Taiwan, a tropical island country about the size of Maryland, is home to beautiful scenery, friendly people, and awesome food such as beef noodle soup and pork dumplings. It was also named the top destination for expats by InterNations for the third year in a row in 2021, due to its affordability, convenient public transportation, and one of the best healthcare systems in the world. For US-trained physicians looking to practice in Taiwan, this is what you need to know.
Taiwan’s Healthcare System
The National Health Insurance (NHI) was implemented in 1995. This single payer insurance plan improved affordability and access to healthcare for all residents and qualified foreigners, and improved the quality of the medical service. The insurance premium is dictated by income level, and notably the median annual income in Taiwan is roughly half of the median income in the US. The monthly average premium per person is 20USD.
All those enrolled with NHI receive a healthcare smart card that contains an individual’s medical history. This enables clinicians to access most medical reports when seeing a patient. Medical Care through the NHI is also affordable. For example, the copay for a routine office visit is about 5 USD and the cost of a Coronary Artery Bypass Surgery (CABG) is 1/5 the cost of a CABG in the US.
That said, it is hard to sustain the delivery of high quality care at low cost in the long term. To this end, the government tries to cut costs whenever possible, by discouraging physicians from seeing too many patients by lowering the reimbursement rate after a certain number of patients in a day and by finding faults in the medical chart to deny payment for certain treatments.
Given the affordability, overutilization of the healthcare system is a problem. For example, the average number of office visits per year is 15 for an individual, compared to 3 in the US. Insurance does not require a primary care referral to see specialists, hence individuals can visit the specialist anytime, often resulting in many unnecessary specialists visits.
Taiwan has had a stagnant population while the number of medical schools has increased. It feels like there is an abundance of doctors in Taiwan, most apparent in urban areas – where you can find a medical clinic on almost every block. This creates a lot of convenience for patients, but also a highly competitive environment where physicians need to work long hours to retain their patients. Physicians often distinguish themselves and increase their income by developing procedural skills such as minor cosmetic surgery or platelet rich plasma injection, which are not covered by insurance, and are paid out of pocket.
The process of becoming a licensed physician in Taiwan, especially for foreign medical doctors, is becoming increasingly strict. This is because many students who were not accepted into medical school in Taiwan chose to study abroad at schools with significantly higher admission rate and less rigorous training.
To work within the Taiwanese healthcare system you need to at least be fluent in Mandarin, and a basic understanding of Taiwanese (a dialect spoken mainly by the older generations) can be very helpful.
You will need to pass the national medical exam (computerized, 200 multiple choices questions), which consists of two steps, with a required one-year internship in between. The exam is not as difficult as the USMLEs but you still need at least 1-2 months to study for the exam, and it is in Chinese.
To register for the exam, you will need to have your original medical school transcript and diploma authenticated at a local Taiwanese consulate in the US (known as Taipei Economic and Cultural Office, TECO), translated into Chinese, and then have this translation notarized. Of note, US osteopathic physicians are not eligible to take this exam currently.
Regarding board certifications, US training is sufficient in most specialties and there is no need to repeat residency. That said, I would always recommend confirming the requirements with your specialty board in Taiwan. Here are the links to the Taiwanese specialty boards in Internal Medicine and Family Medicine.
Finding a Job
Once you have obtained your license, you can find jobs through the Taiwanese Medical Association and by searaching through medical journals, career websites, and various physician organizations.
One other option is to practice telemedicine into the US and see US patients. If you plan to do telemedicine and see US patients, one recommendation will be to get multiple state licenses while in the US, as the process of getting documents notarized and biometrics for background checks can be very inconvenient abroad.
Finally, there are a few teleconsulting companies in Taiwan where having an US license only will allow you to give advice to Taiwanese patients. However, you cannot prescribe medication or labs, and the compensation is significantly lower than US telemedicine companies.
The Taiwanese healthcare system is great for patients but is not an easy system to work in for physicians. For those wishing to live in Taiwan for the short term, it makes more sense to do telemedicine into the US to see US patients instead of becoming licensed in Taiwan and see local patients. More on Salary & Work Culture, Immigration, and Taxes in the next post.
Anderson Tsai, DO completed his internal medicine residency at Santa Clara Valley Medical Center in San Jose, and is currently a primary care physician living in Taiwan working with several telemedicine companies in the US and Taiwan.
Taiwan is a tropical island country about the size of Maryland and is home to beautiful scenery, friendly people, and awesome food such as beef noodle soup and pork dumplings. It was also has one of the best healthcare systems in...