China offers everything from bustling metropolises like Beijing and Shanghai, to the tranquil emerald lakes of Jiuzhaigou, to thousands of years of history – it offers a rich cultural immersion that you are not likely to forget. Here are eight tips to make the move to China as smooth as possible. For information on practicing medicine in China see our Ultimate Guide to Practicing Medicine in China.
1. Bring copies of Birth and Marriage Certificates
Ensure that you have certified copies of your marriage certificate and birth certificates for anyone moving to China. These documents will need an Apostille and a Chinese Consulate Authentication.
China will not accept any documents that state Taiwan on the document. When these documents are translated, ensure the translator writes Taiwan Province, otherwise your application will be rejected.
You can navigate the authentication process yourself or you can use a private service. These documents don’t need to be translated to Mandarin immediately as this can be done in China and your employer may help with this paperwork.
2. Obtain an FBI Background Check
You will need an FBI background check including fingerprinting to immigrate to China. The FBI background check will need an Apostille and a Chinese Consulate Authentication.
Obtaining fingerprinting in China is a little trickier though the US Embassy lists several locations which provides fingerprinting.
3. Keep Your US Medical License Active
It is your active US medical license that translates into an active Chinese medical license and the Chinese Medical License will expire on the same date as your US license. The Chinese medical license is also specific to the clinic or hospital that applied on your behalf.
I am a DO and I worked in Nanjing from 2013 to 2015 without any further clarification about being a DO. This time my hospital asked that I have my American Board of Family Medicine certificate notarized as well. I was able to notarize my certificate at the US Embassy in Shanghai.
4. Negotiate Your Salary
Your salary will depend on your location, how much the employer values US medical qualifications and skills, and the employer’s need to fill a position. If you live in a large city with a large expat population you may have more clout, but you may also have more competition. Most of the time your competition is not US-trained physicians but physicians from other countries. In general, US-trained physicians are highly valued.
When negotiating, know your estimated total cost of living, including the cost of school, rent, relocation, medical insurance if not offered by your employer, utilities, and a car. You can negotiate for the employer to pay these items directly, thereby reducing your taxable income.
You can also compare your earnings at home to that in China. If the cost of living in China is higher than your current cost of living in the US, ask for a higher salary than you would earn in the US to account for this difference in living cost. You can also ask the employer to pay in US dollars – just ensure that your contract includes a fixed exchange rate to reduce currency exchange risk.
Remember, US-trained physicians are an asset to employers and your qualifications help to draw patients to a clinic or a hospital.
5. Hire a Good Tax Accountant
Hire a tax accountant who understands that you will be making income outside of the US, how it affects filing dates, and how to avoid double taxation. It is usually best to work with an accountant who specializes in taxes for US expats living in China.
6. Find the best school for your kids
For families with kids your options include local public schools and international schools. The older your child is, the harder it will be for the child to attain the Mandarin fluency needed to transition to a local public school.
Preschool in China is three years long. The first two years are the two years before traditional kindergarten, and the 3rd year is what we are used to thinking of as kindergarten. It is called “小班， 中班， 大班“ or literal translation of “Small Class”, “Middle Class”, “Big Class.” There are public preschool programs but the good ones are hard to get into. Most families in China enroll their children in a local private preschool and there are many Montessori based private preschools. My three kids attended various preschools in Shenzhen and Nanjing and I had only positive experiences – they had extended hours for working parents, and an enriching curriculum with lots of play, art, singing, with some early introduction to Chinese characters. Importantly the preschools are safe, secure, and nurturing.
Elementary school typically spans first grade through sixth grade, though some private schools consider sixth grade to be secondary school. Typically the district you live in dictates the public elementary schools that are available, however foreigners can attend any public school. Public schools are very strict and there is a lot of school work.
If you would like your children to learn Mandarin, starting as early as possible is best. If your child can complete 3rd grade in China, they will have learned all the Mandarin they need for their adult life. However, if they leave the Mandarin immersion environment it will be harder to maintain. All international schools have Chinese-Mandarin classes although nothing compares to the Mandarin immersion in a public school.
We lived in a good school district in Nanjing and still opted for my daughter to attend a different school which had less emphasis on competition amongst the children.
Currently, in Suzhou, two of my children are attending a private school called OCAC, a bilingual school which teaches English half the time and in Mandarin the other half. It follows both the International Baccalaureate (IB) and Chinese curriculum. This has been a great compromise between choosing an international school that is almost all English and a public Chinese school that may be too demanding. My youngest enrolled in OCAC as a second grader and although it was initially a difficult transition, her Mandarin and Math skills have improved dramatically.
7. Download these crucial apps
China runs on apps, not on cash. Most restaurants and shopping centers do not accept US debit cards or credit cards and very few people in China carry cash. While you can use your US debit card to directly withdraw Chinese Yuan from a Chinese ATM, almost all payments are done via WeChat Pay or Alipay.
WeChat is crucial to living in China – for everything from mobile payment to doctor appointments – so set it up before arriving in China. In preparation for when you first arrive and before you open a local bank account, have friends transfer Chinese Yuan to your WeChat. You can then make mobile purchases.
Alipay, 支付宝, is a mobile payment platform used to pay for everything from food to utilities.
Currently, during the COVID pandemic the Chinese government is tracking everyone’s movement. Alipay hosts the health QR code which is required to for you to be mobile. The embedded feature provides a color coded QR code based on input from a health form, whether you visited a COVID high-risk zone, and whether you were in close proximity with an infected person. Green allows the holder to move unrestricted, yellow means you should stay at home for 7 days, and red means you need to quarantine for 2 weeks. If you have a yellow or red QR code, you will need to comply with the official COVID recommendations, such as getting tested or quarantining before the QR code turns green again. When COVID-19 cases are high, you will be asked for you QR code everywhere before you are allowed to enter – at malls, the movie theaters, restaurants, and on public transportation.
Other important apps are DiDi, a taxi app similar to Uber or Lyft, Baidu Maps – 百度地图 – is similar to google maps, Pleco a Chinese dictionary app, Meituan – 美团 to order groceries and takeout, Baidu Translate similar to Google translate though with more accurate Mandarin translation, and 铁路12306 which enables purchase of high-speed railway tickets.
8. Download VPN services before moving to China
If you are practicing telemedicine from China into the US you will need high speed broadband internet and an excellent VPN.
I highly recommend downloading three to five different VPNs and activating a free trial version before arriving in China. Once in China, you may find that some VPNs work better than others. You can download VPN after you arrive in China, but it is harder.
I currently use ClashX as my primary VPN and ShadowRocket for my smartphone. FlowVPN is my backup VPN and allows up to five devices, hence I along with my three children can use it.
Pinchieh Chiang DO is a family medicine doctor, trained in the United States, living in China, and practicing telemedicine into the United States.