Many physicians (especially the ones reading this blog) save far more than necessary for retirement, driven by the fear that a market crash or prolonged downturn will deplete their funds. This anxiety often leads to oversaving, delayed retirement, or years of unnecessarily frugal living.
True retirement confidence stems not just from accumulating a larger nest egg, but from building resiliency, reducing required spending, and having financial flexibility—so you're never forced to sell investments at inopportune times.
If you can reduce fixed expenses (housing, taxes, insurance, and healthcare) and keep some optional income available (telemedicine, locums, chart review), you gain a powerful advantage in a bear market: you can choose not to sell. One way to do that is to move abroad.
Here are some options to drastically lower the cost of living and survive in a down market without working too hard or for longer.
Relocate Within the US (Lower Your Fixed Costs)
Moving from a high-cost region to a lower cost-of-living area can dramatically reduce your baseline spending. When your required annual expenses drop, your portfolio withdrawal rate decreases proportionally, making retirement more resilient during market downturns. Relocating from high-tax states like New York or California to tax-free states in the Midwest or South is a proven strategy that can reduce living costs by 20%-40%.
Relocate Internationally (Stretch Retirement Dollars Further)
Retiring abroad can stretch retirement dollars even further, but it is important to be realistic and prepared. Before relocating, make sure you understand the local cost of living and what daily life actually feels like (not just vacation life).
A smart way to de-risk the move: rent first, visit multiple times, and treat the first year as a trial period.
Cities like Bangalore and Mysore in India stand out as particularly attractive options. Bangalore offers a cosmopolitan environment with excellent private healthcare, strong internet infrastructure for telemedicine work, and a cost of living that can be 60%-75% lower than major US cities. Mysore provides an even quieter, more affordable lifestyle while still maintaining good healthcare access and livability. Both cities have established expat communities, and they are well-suited for physicians considering remote work or a temporary relocation during the early retirement years.
For physicians with Indian citizenship or eligibility for OCI (Overseas Citizen of India) status, the visa process is straightforward, and the ability to work remotely for US clients while living in India can significantly extend retirement savings. The time zone difference requires planning for live telemedicine, but many physicians find that asynchronous work (chart review, prior authorizations, or consultative roles) works well from India.
Medicare Reality Check
If you are considering living abroad, remember that Medicare generally does not cover routine care outside the US. Think through realistic options such as:
- Local private coverage
- International insurance designed for expats
- Joining the public system, where available
- Budgeting for direct-pay care and keeping catastrophic coverage
- A contingency plan for returning to the US for major medical needs
More information here:
5 Financial Considerations for American Doctors Wishing to Live Abroad
Healthcare-Related Costs If You Move Internationally
If you might return to the US later, understand the implications of dropping Medicare Part B and potential late enrollment penalties. Here are some realistic healthcare-related costs.
Portugal
Residents can access the public system (SNS), but wait times can be long for non-urgent care. Many expats use private insurance for speed and English-speaking clinicians.
- Private expat insurance: ~$150-$400 per month
- Private doctor visit: ~$50-$100
- Private ER visit: ~$100-$300
Mexico
You can get strong private care in major cities (Mexico City, Guadalajara, Monterrey) and medical tourism hubs (Mérida, Puerto Vallarta). Many people pay for routine care out of pocket and keep catastrophic coverage.
- Private insurance: ~$100-$400 per month
- Private visit: ~$30-$60
Thailand
Bangkok and Chiang Mai have world-class private hospitals. Major procedures can be far less expensive than US pricing.
- Private expat insurance: ~$100-$300 per month
- Private visit: ~$20-$50
- Time zone makes live US telemedicine harder, but some physicians use asynchronous work.
Costa Rica
Residents can join the public system (Caja) with a monthly fee based on declared income. Private care is widely available.
- Public system (Caja): ~$50-$150 per month (varies)
- Private insurance: ~$100-$400 per month
India
Most doctor visits are free if you are a doctor yourself. You only pay for hospital stays and procedures (there's an unwritten rule of reciprocity).
Bureaucratic Rules — Visa and Residency: The ‘First Filter'
- Visa rules change often, so treat this as a starting framework and verify with the relevant consulate.
- Continue part-time telemedicine or other flexible work while abroad (avoid selling low).
- Part-time income can be the difference between riding out a downturn calmly and being forced to withdraw from investments when prices are down. For physicians, telemedicine and other remote work can provide flexible cash flow while keeping your schedule lighter.
- If you plan to work while abroad, remember that time zones matter. Latin America often aligns well with US hours. Europe is workable with earlier starts. Southeast Asia can be challenging for live visits, but it may work for asynchronous roles.
Optimize Your Tax Strategy (But Do It Carefully)
Lower spending often lowers taxes automatically, but there may also be opportunities to reduce taxes through thoughtful planning. If you are considering living abroad, consult a tax professional who works with Americans overseas.
A few topics to understand in advance:
- FEIE (Foreign Earned Income Exclusion): If you continue working abroad, you could possibly exclude a large amount of earned income if you meet residence or physical presence requirements (earned income only, not investment income).
- Foreign tax credit and tax treaties: May reduce double taxation depending on the country and the type of income.
- State tax residency: Some states are aggressive about continuing to tax former residents if ties remain.
- Reporting: Understand FBAR (foreign accounts >$10,000 aggregate) and FATCA reporting thresholds.
- PFIC risk: Many non-US mutual funds/ETFs can trigger punitive US tax treatment.
More information here:
The Expat Doctor’s Common Pitfalls: Why Living Abroad Makes Your US Taxes Harder, Not Easier
What Doctors Need to Know About Receiving Gifts from Abroad: Tax Traps and Filing Requirements
Some Examples of Physicians Who Successfully Transitioned
Example #1 — Immigrant Physician (India), Age 58, Market Downturn, ‘Trade Luxury for Family'
Dr. Patel is a 58-year-old physician who immigrated from India decades ago. When the market took a downturn, retirement suddenly felt more fragile, even though Dr. Patel had saved well.
Instead of panicking or delaying life indefinitely, Dr. Patel used flexibility as the solution. With both children already in college in the US, Dr. Patel chose to spend a couple of years living in India with aging parents. The move cut “luxury spending” dramatically: lower housing costs, fewer fixed expenses, and a simpler lifestyle.
The tradeoff was clear: less comfort and fewer conveniences than in the US, but far more time with parents while health and time were still available. Because required spending dropped, Dr. Patel could withdraw less from investments during the downturn and avoid selling heavily when prices were down.
Example #2 — US-Based Physician, Italy for 2 Years, Enjoyed Life, Returned with More
Dr. Smith is a US-based physician who felt burned out and wanted to live differently for a while, without “waiting until everything is perfect.” Dr. Smith took a planned two-year break abroad and moved to Italy.
Instead of treating it like an expensive vacation lifestyle, Dr. Smith made it a structured experiment: rent a modest place, live like a local, and prioritize experiences: language practice, walkable daily life, long meals with friends, and cultural events.
Financially, Dr. Smith stayed invested throughout the downturn and did not interrupt the long-term plan. By keeping the portfolio invested and keeping spending reasonable, the market recovery and continued compounding did the heavy lifting. Two years later, Dr. Smith returned to the US with great memories, and, surprisingly, his portfolio balance ended up higher than when leaving for Italy, despite the volatility in between.
Example #3 — Physician Couple, Age 62, Portugal for 3 Years, Returned to the US for Grandchildren
Drs. Chen and Chen retired at age 62 and moved to Portugal, drawn by the climate, lower cost of living, and quality of life. They obtained D7 visas based on pension and investment income, rented an apartment, and used a mix of public access and private insurance for faster care.
For three years, their lifestyle cost materially less than their previous life in a high-cost US metro. When their first grandchild was born, they decided to return home to be closer to family.
Key lessons: renting preserved flexibility, lower spending reduced withdrawals during volatility, and maintaining Medicare Part B avoided penalties on return.
Example #4 — Single Physician, Age 55, Burned Out, Thailand for 1 Year, Returned Refreshed
Dr. Martinez felt burned out after decades of emergency medicine. With a solid but not enormous nest egg, Dr. Martinez took a one-year “trial retirement” in Thailand.
Living in Chiang Mai, expenses stayed around ~$2,000 per month, including rent, food, insurance, and travel. The lower baseline cost meant minimal withdrawals. During the year, Dr. Martinez explored remote work and found an asynchronous chart review that could be done from anywhere.
Key lessons: a one-year trial clarified priorities, low costs made the sabbatical financially sustainable, and a small amount of flexible income created options.
Example #5 — Split Retirement Between the US and Abroad (Family-First Hybrid)
Dr. Okafor wanted to spend meaningful time with aging parents abroad without giving up US ties entirely.
The solution was a split retirement: 4-6 months per year abroad, with the remainder in the US. During time abroad, the cost of living dropped substantially. During time in the US, Dr. Okafor maintained Medicare coverage, did routine care locally, and stayed connected to family and community.
Key lessons: retirement does not need to be all-or-nothing, and a hybrid plan can preserve both flexibility and peace of mind.
More information here:
Navigating the Minefield of Foreign Investing as a US Expat
When Everything Clicks into Place: How Foreign Travel Can Make You a Better Doctor
The Bottom Line
If your retirement plan gives you options in a downturn—lower fixed costs, flexible income, and a withdrawal strategy that avoids selling low—you may not need to over-save to feel secure.
The goal is not to predict the next crash. The goal is to make your retirement plan strong enough that a crash does not derail it.
Have you thought about moving abroad during your retirement years to save money? Where would you go? What would you do? Would you ever want to return?