By Dr. Jim Dahle, WCI FounderLocation independence is something that gets discussed a lot in the online entrepreneur space but not very often among doctors and other high-income professionals. That, however, doesn't mean that its principles can't be applied in the lives of professionals.
What Is Location Independence?
Location independence is simply having the ability to do your job from anywhere. Many tech and office workers worked from home before the pandemic, but the pandemic definitely accelerated the trend. If you can work from home, why can't home be in another state or even in another country? People moved from New York City or San Francisco to resort towns or even inexpensive small towns to maximize geographic arbitrage, but they kept the same, high-paying jobs.
My Experience with Location Independence
My work with The White Coat Investor has certainly provided me with a taste of location independence. We go on lots of trips, but few of them are true vacations from work. My staff laughs at my phrase, “It's not a vacation, it's a lifestyle.” But they have come to understand it.
Most of our trips are a combination of vacation and work. Maybe I do some writing on the plane or while sitting in the airport, or I'll do some work in the evenings or mornings in the hotel before or after going sightseeing or whatever the day's activity may be. It is far easier to do a little bit of work while on a trip than to try to catch up afterward.
Some trips don't allow for any work at all. It took months for WCI to adequately prepare for me to be completely incommunicado for 23 days in the Grand Canyon in 2021. But most of the time, I can do most of my work from anywhere I can get a decent internet connection. Given hotspot technology, that's pretty much anywhere with LTE cell coverage these days. There are some things I can't do remotely—the main ones are recording podcasts and doing speaking gigs. It's difficult to ensure adequate audio and video quality anytime I'm away from the recording studio we built into the house when we renovated it a couple of years ago. It's also difficult to do a big project like creating a course while traveling.
More information here:
It’s a Lifestyle, Not a Vacation
What Can't Be Done Remotely
Besides podcasts, presentations, and courses, several other factors keep us from traveling more. The first is my clinical work. As we'll discuss below, some medical work can be done in a location-independent manner, but being a partner in an emergency medicine group is not one of them. On six days every month, I've got to be physically present in a particular emergency department here in Utah. Thankfully, Katie's work at WCI can be done remotely. However, given all that we're involved with (and our childrens' learning styles), home schooling (world schooling) is not something that we're going to do.
The biggest factor keeping us from traveling even more is our kids' schedules. Especially as they get into junior high and high school, they simply cannot miss all that much school and still learn what they need to learn. They are also involved in extracurriculars such as sports, which also cannot be done remotely. For many of our trips, one of us stays behind to help manage the household and children. It's more often me on the road than Katie, but she isn't going to have any trouble meeting her goal to visit 50 countries before turning 50. She spent three weeks in Tanzania and Kenya without me in 2023.
Besides the kids, we're also involved in a lot of community activities. We both coach teams and play on teams. We have leadership positions in our church. Katie serves on three school community councils. You can miss this stuff a lot, but you can't just be gone for six months and still do it. Still, most months one or both of us is out of town for 7-14 days. That's about the most I want to be gone anyway.
More information here:
What We Can Learn About Work-Life Balance and Retirement from the French
From Maine to Ukraine: A Physician Finds Meaning in a War Zone
What Can Doctors Do to Become Location Independent?
Some professionals, attorneys, accountants, and financial advisors can do their work online from anywhere using email, phone, and video calls. That's harder for doctors. Still, there are four ways that professionals—even doctors—can benefit from location independence.
#1 Leave Medicine
The first one, of course, is to change careers to something that can be done remotely. There are so many options out there that I won't bother listing them.
#2 Telemedicine
The pandemic taught many of us how to do telemedicine. Many medical problems can be managed perfectly well without physically laying hands on a patient. Psychiatry, in particular, lends itself well to telemedicine. Primary care involves lots of psychiatric care, too. Medication management, monitoring of chronic conditions, surgical follow-ups, and some urgent care problems can all be managed adequately via telemedicine. Consider whether some or all of your practice can be accomplished with telemedicine.
#3 Locum Tenens
It's pretty tough to do orthopedic or general surgery via telemedicine, but you know what isn't hard? Finding a locums tenens gig in those specialties. People need coverage in all kinds of cool locations. Imagine ditching your current “anchored” practice, spending two months in Florida in the winter, and then taking a month off before going to New Zealand for six months. Maybe you take another month off and then finish the year in a small town in Florida. The next year might involve two or three other locations. It might not be true location independence, but it will certainly allow you to experience life in a lot of other places. You might even make more money while doing it. It doesn't work with everyone's lifestyle and everyone's family, but if it works for you, it works for you.
#4 Medically Related Work
Medicolegal and consulting work is mostly office work, and it can be done from anywhere with an internet connection. Lots of nonclinical careers are similar to tech and office workers. That doesn't have to be your entire practice, but what if it were half of your practice? What could you do? How would your life change? Maybe you can do this half-time for a few years after you become an empty-nester.
Location independence might not be the cat's meow, but it does have benefits. If it is something that appeals to you, see what you can do to introduce some of it into your life.
What do you think? What kinds of location independence do you enjoy in your life? What could you do to increase that? Would you want to?
The one thing I do not like about being a a doctor is the fact that you are always stuck to your location due to call and clinic hours especially when you are not in a field like psychiatry when you are location independent. Opening your own practice and being your own boss also comes with the hassle of finding coverage when you take vacation
Locums sounds very attractive but it is a not a solution if kids are young and need you at home
Radiology is a great specialty for location independence. There are numerous positions which allow remote work from virtually anywhere in the US. Working from an international location is much more difficult to arrange, but not impossible.
Radiology turns out to be more flexible and they have a better job market currently. The issue is the overseas component as you state, since culture/women/costs are so poor in the west generally speaking. I’m curious if they’ll ever allow more radiologists to go foreign given the demand and the insolvency of the US health system. Dr. Dahle is protective about this but imaging has only gone up, since it makes life easier for ER docs and the hospitals also get paid more. It’s up like 100% in just 10 years.
There are legal/billing aspects to performing clinical work that can complicate the idea of working from anywhere. For instance, when performing teleradiology, the professional component of an exam for Medicare purposes should bill to the state (or portion of a state) in which you are sitting to interpret the exam, not to where the exam was performed. Also Medicare doesn’t allow international billing. You will also need a current license for the states in which the exams were performed, and many states have unique, additional CME requirements to maintain their licensure.
Excellent points Paul. Thank you for taking the time to make them.
How much of your travel are you able to deduct as a business expense?
All of the business travel. In my case, only a small fraction of my travel is business travel. But traveling to WCICON is deductible. Going to London with the kids is not.
Few years ago, we moved out of state and sold our dream house due to an unfair non-compete agreement with a large health system. I now practice mostly telemedicine and love the flexibility it provides.
Cool example of a good way out of a non-compete.
Great post – great read sir. While location independence is not for everyone, I have enjoyed the amount I have (not fully, we have a 11 and 8 year old). One of the downsides is the ability to choose. I feel my life was a bit easier when we felt we ‘had’ to live in a certain area because we had always lived there….being location independent and able to ‘choose’ presents it’s own challenges and stresses. The choices of ‘where’ have huge impacts on many people (family, kids, etc). From the work you have done over the years, you are helping many become location-independent as they become financially independent!