or do they want longer commitments?

 

[WisNeuro]

Going along with the pay question, I'd ask more generally about overall compensation vs. cost of living. How does it feel there financially compared to the US? How's QoL from a financial perspective, as pay alone does not accurately convey that when there are substantial differences elsewhere.

 

[PsyDr]

1) Why is peerage the same in NZ, but different in Papua New Guinea, when they both recognize the King as sovereign?
2) What is the strangest change in medication names (e.g., Lustral)?
3) Do they use the DSM or ICD, because of the American of it all?
4) How does your American board cert play out in another country? Do they want you to sit for an NZ board?

 

[jbomba]

Are US docs only able to work on rural/under served areas?

Any chance to work in a private practice group in a larger metropolitan?

 

[Stagg737]

What's your favorite type of Kiwi?

 

[forchinet121]

How much money do you earn per year?

 

[G Sheb]

Would love to hear your feedback.
I think most of the important questions have been asked.

 

[Sushirolls]

Not all the important questions...

What's the sheep to people ratio?
What are the gun laws? Can you bring an AR?
How are foreigners viewed and treated?
What side of the road do you drive on?
Can you hunt?
Can you fish?
Can you own land or farmland as a foreigner?
What's the naturalization process? Can you even naturalize?
Are the culture wars present?
Are kindergarteners being taught about transgenderism?
I've heard before differences in mental health treatment for Mauri, compared to non-Mauri, is this true?
Are the poisonous things just as present in NZ as they are in AUS?
What are the cannabis laws?
What are the drugs of abuse? Coke? Crack? Meth? Heroin? Fentanyl?
What military defenses does NZ have? I.e. can it even mount a defense against China?
How much Tourism does it get from Lord of the Rings fans? Is there like a season, "oh, great they're back again!"
If you throw a 4th of July party will anyone join you?
Is it part of the Pacific Ring of Fire, and got any active volcanos? Does it get earth quakes?

 

[jbomba]

Sorry one other question. Can a board certified US psychiatrist come over and begin practicing or are there licensing issues, NZ residency, etc that has to be completed first?

 

[nmbutah]

Have you met Brett and Jemaine yet?

tragically no. so...the whole move has basically been a failure

 

[nmbutah]

What are the biggest differences between living in the U.S. and living in NZ? What do you miss about living in the U.S.?

What is better about practicing in NZ versus the U.S.? What is worse?

What is your workload like? What is your compensation? Will you keep U.S. citizenship? What are taxes like?

Thank you!

For me the biggest differences are I find kiwis to be far less materialistic and the society to be much more socially cohesive. In 3 years of living in my neighborhood in the states I barely got to know my neighbors. Here I know almost all of them. Interactions with strangers are much more pleasant. There's a sense that everyone is on the same team and everything is going to be alright.

practicing in NZ is much more different than I anticipated. I see 3-6 patients a day. A lot of supervising nurses who have a ton more autonomy...and I thought I was escaping the NP thing. GPs handle the vast majority of cases so the patients I see are quite unwell. The system is in general overburdoned and very beaurocratic. That said nobody struggles to pay for their care nor meds. The community support services are excellent. Pay is about 1/3 of what I made in the states. Taxes are actually pretty comparable to the states-I believe the top bracket is 33%. One huge difference is there are no deductions for...anything. So no 401ks, no filing your taxes at all, they are just taken from your paycheck

 

[nmbutah]

How easy/difficult was the credentialing process?

Major cultural differences in practice patterns?

Is your place of employment open to, say, a six month gig or do they want longer commitments?

we used a recruiter and it took about 3 months. A fair amount of paperwork but nothing too onerous. Your initial license only allows you to practice under supervision, It will take me just over a year to get an unsupervised license

see above, I'd say in general medication practices are 10 years behind the states, at least. It's weird what medications aren't available-no trazodone, cymbalta, nor guanfacine. They are much more liberal with benzos and stimulants than I am used to.

I believe in general they ask for a minimum of 6 month commitment to justify the licensing process

 

[nmbutah]

Going along with the pay question, I'd ask more generally about overall compensation vs. cost of living. How does it feel there financially compared to the US? How's QoL from a financial perspective, as pay alone does not accurately convey that when there are substantial differences elsewhere.

this is the biggest downside. Pay is much much worse. I make about 250 NZD. Costs are comparable to slightly higher to what you would pay in the USA. Houses are comparable prices for much lower quality. It would be hard to find a house a US physician would feel is an equal trade for less than 2 million dollars...more in the big cities. Now, a lot of the essentials are cheap/free. University is much cheaper. Public healthcare is free-although most people highly recommend private insurance, social security is generous.

 

[zenmedic]

Did you ever consider doing telepsychiatry based in the US and still living in NZ?

 

[Candidate2017]

What are the gun laws? Can you bring an AR?

Yes, you can. NZ will recycle it for you, as well as provide free room and board. They confiscated everyone's bang bangs in less than two weeks after the Christ Church shooting.

Interestingly, NZ gun crime has since nearly tripled. But less than the U.S. As an aside, the gun murder rate in the U.S. is remarkably much less than many other countries where guns are generally illegal, and surprisingly exponentially way less than expected given the very high number of guns in America.

 

[forchinet121]

For me the biggest differences are I find kiwis to be far less materialistic and the society to be much more socially cohesive. In 3 years of living in my neighborhood in the states I barely got to know my neighbors. Here I know almost all of them. Interactions with strangers are much more pleasant. There's a sense that everyone is on the same team and everything is going to be alright.

practicing in NZ is much more different than I anticipated. I see 3-6 patients a day. A lot of supervising nurses who have a ton more autonomy...and I thought I was escaping the NP thing. GPs handle the vast majority of cases so the patients I see are quite unwell. The system is in general overburdoned and very beaurocratic. That said nobody struggles to pay for their care nor meds. The community support services are excellent. Pay is about 1/3 of what I made in the states. Taxes are actually pretty comparable to the states-I believe the top bracket is 33%. One huge difference is there are no deductions for...anything. So no 401ks, no filing your taxes at all, they are just taken from your paycheck

Are you the OP??

 

[Sushirolls]

Are you the OP??

Shhh. Don't be bringing logic in to this. We want to believe that the grass is greener in NZ. We want this narrative to be truth, and don't care who answers the questions.

Next question, do rainbows shine even on non rainy days?
Is it true that micro plastics don't exist in NZ, nor PFAS chemicals?
All the coral reefs in Australia didn't die, they just moved to NZ?
Rather than giving people a Lai like in Hawaii, they just give people puppies when they step off the plan?

 

[nmbutah]

1) Why is peerage the same in NZ, but different in Papua New Guinea, when they both recognize the King as sovereign?
2) What is the strangest change in medication names (e.g., Lustral)?
3) Do they use the DSM or ICD, because of the American of it all?
4) How does your American board cert play out in another country? Do they want you to sit for an NZ board?

1) Haha, valid question. I still don't really understand the royalty thing. I get a day off next week for the kings birthday so that makes me a royalist
2) I had referring to tylenol as paracetamol
3) They do use the DSM, but less religiously
4) It is more or less honored, I had to do a year of supervised practice. I am now a member of the "Royal college of Australian and New Zealand Psychiatrists" which sounds way fancier than ABPN

 

[nmbutah]

Are US docs only able to work on rural/under served areas?

Any chance to work in a private practice group in a larger metropolitan?

no, pretty much anywhere will take you -this is not true of Australia
You would have no problems getting a job in the public sector in Auckland/Wellington. Private practice is trickier until you get your "vocational practice certificate" which takes about a year

 

[nmbutah]

What's your favorite type of Kiwi?

the avian type...though I haven't met one yet.

 

[nmbutah]

How much money do you earn per year?

How much money do you earn per year?

About 220K NZD per year -maybe closer to 250 when you include benefits like 15K for CME

 

[nmbutah]

Would love to hear your feedback.
I think most of the important questions have been asked.

the favorite type of kiwi question right?

 

[nmbutah]

Not all the important questions...

What's the sheep to people ratio?:

There was just an article saying it is at an all time low! 5:1. These are truly dark times.

What are the gun laws? Can you bring an AR?

I never thought I would say this but...too strict. Nobody with any mental health history is allowed to own a gun. I believe nothing but rifles and the process to get a gun is very onerous

How are foreigners viewed and treated?

Foreigners from english speaking countries seem to generally be quite welcome and treated well. There's a fair amount of prejudice against other groups. Not all that different from the state

What side of the road do you drive on?

the wrong one

Can you hunt?

I can't, but others can. I hear it is quite good

Can you fish?

poorly, but again, for others, lots of options -they even have a salmon run!

Can you own land or farmland as a foreigner?

you need to reside here for a year before you can buy land (even then there are some work arounds)

What's the naturalization process? Can you even naturalize?

Currently you can apply for residency on arrival, it took about 6 months for them to process our paperwork but I think they are catching up. With residency you get full access to social services and can vote. You need to spend 51% of the time in the country for 2 years, then you are eligible for permanent residency. Then after 5 years you can apply for citizenship but as far as I can tell there aren't too many perks of citizenship except a cool passport with a fern on it.

Are the culture wars present?

present yes, all encompassing, no. This was one of the major things that brought us here.

Are kindergarteners being taught about transgenderism?

not until 1st grade, the kiwi education system is a bit lax.

I've heard before differences in mental health treatment for Mauri, compared to non-Mauri, is this true?

There are health services that are primarily intended for maori patients. They are also welcomed in the general healthcare system

Are the poisonous things just as present in NZ as they are in AUS?

nope! no posionous animals in NZ ....except for a small and rare spider I recently learned

What are the cannabis laws?

they just legalized medical and failed to legalize recreational by 1%

What are the drugs of abuse? Coke? Crack? Meth? Heroin? Fentanyl?

mostly meth, almost no opiates

What military defenses does NZ have? I.e. can it even mount a defense against China?

a couple row boats and slingshots. No, they could not defend against china. I imagine the kiwis would deter an invasion with their charm and cheeky humor

How much Tourism does it get from Lord of the Rings fans? Is there like a season, "oh, great they're back again!"

yes, there are some areas that are super touristy from it

If you throw a 4th of July party will anyone join you?

we had a rocking halloween party

Is it part of the Pacific Ring of Fire, and got any active volcanos? Does it get earth quakes?

many

 

[nmbutah]

Sorry one other question. Can a board certified US psychiatrist come over and begin practicing or are there licensing issues, NZ residency, etc that has to be completed first?

it requires a ton of paperwork but is fairly straightforward. You likely will have to complete a year of supervised practice before being fully independent-it's not too onerous.

 

[nmbutah]

Did you ever consider doing telepsychiatry based in the US and still living in NZ?

I am doing a bit of tele. The downsides are 1) I'm not totally confident my malpractice insurance will be happy to provide coverage in the longterm, but for now they are 2) you need to work for the public healthcare system to get a visa until you are a resident, but that doesn't take long 3) I find tele a bit isolating 4) Most tele companies-but not all-won't let you work from abroad

 

[acleverpsychpun]

Are you the OP??

woops, I was logged into a different account, Yes. I'm OP on both accounts

 

[acleverpsychpun]

Shhh. Don't be bringing logic in to this. We want to believe that the grass is greener in NZ. We want this narrative to be truth, and don't care who answers the questions.

Next question, do rainbows shine even on non rainy days?
Is it true that micro plastics don't exist in NZ, nor PFAS chemicals?
All the coral reefs in Australia didn't die, they just moved to NZ?
Rather than giving people a Lai like in Hawaii, they just give people puppies when they step off the plan?

I was logged into my other account, both are me. And yes NZ is a perfect fairy land with no suffering or difficult patients.
It has ups and downs like anywhere else

 

[acleverpsychpun]

I appreciate the answers. Thank you for not getting sucked into unfruitful debates about firearm policy and speaking more to daily life as a psychiatrist, good and bad. People can Google NZ politics.

How do you invest or save for retirement if there are no 401k?
(Looks like $250,000 NZD is about $151,000 USD in case anyone else is wondering.)
Also, you aren't OP. I suppose you are a different person practicing in NZ?

there is kiwisaver in which your employer will mach your contributions up to 3%. The downsides are it isn't tax deductible-nothing is!, you have to put it into a "plan" which charges fees I find high. Otherwise your pretty much on your own.

I am OP I just had an old SDN account my computer was logged into

 

[wellbutrin.girlfriend]

1. How does it feel to be living my dream?
2. Did you have significant loan burden going into this adventure? Did that factor into your decision at all?

 

[Ceke2002]

1) Haha, valid question. I still don't really understand the royalty thing. I get a day off next week for the kings birthday so that makes me a royalist

The Monarchy in NZ and Aus is basically the same. We both have a Governor General, who is appointed by the Sovereign on the advice of the Prime Minister. In practice all this means is the Prime Minister of either country simply contacts the Sovereign and says, "Right, here's our next Governor General"and the Sovereign replies, "Okay".

The role of Governor General in both countries is largely ceremonial, although they do have some constitutional duties as well. Essentially their constitutional role is to ensure that Government runs smoothly and to help facilitate the work of Parliament. Basically the Sovereign reigns, but the Government rules. In both countries the Governor General acts on the advice of Ministers, who are responsible to Parliament and elected by the people.

The Governor General in Australia and New Zealand does hold some reserve powers, but they are used sparingly. Reserve powers include the ability to dissolve Parliament and force an early election. In Australia the Governor General's reserve powers to dissolve Parliament and force an early election (double dissolution) have only been used 7 times since 1914.

New Zealand also has a Traditional Maori Monarchy, which was established in 1850 under the Maori King Movement (or Kingitanga) as a way of trying to halt the alientation of Maori land. Tūheitia Potatau Te Wherowhero VII (Kingi Tūheitia) is the current Maori King, although not all Maori people or communtiies accept this.

 

[trophyhusband]

Awesome, we moved to Canada and the wife started working as a CAP here in Feb. Liking it a lot so far but we might eventually be interested in NZ. That pay is rough and the exchange rate is even worse than CAD... though the way they do taxes does sound nice.

 

[MedMan80]

It sounds good but i wonder what the living standards are there, I'm sure you do well. But doubt that you can have a "doctor living", maybe all of that is overrated to begin with. I think it depends on what you value at the end of the day.

 

[acleverpsychpun]

Awesome, we moved to Canada and the wife started working as a CAP here in Feb. Liking it a lot so far but we might eventually be interested in NZ. That pay is rough and the exchange rate is even worse than CAD... though the way they do taxes does sound nice.

How was getting licensed in Canada? I’ve heard they’ve recently made it a lot more straightforward in Ontario and the Maritimes? We’ve thought about Canada as a place that’s “closer” to the US. Both physically and pay/culturally

 

[acleverpsychpun]

It sounds good but i wonder what the living standards are there, I'm sure you do well. But doubt that you can have a "doctor living", maybe all of that is overrated to begin with. I think it depends on what you value at the end of the day.

We’re definitely much materially poorer here. That said we are more than “comfortable”.

 

[trophyhusband]

How was getting licensed in Canada? I’ve heard they’ve recently made it a lot more straightforward in Ontario and the Maritimes? We’ve thought about Canada as a place that’s “closer” to the US. Both physically and pay/culturally

Yeah, Ontario and Nova Scotia have made things easier. We're in Calgary so we had to go through the more painful process. That said it's not that bad, the licensing bodies just don't help you much along the way. No one in the department had gone through this previously so there wasn't really anyone to ask either.

She had to do a 12 week "supervision" where another doc did chart reviews with her but the good news is she could bill for that time so she got paid for doing it. It's a bit ridiculous in that the only person who can supervise you is the person doing the exact same job as you... so the person most desperate to bring you on is the only one who can decide if you're qualified.

British Columbia's process is supposed to be much worse so it's probably good that we didn't try their first.

Physicians are largely self-employed. She bills the Province for everything and gets paid by them weekly. They pay almost everything unless you screw something up. I've gotten pretty good at billing and it only takes 20 min or so at the end of the night to submit everything. It's a lot easier than the US.

Not working super hard it looks like she should make low to mid-$300's in USD. She's doing ER, Inpatient CL and Outpatient CL... not all on the same day.

She gets paid based on time so there's not a huge incentive to blow through assessments. And she gets paid for lots of stuff she had to do for free in the US. Talk to parents outside the room? There's a code for that. Do family therapy during an appointment? There's a code for that. Call the parents on the phone? There's a code for that. Talk to any medical personnel (nurse, physician, resident, therapist, social worker, etc.)? There's a code for that. Did you do rounds in the morning and afternoon for ER patients? Charge for all of them. Did the pharmacist call you to carify something? There's a code for that. Did you have to put a patient on a psych hold? There's a code for that. Did you do group therapy for patients? Charge for each and every patient in the group.

Now you do get paid more for the initial part of the appointment. So the days where you're in the ER and see 12 patients you make a killing going from pod to pod charging for the consult and then talking to the ER nurse posted there for every patient. But on days when there's only 3 or 4 patients you're not totally screwed because you just spend more time with those patients and charge the time to them.

She's digging it so far. There's call once a month but it's super benign compared to what she experienced in residency/fellowship (doesn't stop the Canadian docs from whining about it) and seeing patients at night/on weekends/on holidays pays more. Oh and they work from 9-4 here and everyone whines if they have to come in earlier or leave later.

It's only been a few months but so far so good.

 

[Merovinge]

Yeah, Ontario and Nova Scotia have made things easier. We're in Calgary so we had to go through the more painful process. That said it's not that bad, the licensing bodies just don't help you much along the way. No one in the department had gone through this previously so there wasn't really anyone to ask either.

She had to do a 12 week "supervision" where another doc did chart reviews with her but the good news is she could bill for that time so she got paid for doing it. It's a bit ridiculous in that the only person who can supervise you is the person doing the exact same job as you... so the person most desperate to bring you on is the only one who can decide if you're qualified.

British Columbia's process is supposed to be much worse so it's probably good that we didn't try their first.

Physicians are largely self-employed. She bills the Province for everything and gets paid by them weekly. They pay almost everything unless you screw something up. I've gotten pretty good at billing and it only takes 20 min or so at the end of the night to submit everything. It's a lot easier than the US.

Not working super hard it looks like she should make low to mid-$300's in USD. She's doing ER, Inpatient CL and Outpatient CL... not all on the same day.

She gets paid based on time so there's not a huge incentive to blow through assessments. And she gets paid for lots of stuff she had to do for free in the US. Talk to parents outside the room? There's a code for that. Do family therapy during an appointment? There's a code for that. Call the parents on the phone? There's a code for that. Talk to any medical personnel (nurse, physician, resident, therapist, social worker, etc.)? There's a code for that. Did you do rounds in the morning and afternoon for ER patients? Charge for all of them. Did the pharmacist call you to carify something? There's a code for that. Did you have to put a patient on a psych hold? There's a code for that. Did you do group therapy for patients? Charge for each and every patient in the group.

Now you do get paid more for the initial part of the appointment. So the days where you're in the ER and see 12 patients you make a killing going from pod to pod charging for the consult and then talking to the ER nurse posted there for every patient. But on days when there's only 3 or 4 patients you're not totally screwed because you just spend more time with those patients and charge the time to them.

She's digging it so far. There's call once a month but it's super benign compared to what she experienced in residency/fellowship (doesn't stop the Canadian docs from whining about it) and seeing patients at night/on weekends/on holidays pays more. Oh and they work from 9-4 here and everyone whines if they have to come in earlier or leave later.

It's only been a few months but so far so good.

Thanks for the write up.

Love hearing people whine about how much US MDs make as though one can't do well as a doc working in Canada, private practice UK, or Australia (three countries that speak the same language and have a lot of cultural similarities as well...).

 

[alina_s]

Awesome, we moved to Canada and the wife started working as a CAP here in Feb. Liking it a lot so far but we might eventually be interested in NZ. That pay is rough and the exchange rate is even worse than CAD... though the way they do taxes does sound nice.

Are you planning on staying long-term? I looked into BC at one point but the process was complicated and slow and I didn’t have enough $$$ saved up to wait months to start working. I also think the hospital where I interviewed was less organized than most. It sounded like I was eventually going to have to take the Canadian equivalent of the ABPN exams if I ever wanted to be independent- not required to work at a site with a supervisor. Is that the case in Alberta, or is your wife independent after those probationary month?

 

[trophyhusband]

Are you planning on staying long-term? I looked into BC at one point but the process was complicated and slow and I didn’t have enough $$$ saved up to wait months to start working. I also think the hospital where I interviewed was less organized than most. It sounded like I was eventually going to have to take the Canadian equivalent of the ABPN exams if I ever wanted to be independent- not required to work at a site with a supervisor. Is that the case in Alberta, or is your wife independent after those probationary month?

We'll see about the staying long-term thing. The wife is latin so there's always this strong pull to be near her family... we keep yo-yo'ing back and forth between Texas and dear God anywhere but Texas. Hoping to stay long enough to get citizenship at least.

BC seems to be pretty notorious for being the worst province to try to practice outside of Quebec. They seem to make it difficult for even other Canadian docs to make the move.

Onterio and Nova Scotia (and maybe a couple of other Atlantic provinces) just made it super easy for Board Certified docs from the US to make the move.

Alberta isn't quite as accommodating but it's not as bad as BC. Now that she's completed her practice assessment they recommend that she take the Canadian exams and certification but she isn't required to do so. I think she would get an independent license quicker if she did so but that's not a big deal to her right now. She now has a 6 year provisional license and after 5 years on it she can convert to a full independent license. All provisional means is that she's required to keep her sponsorship with Alberta Health Services (the provincial hospital system) which she's planning to do anyway. So she couldn't go and do a full private practice or anything.