By Dina Cheney

Ashwini C. Bapat, MD, a palliative care physician, and her husband, a psychiatrist, had always planned to move abroad. But their resolution was solidified during a vacation in Portugal with their then 2-year-old daughter. While exploring towns on foot, passersby would turn around, smile, and tell them how cute their daughter was, she said.

In Boston, where they lived at the time, their experiences were quite different. Walking with their daughter on a bike path each Saturday morning, “bikers would go past, turn around, and yell at us to get out of the way,” Bapat said. “It happened so many times.”

The couple was intent on moving to Portugal but wasn’t sure it would be feasible. That is, until they began reaching out to overseas MDs to ask how they had made the transition. From these conversations, Bapat and her husband realized they could both continue to work via telemedicine. Her husband could even maintain his private practice by keeping his medical license active in states where his patients resided.

What they learned inspired them to create Hippocratic Adventures, a Facebook group and website for physicians interested in moving and practicing abroad. It also helped them decide where to settle: Coimbra, Portugal. Because they had each taken Spanish as a second language in school, they figured learning Portuguese wouldn’t be overly challenging. Plus, the country’s warm climate and family-friendly culture “felt right in our bones,” Bapat said.

In August 2020, Bapat, her husband, and their now-two children (then aged 3 and 10 months) made the move. And they haven’t looked back since.

Why Move Abroad?

In Bapat’s experience, doctors leave the US for three primary reasons. Like her, some want an adventure or simply to experience living abroad. Others, like Nataly Ghanem, MD, MHCM, a senior pediatrics consultant, have ties to another country.

In 2022, Ghanem and her husband and two daughters — then aged 14 and 2 years — relocated from California to Qatar. “Our family is originally from Jordan, and we wanted our kids to connect more deeply with our language and heritage,” said Ghanem, who now works at The View Hospital in Doha, Qatar, which is affiliated with Cedars-Sinai in Los Angeles.

Along with being closer to extended family, Ghanem appreciates the quality of life in her new home. “It’s clean, safe, and civilized,” said Ghanem, who originally lived in a gated compound and now resides in a tower apartment with ample views of the water. “In Qatar, a woman can go out at 2 AM and feel safe,” she said.

Ghanem also appreciates the diversity of food and architecture, which she described as a mix of modern high-rises and older buildings, including Victorian- and Spanish-style. “The culture here is conservative but with full access to sports, education, art, food, and music. The old souq (Souq Waqif) is like an adventure,” she added.

Another subset of doctors move abroad due to burnout and frustration with the for-profit US healthcare system. In this group is Everett Fuller, MD, who moved from Texas to Cape Breton Island in Nova Scotia, Canada, in 2015. Now emergency department site lead at the Cape Breton Regional Hospital, Fuller wanted to practice medicine, not “the business of medicine,” he said.

For Fuller, healthcare in the US involves “private equity firms buying up practices, then cutting staff and demanding more output, treating physicians as replaceable widgets that can be flogged for more profit and fired as soon as they fail to toe the line.”

Fuller has a long list of US healthcare issues that he was happy to leave behind: “Having your computer populate with 20, 30, 40 charts to sign at the end of your shift well after the patient is long gone. Some places seeing wholesale replacement of physicians by NPs [nurse practitioners] and PAs [physician assistants] because corporate medicine can bill just as much while paying lower salaries. Decreasing pay and being treated as just another worker bee rather than as a licensed professional with years and years of training.”

Prepare for the Licensing Process

Moving and practicing abroad is not easy, especially in countries with a language barrier, said Bapat. Because she didn’t speak Portuguese, her medical license was not automatically approved when she moved to Portugal. “The first thing we had to do was learn the language,” she said.

While Bapat took a Portuguese immersion course, she practiced telemedicine and started a caregiver palliative coaching service. Then, 3 years ago, she began working toward her Portuguese medical license. This has involved completing paperwork and taking language, medical knowledge, and clinical practicum exams (all in Portuguese). She recently completed the final step: presenting research to a panel.

Fortunately, the process is simpler in some other countries, such as Canada, the UK, Australia, New Zealand, the United Arab Emirates, Qatar, and Bahrain. “Most Canadian provinces now accept US board certification,” said Fuller. “More recently, the province created a pathway for physicians from the US to come work as locums. Plus, many provinces employ immigration consultants to help expedite the work permit process.”

Even in countries without a language barrier, expect some headaches. For Xiaomang Stickles, MD, a gynecologic oncologist who moved from Philadelphia to Norwich, England, in 2023, “The British medical licensing process was an extremely painful and tedious bureaucratic exercise. It makes the worst DMV look like a model of efficiency.”

It took Stickles 5 months to procure a general license, then about a year to complete the application for a certificate of equivalence for specialist registration. If her application is approved, she will receive a tenured position, which is akin to US board certification. Until then, she is a locum consultant at Norfolk and Norwich University Hospitals, and her contract must be extended every 12 months.

Consider the Trade-Offs

Along with the red tape, these MDs have had to accept some compromises. It’s likely that you won’t be able to practice medicine in a new country for a period of time. “I went from 100% patient-facing interaction to telemedicine to nonclinical work to not seeing patients daily,” said Bapat. “That transition was hard when it came to redefining what being a physician meant to me and what a physician can do.”

The reduced income that typically characterizes practicing abroad can also be an obstacle. Bapat noted salaries in Portugal are among the lowest in the EU. Stickles — who stressed that she was expressing her own opinions and not representing her employer — pointed out UK pay for doctors is lower than in Canada or Australia. Plus, some expenses, such as housing and private school in Qatar, can be higher, added Ghanem. That said, government benefits, such as free healthcare and public education, can often offset these factors.

On the nonwork front, Fuller needed to adjust to life in a much more rural area and on an island. “The ease of travel was something I didn’t fully appreciate before moving north,” he said. “It’s definitely much more of a production to go out of town from where I am now.”

But he turned what could have been a disadvantage into a hobby. “When we first moved here, the local food options were limited,” he said. So he taught himself how to cook Southern dishes, barbeque brisket, ribs, butter chicken, and tuna poke. “Cooking has turned into a way of expressing myself, and it’s become a real hobby exploring new ideas and styles.”

Building a Balanced Life

Despite the hassles and drawbacks, none of these transplanted physicians have any regrets. “We regained the love of medicine, taking care of people at their most vulnerable,” said Stickles. “By and large, British patients are extremely grateful and proud of their NHS [National Health Service].”

The work-life balance is also better. “We work about 15-20 hours less per week compared to the US despite being full-time,” Stickles added. “I also take fewer weekend calls: four times per year compared to every three weekends before.”

Finally, there is less moral injury. “[In the UK], no one is denied treatment because of lack of money,” said Stickles. “If a patient needs a medically appropriate scan or surgery, they will get it. Conversely, no one is going to get a fifth-line chemo that has no chance of working just because they demand it.”

While Stickles appreciated the “efficiency” of the US healthcare system and loved taking care of her patients, she describes her former job as “sucking the soul out of [her].”

Similarly, Fuller is relieved he no longer “needs to worry whether he’ll make a diagnosis that will bankrupt a family with medical bills,” he said.

Bapat feels particularly grateful on her runs along Portugal’s Mondego River. “There’s the most beautiful view of the skyline, which hasn’t changed for 100-200 years,” she said. “It takes my breath away each time.” She also treasures her daily routines, such as driving under a Roman aqueduct while driving her children to school.

Perhaps her favorite part, though, is the fruit trees in her backyard. “Every season, there’s a treat to be had,” she said. “When we get home from school, the first thing [my kids] do is hop out of the car and run to see what fruit they can pick.”

Through Hippocratic Adventures, Bapat says, “The number-one thing we hear is, ‘I can’t move abroad because I’m a surgeon and I can’t practice telemedicine as a surgeon.’ But you have a whole skill set that people in other countries want. There are tons of ways to use your procedural skills and to use them clinically. Your medical degree is a passport to different opportunities. You just have to see them.”