Leaving US

[JohnnyDoc]

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Hi there,

With all the bull**** that physicians have to deal with (government limiting how much you can earn, nurses who think they are equal or better than you, everyone thinking you're rich and should earn less, declining reimbursement, confusing coding for reimbursement, turf wars, people with less training getting more autonomy (NPs and CRNAs), and politicians screwing you financially), would you think about leaving US and practice in another more physician-friendly country? If yes, where would you move to?

 

[YF786]

Hi there,

With all the bull**** that physicians have to deal with (government limiting how much you can earn, nurses who think they are equal or better than you, everyone thinking you're rich and should earn less, declining reimbursement, confusing coding for reimbursement, turf wars, people with less training getting more autonomy (NPs and CRNAs), and politicians screwing you financially), would you think about leaving US and practice in another more physician-friendly country? If yes, where would you move to?

From what I know, I believe physicians earn the best in the US in comparison to other countries around the world. Southeast Asia for example has not so great conditions for doctors, they have way too many and they are not paid what they deserve.

 

[graviton]

in another more physician-friendly country?

Do tell us more about these countries more "physician-friendly" than the US. I guess grass is always greener on the other side (of the Pond).

 

[cbrons]

Yes (Singapore)

 

[deleted547631]

Australia


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[Pagan FutureDoc]

Not really, as bad as it gets I really want to help people in the US. I look at other countries and almost every on of them seems worse for doctors.

 

[deleted480308]

nowhere else has the same level of money and firearm freedom...

 

[ERDOC555]

As many people have said before, the US is surprisingly a decent place to practice when you look at almost all the other developed countries.

Most countries pay their doctors less and even the ones where doctors make about the same or more (ratio of doctor salary to average population salary) have such ridiculous taxes that your buying power and financial well-being are reduced. I researched it a while back and the explicit ($$$) and implicit (I actually like living in America) costs were simply too high to justify practicing anywhere else. Yes, the US system has a plethora of issues, but as bad as it is, I can't see myself practicing anywhere else!

 

[Brahnold Bloodaxe]

The US currently has the best physician compensation. However, this may change by the time we here are attendings earning attending paychecks. If there comes a day where I can make more money in Australia or Canada, or even Asia, then I will definitely move there if I can. Better money AND dealing with less PITA patients? lol why not

 

[Stagg737]

Australia, though it wouldn't be for compensation reasons.

 

[sloop]

I probably would not leave the U.S. The simple reality is that it is unlikely now or in the near future that it would be financially sensible to train here and practice elsewhere.

Additionally, while I am not strongly patriotic in the traditional sense of the word (as anybody who knows me would attest), I do believe that I have some duty to the people who have surrounded me and supported me to be around for them in the future. I feel this way both professionally and personally. I feel like I owe it to my family, which has only given me love and support, but I also feel like I owe it to Americans who have supported me in my professional career. I went to a public high school, I was supported by scholarship money in college, and was probably supported by Americans in so many other ways I do not even notice. I would feel a little dirty about forgetting that stuff and moving on to greener pastures.

I respect people who do not have this sense of public duty, but I do feel it to some extent and it does keep me from wanting to fly off to some other country to practice.

 

[IslandStyle808]

What sources do people use for their physician compensations across countries? The only source I know of with a comparison is the OECD, anything else?

 

[deleted731525]

I have heard while Canadian doctors make a bit less(although I think some specialties make around the same), that they are generally happier. That is the only place I could see myself moving but I hear it is hard as hell to move there as a physician.

 

[WingedOx]

less PITA patients?

that's quite the assumption...

 

[TBV]

Australia in a heartbeat if my paycheck was made comparable

 

[Bacchus]

Don't forget, in a lot of countries, it is difficult, if not impossible, to practice as a foreign physician REGARDLESS of your education.

 

[Mansamusa]

Last I heard, in Australia you need to work 10 yrs in an underserved rural area if you want to be a fully practicing physician (which is actually an idea we should toss around in the US), so you'd have to be okay with that.

I would actually also do Singapore, but my school isn't on their pre-approved list. I would have to look into that. Otherwise, maybe a mix of US and international locums work

 

[eteshoe]

If conditions got bad enough in the US, I would just phase out practicing and rely on my PhD more. I spent all this time and effort to get into this country so I might as well stay

 

[Dr. Janitor]

nowhere else has the same level of money and firearm freedom...

Your words do justice for your profile pic.

 

[68PGunner]

Singapore used to be a hidden gem. It has incredibly gotten overrated in the past few years. Have fun renting a decent sized apartment for 3-4K/month.

 

[ConfusedChemist]

I have heard while Canadian doctors make a bit less(although I think some specialties make around the same), that they are generally happier. That is the only place I could see myself moving but I hear it is hard as hell to move there as a physician.

There's also so few nonFM jobs that Canadians will jump through tons of visa-hoops to work in the US.

 

[Mansamusa]

Singapore used to be a hidden gem. It has incredibly gotten overrated in the past few years. Have fun renting a decent sized apartment for 3-4K/month.

One of my best friends from college is the child of someone in the Singaporean ministry (they make bank) and she is starting her trek up through the finance ministry. I stayed with her in Singapore the other month and we discussed this kind of stuff. It seems like a good deal to me as long as you are specialized (general surgeons, IM, FM don't make a ton). The average specialize doctor brings in $276K, which is only charged with a 12.37% tax rate. That leaves $242K.

 

[Mad Jack]

Don't forget, in a lot of countries, it is difficult, if not impossible, to practice as a foreign physician REGARDLESS of your education.

Australia, Canada, the Middle East, New Zealand, and Singapore are pretty easy for a US grad to transition to, particularly if your specialty is FM.

 

[Mad Jack]

If conditions got bad enough in the US, I would just phase out practicing and rely on my PhD more. I spent all this time and effort to get into this country so I might as well stay

Sunk cost fallacy 😉

 

[bannie22]

Singapore/Japan is the plan.

 

[68PGunner]

One of my best friends from college is the child of someone in the Singaporean ministry (they make bank) and she is starting her trek up through the finance ministry. I stayed with her in Singapore the other month and we discussed this kind of stuff. It seems like a good deal to me as long as you are specialized (general surgeons, IM, FM don't make a ton). The average specialize doctor brings in $276K, which is only charged with a 12.37% tax rate. That leaves $242K.

Even if you do make $250-300K in this country, you will only pay about 12-18% in tax rate if you have a good accountant. I have done my tax for the past 8-9 years so I'm very well versed in all the deductions and loopholes available out there.

For example, White Coat Investor makes like $350-400K/yr and he pays like 18% in tax.

 

[68PGunner]

Singapore/Japan is the plan.

Are you fluent in Japanese? That's the only way for you to practice medicine in Japan. I had lived in Japan for 3 years. You don't want to be a physician in Japan considering its lower income due to the one payer system.

 

[bannie22]

Are you fluent in Japanese? That's the only way for you to practice medicine in Japan. I had lived in Japan for 3 years. You don't want to be a physician in Japan considering its lower income due to the one payer system.

How much do they make?

 

[68PGunner]

How much do they make?

$140K for primary care before taxes.

 

[68PGunner]

Lastly, if things go hot in Asia especially with China and North Korea, you don't want to be caught in that bottleneck of Americans trying to go back home. Money doesn't do much when bullets start flying. You're paying a higher tax rate in order to have the world biggest bully, aka the US military, on your side.

 

[Anicetus]

As we shift towards "being like the European countries" like all the youngins of today want America to be, our compensations as physicians in the U.S. will inevitably drop. You really can't deny it.

I would still only leave this country if I had no choice but to practice in the Deep South, Wyoming, or anywhere that isn't around the ocean or a diverse city such as the coasts. Who knows, maybe one day they may start shipping us to rural areas to practice if we don't make the cut in the saturated cities of America. They already indirectly do this arguably through Step 1 and the match. You think the guy practicing in northern Nevada got a 260 on his step 1?

America is great, but I'd rather live in another country than in one of America's rural towns.

 

[68PGunner]

As we shift towards "being like the European countries" like all the youngins of today want America to be, our compensations as physicians in the U.S. will inevitably drop. You really can't deny it.

I would still only leave this country if I had no choice but to practice in the Deep South, Wyoming, or anywhere that isn't around the ocean or a diverse city such as the coasts. Who knows, maybe one day they may start shipping us to rural areas to practice if we don't make the cut in the saturated cities of America. They already indirectly do this arguably through Step 1 and the match. You think the guy practicing in northern Nevada got a 260 on his step 1?

America is great, but I'd rather live in another country than in one of America's rural towns.

What makes you think we're becoming Europe? We're nothing like Europe.

 

[deleted480308]

One of my best friends from college is the child of someone in the Singaporean ministry (they make bank) and she is starting her trek up through the finance ministry. I stayed with her in Singapore the other month and we discussed this kind of stuff. It seems like a good deal to me as long as you are specialized (general surgeons, IM, FM don't make a ton). The average specialize doctor brings in $276K, which is only charged with a 12.37% tax rate. That leaves $242K.

you're information is incorrect.... https://www.iras.gov.sg/IRASHome/In...xes/Tax-Rates-for-Resident-and-Non-Residents/

 

[bannie22]

$140K for primary care before taxes.

That wage is equivalent to being in the US!

what about for specialties?

 

[deleted480308]

That wage is equivalent to being in the US!

what about for specialties?

you are being robbed if you only make $140 in the US pre-tax

 

[Mansamusa]

you're information is incorrect.... https://www.iras.gov.sg/IRASHome/In...xes/Tax-Rates-for-Resident-and-Non-Residents/

Put the salary into the tax calculator on the side.

It gives the same value that this site does as well http://www.salary.sg/2015/income-tax-calculator-ya2015/
http://www.salary.sg/2014/income-tax-calculator-ya2014/ And the same for the year before

 

[deleted480308]

Put the salary into the tax calculator on the side.

It gives the same value that this site does as well http://www.salary.sg/2015/income-tax-calculator-ya2015/

I see now.....you meant effective and not stated

 

[Stagg737]

Last I heard, in Australia you need to work 10 yrs in an underserved rural area if you want to be a fully practicing physician (which is actually an idea we should toss around in the US), so you'd have to be okay with that.

I haven't heard of their 10 year rule, but there are always ways around it. If you practice in an "area of need" (meaning field of medicine where they need more doctors, not geographic area) they'll essentially fast-track you to get you to there. I also know that 7 or 8 years ago they were on a population decline and were offering some pretty major benefits to young couples to move there and have kids. I'm sure that they would have been willing to waive or shorten that 10 year requirement to attract a young, educated couple, as a former co-worker moved there during that time. Idk if that's still available, but it would potentially be something to look into when moving to any foreign country.

Link to tracts to practising medicine there:http://www.medicalboard.gov.au/Registration/International-Medical-Graduates.aspx

 

[MarioKart]

I plan on staying in the U.S., but Australia is a good option, and England is too. In England though I believe you start straight out of high school (correct me if I'm wrong) and then you are a "junior Doctor" for a few years, so idk if that would work since most of us are done with high school, but I still want to live in England

 

[67552931811]

I plan on staying in the U.S., but Australia is a good option, and England is too. In England though I believe you start straight out of high school (correct me if I'm wrong) and then you are a "junior Doctor" for a few years, so idk if that would work since most of us are done with high school, but I still want to live in England

 

[Crayola227]

what's crazy in England you are finished with high school at 16!
and it is the age of consent
and you can't drive until you are 18 years old

they let you **** before you drive. blows my mind kids being done with school at 16

 

[cbrons]

I plan on staying in the U.S., but Australia is a good option, and England is too. In England though I believe you start straight out of high school (correct me if I'm wrong) and then you are a "junior Doctor" for a few years, so idk if that would work since most of us are done with high school, but I still want to live in England

Have fun in Londonnistan. That entire country will be under Sharia law within a decade.

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[YF786]

Have fun in Londonnistan. That entire country will be under Sharia law within a decade.

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I don't understand why religion would play a role in how doctors are paid. If that's the case then must be the same with Christianity in the US.
P.S. If you think you know "sharia law" by what you see in social media then you have got it all wrong. Islam is the religion of peace! Quran teaches respect to every religion. For example India has the largest amount of people practicing Islam but it produces some of the best doctors in the world and I don't see any of them leaving the country because of " sharia law"!

 

[YF786]

No

I plan on staying in the U.S., but Australia is a good option, and England is too. In England though I believe you start straight out of high school (correct me if I'm wrong) and then you are a "junior Doctor" for a few years, so idk if that would work since most of us are done with high school, but I still want to live in England

not just England but many European countries and all of Middle East and Southeast Asia is like that. The students in middle east and Southeast Asia go to med school right after 12th standard. In England it's right after 10th standard. They don't need any bachelors to get into med schools. Their board exams after finishing 12th/10th standard is the deciding factor as to whether they can go to med school or not.

 

[IslandStyle808]

No
not just England but many European countries and all of Middle East and Southeast Asia is like that. The students in middle east and Southeast Asia go to med school right after 12th standard. In England it's right after 10th standard. They don't need any bachelors to get into med schools. Their board exams after finishing 12th/10th standard is the deciding factor as to whether they can go to med school or not.

Just to emphasize this post, medical school is at the baccalaureate level in this case (i.e. MBBS, MBBCh, etc.).

 

[nonick123]

Actually, there are many doctors in England who are from India and Eastern Europe. And if u went to med school in the latter(usually 6 year programme), u must do two years( as I remember) as an intern(rotate in different specialities) and after that it is possible to start the "real"residency. It is a long route and many times after your intern years there aren't any free spots and u must wait or choose to become GP.

 

[tux4]

It might be a good temporary experience but long term not so much. Practicing in a country with limited resources could help develop physical exam skills.


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[deleted564680]

Just to emphasize this post, medical school is at the baccalaureate level in this case (i.e. MBBS, MBBCh, etc.).

Best part about this is there are many physicians of British-system origin (India usually) who have an MBBS and they come to the US and poof! MD on the coat.

 

[Brahnold Bloodaxe]

The Singapore approved schools list is ridiculous. There are nearly as many UK schools on it as American schools, despite the UK being only slightly more populous than the state of California and not exactly a research powerhouse. Singapore be like it's still the 19th century.

 

[Seth Joo]

Hi there,

With all the bull**** that physicians have to deal with (government limiting how much you can earn, nurses who think they are equal or better than you, everyone thinking you're rich and should earn less, declining reimbursement, confusing coding for reimbursement, turf wars, people with less training getting more autonomy (NPs and CRNAs), and politicians screwing you financially), would you think about leaving US and practice in another more physician-friendly country? If yes, where would you move to?

The problem you will have as a doctor, even as a US trained and educated physician is that it won't be easy to get practice rights in another country. The most likely foreign country that would grant a US physician practice rights would be Canada and I have heard horror stories about getting a license to practice there. There is also the issue of language and culture in another country, things will be very different overseas, you might feel like you are on another world.

I have been to Japan numerous times because that is my parent's homeland, its a nice place but its impossible for US physicians to practice medicine there. Also Japanese physicians earn on average less than half their US counterparts. Also factor in that the cost of living there is much higher than the US, a bowl of Ramen can cost 10 bucks outside the largest cities.

If you were keen on working outside of the US, maybe you should have received your education and training overseas as well. Your financial burden would have been much lower.