Psychologists living as a Digital Nomad

[psychpro]

I currently work as a licensed psychologist in New Jersey, and have a passport to practice telehealth in approved states. I will probably get licensed in New York pretty soon as well.

I have gotten to a place where I enjoy my work, and I am in a good position financially, and also see things only getting better. Lately I find myself being just a bit envious of those who can work from whatever location they choose in the world. I've always loved to travel, and being single and childless the only thing keeping me state side is work. I have started to explore the possibility of a digital nomad lifestyle for psychologists, and wonder if there are any psychologists who practice psychology remotely (Treating USA patients but living in a different country). I know many states allow you to practice remotely as long as you are seeing clients in a state you are licensed, but not really sure how it would work internationally. Anyone know of anyone who has done something like this before?

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[AbnormalPsych]

This has come up on the board in other contexts before if you search a bit. There's a lot of issues as I am sure you are aware. Insurance and law related being only a few of them.

Paging @PsyDr

 

[erg923]

Is there a less douchebaggy term for what you are describing?

 

[WisNeuro]

This has come up on the board in other contexts before if you search a bit. There's a lot of issues as I am sure you are aware. Insurance and law related being only a few of them.

Paging @PsyDr

Don't forget the possibility of double taxation.

 

[PsyDr]

1) For CMS (Medicare, Medicaid) patients, you MUST be physically within the USA or it’s territories. So your plan must exclude anyone with that insurance. And you have to opt out every two years.

2) Within the EU, foreign telemedicine falls within their digital privacy laws. IMO, it is not possible to meet those standards with telemedicine from the USA. PRC is a nightmare. Japan too. Stralia is basically EU laws. And the UK is the easiest place to sue people in the world. South Park made a joke about it.

3) for states where you can hospitalize people, you must be physically present. This cannot be accomplished via telemedicine.

4) Once the emergency exemption ends, most telemedicine things become much much more complicated.

5) Banking becomes a problem. The set up will look concerning to the IRS and third party payors. There are scams attempting to offshore US dollars. You’ll look like one.

6) Work visas are a huge issue. You can arguably say that you are a tourist, but then your stay is limited to 90 days, and you can’t leave briefly and reset the clock. That means you have to move 4 times per year, leaving weekends to travel to a new country, get set up with internet and goods, and then back to work. Every 89 days. Returning to a preferred country will ring alarm bells, with some places limiting how long you can be a tourist. And the UK is all weird about shops being open on sundays. Plus border agents are going to ask about your finances. “I have variable money coming in each month” sounds bad.

7) time difference is a huge issue. It’s easy to work from 2pm-10pm for a while. Not so much long term. Best case scenario: you can’t really date or see your kids during the week. Worse case: your schedule isolates you from everyone else. Plus patients are going to ask why it’s dark in your side of the screen.

8) Most countries including the USA allow their border agents to look through your laptop and cell phone without a warrant. You have zero rights within 100 miles of a US border. This violates HIPPA. Some countries are bad enough that fortune 100 companies send burner laptops and phones with their employees.

9) The number of countries that have unfailing internet, unfailing cell reception, and do not cap internet usage, are limited and expensive. Most EU countries have caps on data. Most South American, Caribbean, and south Asian countries lack the stable infrastructure to support unfailing internet. Guessing that applies to most African countries. One time I paid a $300 phone bill for a teleconference meeting abroad.

10) size of housing becomes an issue for WFH. Are you willing to essentially confine yourself to a 968sq ft cell? How sure are you that the neighbors are going to be unheard?

11) Most state boards require a response to their letters in a certain time frame. While this can be worked around, it’s still a risk.

12) Long term travel health insurance sounds expensive .

 

[borne_before]

I've thought about this, but for the US of A.

My ex-nurse prac for ADHD meds does this. She's got a beast of a 5th wheel and a 2500HD or F350 or some other beast to tow it. She doesn't tell people when she does it, but I noticed her set up one time and she was like taken aback a little that I noticed (campers have a very unique aethstetic). She kinda sucks and I transferred because she thought I have ASD (he kid has so everyone has it to her).

Most people don't even notice though. You could do simple practice/utilization review stuff. Gotta consider WIFI and power usage if nomading on public land (east coasters - most of the western states are majority publicly owned and you can camp/hunt/fish on that land without permission for up to two weeks before moving this is also called boondocking). Also, I hope you enjoy pooping in a bucket with some kitty litter and a bag...

 

[BuckeyeLove]

I've thought about this, but for the US of A.

I feel like this would be much more possible/plausible/feasible than the OP's idea. But our state-bound licensing culture still makes things annoyingly difficult. taxes too. Maybe it's not too late to get into the life coaching game. Way less headaches. Still call myself dr.

 

[foreverbull]

I currently work as a licensed psychologist in New Jersey, and have a passport to practice telehealth in approved states. I will probably get licensed in New York pretty soon as well.

I have gotten to a place where I enjoy my work, and I am in a good position financially, and also see things only getting better. Lately I find myself being just a bit envious of those who can work from whatever location they choose in the world. I've always loved to travel, and being single and childless the only thing keeping me state side is work. I have started to explore the possibility of a digital nomad lifestyle for psychologists, and wonder if there are any psychologists who practice psychology remotely (Treating USA patients but living in a different country). I know many states allow you to practice remotely as long as you are seeing clients in a state you are licensed, but not really sure how it would work internationally. Anyone know of anyone who has done something like this before?

As discussed in many threads about practicing overseas, the short answer is—no, there’s no way to ethically do this and travel the world at the same time. It IS possible to move to another country and get licensed to practice there after navigating their rules and requirements, but I’m not sure how you’d maintain a license in the U.S. without a residence and practice with U.S. clients (see PsyDr’s comments).

I think about this every time I watch House Hunters International and see a couple moving to X country and working from home, and the best I can come up with is the easiest way to do this is to switch to providing a service in your area that is not overseen by a board and is remote-work-friendly, like non-clinical consultation or some kind of training, and once you have a solid and ongoing market demand for your services in your locale, you might be able to transfer that out of state or country. As long as the service isn’t under a board, you have good WiFi where you are, and you can support yourself financially, it could theoretically work.

 

[Sanman]

As discussed in many threads about practicing overseas, the short answer is—no, there’s no way to ethically do this and travel the world at the same time. It IS possible to move to another country and get licensed to practice there after navigating their rules and requirements, but I’m not sure how you’d maintain a license in the U.S. without a residence and practice with U.S. clients (see PsyDr’s comments).

I think about this every time I watch House Hunters International and see a couple moving to X country and working from home, and the best I can come up with is the easiest way to do this is to switch to providing a service in your area that is not overseen by a board and is remote-work-friendly, like non-clinical consultation or some kind of training, and once you have a solid and ongoing market demand for your services in your locale, you might be able to transfer that out of state or country. As long as the service isn’t under a board, you have good WiFi where you are, and you can support yourself financially, it could theoretically work.

Just resign your license and become a life coach.

 

[psychpro]

As discussed in many threads about practicing overseas, the short answer is—no, there’s no way to ethically do this and travel the world at the same time. It IS possible to move to another country and get licensed to practice there after navigating their rules and requirements, but I’m not sure how you’d maintain a license in the U.S. without a residence and practice with U.S. clients (see PsyDr’s comments).

I think about this every time I watch House Hunters International and see a couple moving to X country and working from home, and the best I can come up with is the easiest way to do this is to switch to providing a service in your area that is not overseen by a board and is remote-work-friendly, like non-clinical consultation or some kind of training, and once you have a solid and ongoing market demand for your services in your locale, you might be able to transfer that out of state or country. As long as the service isn’t under a board, you have good WiFi where you are, and you can support yourself financially, it could theoretically work.

Haha House Hunters International is definitely where the seed was planted. Since Covid I have a handful of friends and family who have done this in real life, which makes me feel like it can now actually be a reality lol. I do like the idea of non-clinical consultation as that is an interest of mine anyway. So maybe this is additional motivation to build that up a bit more?

 

[psychpro]

Just resign your license and become a life coach

1) For CMS (Medicare, Medicaid) patients, you MUST be physically within the USA or it’s territories. So your plan must exclude anyone with that insurance. And you have to opt out every two years.

2) Within the EU, foreign telemedicine falls within their digital privacy laws. IMO, it is not possible to meet those standards with telemedicine from the USA. PRC is a nightmare. Japan too. Stralia is basically EU laws. And the UK is the easiest place to sue people in the world. South Park made a joke about it.

3) for states where you can hospitalize people, you must be physically present. This cannot be accomplished via telemedicine.

4) Once the emergency exemption ends, most telemedicine things become much much more complicated.

5) Banking becomes a problem. The set up will look concerning to the IRS and third party payors. There are scams attempting to offshore US dollars. You’ll look like one.

6) Work visas are a huge issue. You can arguably say that you are a tourist, but then your stay is limited to 90 days, and you can’t leave briefly and reset the clock. That means you have to move 4 times per year, leaving weekends to travel to a new country, get set up with internet and goods, and then back to work. Every 89 days. Returning to a preferred country will ring alarm bells, with some places limiting how long you can be a tourist. And the UK is all weird about shops being open on sundays. Plus border agents are going to ask about your finances. “I have variable money coming in each month” sounds bad.

7) time difference is a huge issue. It’s easy to work from 2pm-10pm for a while. Not so much long term. Best case scenario: you can’t really date or see your kids during the week. Worse case: your schedule isolates you from everyone else. Plus patients are going to ask why it’s dark in your side of the screen.

8) Most countries including the USA allow their border agents to look through your laptop and cell phone without a warrant. You have zero rights within 100 miles of a US border. This violates HIPPA. Some countries are bad enough that fortune 100 companies send burner laptops and phones with their employees.

9) The number of countries that have unfailing internet, unfailing cell reception, and do not cap internet usage, are limited and expensive. Most EU countries have caps on data. Most South American, Caribbean, and south Asian countries lack the stable infrastructure to support unfailing internet. Guessing that applies to most African countries. One time I paid a $300 phone bill for a teleconference meeting abroad.

10) size of housing becomes an issue for WFH. Are you willing to essentially confine yourself to a 968sq ft cell? How sure are you that the neighbors are going to be unheard?

11) Most state boards require a response to their letters in a certain time frame. While this can be worked around, it’s still a risk.

12) Long term travel health insurance sounds expensive .

These are certainly great things to consider, some of which I have already found a resolution/work around to. It seems what might work is maintaining a home in the US, like a crash pad of sorts, while living somewhere in South America for a few months at a time using a short-term rental situation. A few countries in South America have very solid wifi, and the timezones are identical to US timezones. Having to hospitalize definitely becomes a problem, and I don't know of a work-around for that

 

[cam88]

Is there a less douchebaggy term for what you are describing?

I think this is perhaps the most douchebaggy response on this thread.

 

[psychpro]

If you ever figure out how to tap the market in your area on nonclinical stuff like training/consultation, etc., let me know! That niche is a very tough one to crack, speaking from experience.

You got it!

 

[bluecolourskies]

Is there a less douchebaggy term for what you are describing?

No that is what the movement is called- digital nomad.
Several countries have opened up their visas so you can stay 1-2 years, as long as you show that you have traveler’s insurance, and make a certain income. There are a resources starting to pop up for those interested in pursuing this lifestyle.

What is different than before is the work from home thing pushed by the pandemic, and countries want to take advantage to have you move there and support their economy. Although it also leads to gentrification. I just read an article about this happening in Mexico City where it’s cheaper but it has raised rents for the locals.

Sorry just in case people weren’t aware of this movement and term, it’s not just something OP made up

 

[erg923]

I think this is perhaps the most douchebaggy response on this thread.

5 bucks to someone who can say it with a straight face. The hashtag van life thing too.

 

[DynamicDidactic]

As others have said, try it in the US first. Plenty of travel and sightseeing in this country. I always recommend people try out something smaller before jumping into a big change. Who knows, you might love it and slowly figure out how to make it happen globally. Or, you might hate it but find a new state of residence.

 

[psychpro]

No that is what the movement is called- digital nomad.
Several countries have opened up their visas so you can stay 1-2 years, as long as you show that you have traveler’s insurance, and make a certain income. There are a resources starting to pop up for those interested in pursuing this lifestyle.

What is different than before is the work from home thing pushed by the pandemic, and countries want to take advantage to have you move there and support their economy. Although it also leads to gentrification. I just read an article about this happening in Mexico City where it’s cheaper but it has raised rents for the locals.

Sorry just in case people weren’t aware of this movement and term, it’s not just something OP made up

Thank you for clarifying to the readers. I wasn't really sure what to make of the "douchebag" comment.

You also bring up a good point on the gentrification aspect of things. An allure of this lifestyle is also the level of savings since things are so cheap relative to the United States. Many people I know are using this as a way to get out of debt since you end up spending way less on your day to day expenses if you choose somewhere in the Caribbean or South America, which are both time zone friendly. Unfortunately, in an attempt to escape the effects of gentrification and rising costs in the U.S. they are creating similar conditions for the locals in the country they choose to set roots in temporarily.

 

[bluecolourskies]

Thank you for clarifying to the readers. I wasn't really sure what to make of the "douchebag" comment.

You also bring up a good point on the gentrification aspect of things. An allure of this lifestyle is also the level of savings since things are so cheap relative to the United States. Many people I know are using this as a way to get out of debt since you end up spending way less on your day to day expenses if you choose somewhere in the Caribbean or South America, which are both time zone friendly. Unfortunately, in an attempt to escape the effects of gentrification and rising costs in the U.S. they are creating similar conditions for the locals in the country they choose to set roots in temporarily.

It’s difficult because everyone is doing the best we can. You could say I felt pushed out by all the Amazon/Microsoft/Google/CenturyLink/DropBoxheadquarter employees that set up shop in my state, so I’m aiming to move south, where people are also consequently complaining about the increase cost of living and infrastructure not being able to handle the huge influx of people that had the same idea as me 😅

I actually felt somewhat guilty because I have the resources to escape such a situation but not everyone can. But I’m still moving, sorry everyone!

 

[psychpro]

It’s difficult because everyone is doing the best we can. You could say I felt pushed out by all the Amazon/Microsoft/Google/CenturyLink/DropBoxheadquarter employees that set up shop in my state, so I’m aiming to move south, where people are also consequently complaining about the increase cost of living and infrastructure not being able to handle the huge influx of people that had the same idea as me 😅

I actually felt somewhat guilty because I have the resources to escape such a situation but not everyone can. But I’m still moving, sorry everyone!

Haha I totally get it. Ultimately we all just want to live a life where we do not feel so stressed out by rising costs of living. It is very tough for those of us living in coastal cities right now.

 

[Sanman]

As others have said, try it in the US first. Plenty of travel and sightseeing in this country. I always recommend people try out something smaller before jumping into a big change. Who knows, you might love it and slowly figure out how to make it happen globally. Or, you might hate it but find a new state of residence.

That might be true, but it does not help as much with the geoarbitrage aspect of it. I do agree with the slowly figure it out aspect. The OP would need to figure out a business model that works and does not impact state and federal law. This will take time to build before pressing the eject buttton. At that point, geoarbitrage may not be necessary (though may still be alluring...I have lived like a king/celeb in less developed countries on vacation).

 

[Sanman]

It’s difficult because everyone is doing the best we can. You could say I felt pushed out by all the Amazon/Microsoft/Google/CenturyLink/DropBoxheadquarter employees that set up shop in my state, so I’m aiming to move south, where people are also consequently complaining about the increase cost of living and infrastructure not being able to handle the huge influx of people that had the same idea as me 😅

I actually felt somewhat guilty because I have the resources to escape such a situation but not everyone can. But I’m still moving, sorry everyone!

Don't feel bad. Locals will complain, but it is the way of the world. If no one ever left, all the wealth will continue to be locked up in the Northeast and CA.

 

[clausewitz2]

5 bucks to someone who can say it with a straight face. The hashtag van life thing too.

I never used the hashtag but in the late oughts I did actually live in a van (well, Class B RV) for six months while I went around the country to med school interviews. I have also lived in a couple of developing countries for prolonged periods of time as someone with no ethnic/cultural ties to them (i.e. distinctly an expat) so feel I can speak somewhat to the nomad kind of experience.

Re: @PsyDr 's comment about visas, you would not have to worry about this in SE Asian countries, Singapore excepted. Renewing tourist visas is ridiculously easy and work visas are easy to come by. The best balance of ease of visas with creature comforts/stable Internet would probably be Viet Nam or Thailand, although they are basically the worst possible choice in terms of time zones. Still, easy to offer those coveted evening hours, I suppose...

You would definitely need travel health insurance that would cover medivac to Bangkok or Singapore in case of a real medical emergency but as long as you got a gas generator as back up for power outages, it could be made to work.

 

[PsyDr]

...all the wealth will continue to be locked up in the Northeast and CA.

There is a reason why Epstein had residency in the only state that allows for anonymous LLCs. It's not in the northeast or California.

 

[WisNeuro]

There is a reason why Epstein had residency in the only state that allows for anonymous LLCs. It's not in the northeast or California.

I thought there were several states that allowed anonymous LLCs. But, the one that is fairly business friendly that you'll see a lot of legal shell corporations in is probably Delaware.

 

[Sanman]

I thought there were several states that allowed anonymous LLCs. But, the one that is fairly business friendly that you'll see a lot of legal shell corporations in is probably Delaware.

A bit of googling tells me there are four states that allow anonymous LLCs. Delaware, New Mexico, Nevada, Wyoming. Delaware is the one I was familiar with as well.

 

[PsyDr]

It's only NM, where Epstein had his ranch.

The other states do not require you to name the owner, but their annual filing requirements do.

It's why Maxwell said she didn't know who owned the house.