5 Tips for Practicing Telemedicine Abroad for US-trained Physicians without US Citizenship or a Green Card

I am a psychiatrist who has completed his residency and fellowship in the US. I do not hold a green card and I am not a US citizen. I was on a F1-visa for medical school, on OPT for internship, and on a H1B visa for residency and fellowship. I am currently living in Malaysia and working in telepsychiatry with Teladoc.  

Here are five tips for US trained physicians, who are not US citizens, who are living abroad, and want to care for patients in the US through telemedicine.

1.Obtain State Licenses before your move: Some state medical boards ask for fingerprints and notarized documents which can be challenging to obtain if you are already abroad. Most states will also ask for your US residential and/or work address. Taking care of the paperwork and having important state licenses in hand before leaving will save you considerable hassle or a trip back to the US.

2. Have a Registered Agent with mail-forwarding capacity: You will need a US address registered with the DEA and your US bank accounts. You may also receive paperwork with patient information such as prior authorizations, etc. There are several companies who offer the services of a ‘Registered Agent’ which provides a US address and which may forward your mail. A *very trusted* friend can also do this for you but beware issues around HIPAA if you receive patient information at their address.

3. Independent Contractors living abroad do *not* need a visa: Many telemedicine companies will pay you as an independent contractor. Since you are not technically their employee, you do not need permission to work in the US; and since you are not on US territory, you also do not need a visa for immigration purposes.

4. You will need to maintain a US bank account, where you can be paid in USD: You would benefit from this anyways, if you are paying loans or other bills in the US, and also to help manage currency exchange risk.

5. Filing taxes abroad – As a contractor you are not ‘employed’ in the US and if you are living abroad you are not a tax resident, hence you do not need to file taxes in the US. For that matter, you are exempt from social security and Medicare taxes. Submit form W-8BEN with your US payor in case they are audited to support their not providing a 1099 and not withholding taxes.

Bottom Line

No US citizenship or green card status? No problem. In addition, you will not have income tax liability in the US as long as a US company is willing to hire you as a contractor.

Dr. Aw is a consultation-liaison psychiatrist. He completed his psychiatry residency and served as chief-resident at Thomas Jefferson University Hospital and completed his consult-liaison fellowship at Yale-New Haven Hospital.

For a personalized approach to building your own telepsychiatry private practice, learn about how our Guidance Service can help

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