Feasibility of picking up locums 3-6 months a year?

[uhmocksuhsillen]

Spouse and I have decided to check out. We're going to "retire" early and get rid of our house and her job. Plan is to slow travel 6-9 months a year; i.e. spending a couple of months apiece in a few different locations abroad. We're going to let our nest egg grow over the next 20 or so years while we fund ourselves with work I do 3-6 months of the year.

How realistic is this and/or what would be the best way to accomplish this? I would probably end up committing to working half the year (maybe less). Is it reasonable to find locums that could accommodate this year after year?

I do have about 8-10 hours a week of insurance based practice I do for another clinic. I can't find anything wrong with billing insurance abroad (obv cannot do CMS), so there is thought to keep this job as well. Any thoughts on this?

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[TexasPhysician]

The biggest problem I see is maintaining good health insurance.

 

[uhmocksuhsillen]

The biggest problem I see is maintaining good health insurance.

Ive been looking at expat insurance for this. Seems to be some decent options. As an s corp owner I also have some better options and write offs too if I have to self insure.

But I take your comment to mean you think finding once a year locum gig won't be too difficult?

 

[TexasPhysician]

Ive been looking at expat insurance for this. Seems to be some decent options. As an s corp owner I also have some better options and write offs too if I have to self insure.

But I take your comment to mean you think finding once a year locum gig won't be too difficult?

I don’t think it would be hard. I’d probably keep something minimal on my CV that is continuous to make it appear like I’m staying current.

Most health issues for physicians are manageable to just pay off. If I need to drop $2k for a procedure today, it would be a problem. I insure for the day I get cancer (pray it doesn’t happen). Treatment at MD Anderson or Sloan Kettering is likely millions. These top places usually only accept plans that are reserved for businesses. Marketplace plans, United’s self plans, and others that you can find out there aren’t covering top hospitals.

 

[PsyDr]

1) You might not be able to prescribe any controlled medications from outside the USA and her territories. Registration Q&A
2) Your DEA license HAS to be a physical address in the US, from which you conduct your business. This pierces a lot of liability protections. If you label your parents house as the place you conduct your business, and get sued, there is a potential problem.
3) Malpractice policies have clauses prohibiting practicing from abroad. You could violate that unintentionally.
4) Health insurance, especially for more chronic or severe things (e.g., if you have to return to the states for cardiac rehab or something).
5) Some countries have extremely strict IT laws, that encompass telemedicine. Notice how some EU countries don't use telemedicine at all? Yeah...
6) The IRS moved to a pro-rated thing for overseas income, the other year.
7) If you are putting money in foreign accounts, at a physician level of income, I would expect to get delayed at Customs regularly.
8) Keep in mind that there is a 4th amendment exemption at the border. I don't know how that works with HPI on your computer.

 

[Merovinge]

I don’t think it would be hard. I’d probably keep something minimal on my CV that is continuous to make it appear like I’m staying current.

Most health issues for physicians are manageable to just pay off. If I need to drop $2k for a procedure today, it would be a problem. I insure for the day I get cancer (pray it doesn’t happen). Treatment at MD Anderson or Sloan Kettering is likely millions. These top places usually only accept plans that are reserved for businesses. Marketplace plans, United’s self plans, and others that you can find out there aren’t covering top hospitals.

I totally agree, having health insurance that is good is a big deal. I self-insure everything else when possible, but for healthcare you would need to have 8 figures floating around to be able to fully cover the worst yet treatable conditions. I have already seen care get into the 7 figures at the drop of a hat without any pre-existing conditions in a young adult.

 

[uhmocksuhsillen]

1) You might not be able to prescribe any controlled medications from outside the USA and her territories. Registration Q&A
2) Your DEA license HAS to be a physical address in the US, from which you conduct your business. This pierces a lot of liability protections. If you label your parents house as the place you conduct your business, and get sued, there is a potential problem.
3) Malpractice policies have clauses prohibiting practicing from abroad. You could violate that unintentionally.
4) Health insurance, especially for more chronic or severe things (e.g., if you have to return to the states for cardiac rehab or something).
5) Some countries have extremely strict IT laws, that encompass telemedicine. Notice how some EU countries don't use telemedicine at all? Yeah...
6) The IRS moved to a pro-rated thing for overseas income, the other year.
7) If you are putting money in foreign accounts, at a physician level of income, I would expect to get delayed at Customs regularly.
8) Keep in mind that there is a 4th amendment exemption at the border. I don't know how that works with HPI on your computer.

Seems like I could rent an office in the US and use that as my DEA location. Could also just not rx controlled meds too I suppose. I would essentially be working while a tourist, so wouldn't have foreign bank accounts - I'd still be based in the US for roughly half the year.

 

[comp1]

I just cannot relate to wanting to do that much travel and not having a consistent home to return to...

 

[surfguy84]

I just cannot relate to wanting to do that much travel and not having a consistent home to return to...

Slow travel is a lifestyle more than a trip. I do think it's a great way to FIRE early if you're spending half the year in low cost destinations. I see the allure.

 

[calvnandhobbs68]

I don’t think it would be hard. I’d probably keep something minimal on my CV that is continuous to make it appear like I’m staying current.

Most health issues for physicians are manageable to just pay off. If I need to drop $2k for a procedure today, it would be a problem. I insure for the day I get cancer (pray it doesn’t happen). Treatment at MD Anderson or Sloan Kettering is likely millions. These top places usually only accept plans that are reserved for businesses. Marketplace plans, United’s self plans, and others that you can find out there aren’t covering top hospitals.

Almost anyone who is traveling out of state to go somewhere like MD Anderson is likely paying significant out of pocket costs. There are tons of employer plans that have a fairly restrictive network or have no out of network coverage whatsoever. Many many large academic places “self insure” with their own health plan, so if you can technically find the service in their network, they aren’t covering out of network.

I wouldn’t base being employed on whether I can find health insurance coverage that might possibly cover if I need to go to Sloan Kettering some day.

 

[Candidate2017]

Finding 6 months' locums is easy. But you're probably asking about locums at the same place for 6 months every year? Probably difficult. It may be easier to negotiate 2 week on/2 week off inpatiet job, or work something out with telepsych and your present job.

Life abroad is easy while healthy and young. But health issues will certainly arise (including for both sets of your parents who are geriatric or approaching geriatric). Kids, divorce, and life in general can also throw kinks in your plan. It may be simpler to work a lot and make a lot over a few years then semi-retire, but do locums a few months per year to keep your skills and finances sharp.

 

[uhmocksuhsillen]

Finding 6 months' locums is easy. But you're probably asking about locums at the same place for 6 months every year? Probably difficult. It may be easier to negotiate 2 week on/2 week off inpatiet job, or work something out with telepsych and your present job.

Life abroad is easy while healthy and young. But health issues will certainly arise (including for both sets of your parents who are geriatric or approaching geriatric). Kids, divorce, and life in general can also throw kinks in your plan. It may be simpler to work a lot and make a lot over a few years then semi-retire, but do locums a few months per year to keep your skills and finances sharp.

I'm totally flexible. I'd just like to find locums in the same general metro region, not necessarily the same facility.