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  #1  
Old 08-21-2007
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Financing the cruising dream

Trying to get creative about financing big cruising dreams. I'm an MD, and want to leave Stateside to make full-time cruising with my wife and daughter a reality. I'll need an income, of course, and one idea is to set up an Urgent Care type medical center in some far-away yet idyllic sailing destination. Best choices would be locations where there are enough foreign tourists to allow the place to turn a reasonable profit, but not so built up that a strong medical system is already in place and thus my services wouldn't really be needed. Local laws and regs might be too thorny in certain places, which I'll have to investigate further. For you Lefties out there ready to pounce against the greedy doctor or what may sound like medical imperialism, let me plead that I've given my services away for more than a decade and will surely continue to do so in various venues (maybe this one, too, if things work out). But this venture needs to turn a profit or it won't help me or anyone else. So, have you been somewhere with beautiful sailing where you found yourself thinking you would pay good cash if only for an American trained doctor? Were you surrounded by tourists who might have been thinking the same? Which places top the list?
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Old 08-21-2007
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most countries have pretty strict laws against foreign doctors practicing in their jurisdiction without doing alot of paperwork. American trained doesn't necessarily mean you're competent in the rest of the world... and the local authorities will usually want some paperwork to prove you're not only trained but competent. Also, I, for one, would be hesistant to trust someone about medical care just on their say so that they were American trained... I've dealt with a lot of doctors over the past 30 years, and some were good, some were okay and some were bad...
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Old 08-21-2007
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It would seem that you're working at cross purposes here. Either you're cruising, or you're running a shoreside business. And with one where you are the primary employee, that doesn't leave much time for cruising. From reading your post, it sounds like you need to further define to yourself, just what it is you want to do.
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Old 08-21-2007
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Now if you were a dentist I could see you making ends meet sailing in paradise, there are a lot of cruisers out there who at some time would love to get their teeth problems fixed but payment might be more in the way of barter.
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Old 08-21-2007
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Guatemala has need of physicians, as I understand. However, I am not sure about the turning profit thing. Many of the places that need physicians the worst probably won't have much/any money.

I know my presonal physician (she and I were "friends") said that she was asked to move to the USVI to practice. They were going to give her a pretty reasonable income - but she declined since her husband was involved in building and would have an issue moving. That might be an option.

I noticed that if you are a physician, you can move to Australia. That skill is needed there I believe. THat is is pretty area, though it will put you closer to TDW which carries a whole other risk (smile).

Of course, quite candidly, I think PBeezer is right... sounds more like working to me. Save up your money. Buy a conservative but nice boat. Take off and enjoy what you are doing. If you find an island that needs some help and they are willing to pay, all the better.

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Old 08-21-2007
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My 2 cents:

There is a great book called "The 4 hour work week" I highly suggest you read it. The bottom line is if you want to cruise, whatever you do for income will have to be automated and passive. If you are going to practice you will be trading time for dollars, that leaves little time for cruising. So write a book on being a smart patient, give lectures, do something that is more product orientated so you free up time to do what we love, which is sail. So what ever you decide Doc, you have to take in money in this economy and spend it where your dollar is worth more. If in your cruising you barter or take in cash "under the mast" fine, but don't count on it, and in many countries...don't get caught. You might also check "Doctors with out Borders" if you want to set up clinics as you sail.
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You might want to consider joining an existing clinic that serves the expat and tourist community in your "far-away yet idyllic sailing destination." It has some advantages: You could rotate through for say 4 months every 12. The patients are foreign nationals (US & Europe) and and used to paying top buck. They have insurance or credit cards and the clinic can bill them. You'll probably have a full time asst./nurse to act as interpreter. Malpractice insurance won't be an issue. The patients are transits so there's no continuum care issues. Licensing can be permitted by association with your colleagues at the clinic.
I've found these clinics all over the world, even in marinas in the Canaries and Portugal. They had US docs working there that were sailors. Remember the locals usually get subsidized care and don't use them. So you can't extract money from that system unless you work for the government.
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Old 08-21-2007
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Good thoughts, all of them. Sailingdog, I understand your reluctance to equate "American trained" with quality care, and I agree with you, there are a lot of lousy docs out there, American or otherwise. It happens that I'm an ER doc, so by training I'm pretty good at the Urgent Care type of setting. Hopefully, doing good work would grow referrals and build the business, like any other venture. Being a board certified American trained ER doc might not be much of a selling point in a lot of places I've been since their medical systems are already well developed (ie Costa Rica, Thailand, BVI), but I imagine that isn't the case in a lot of choice destinations around the globe. Somewhere out there, there's likely a place where there are a lot of tourists who would be very relieved to know they didn't necessarily have to navigate a local ER in a foreign country if they got sick or injured.

Pbzeer and CruisingDad, you are right, I could be trading one land-based practice for another, which certainly doesn't get me cruising. I'd fully expect to be married to it 24/7 for a while (6 mos, a year?), but I've got a like-minded partner to share the burden, and the hope would be to grow it enough to employ others so that eventually, we could run it mostly from afar.

I think GySgt has it exactly right (thanks for the book suggestion, I'll definitely look for it), the ultimate object is to have an "automated and passive" income source, which is the whole idea. Don't need to be making piles of money, just enough to keep the place (and boat) afloat, ultimately without having to keep a strict schedule at the office...

Azeotrope, thanks for your info, I'm glad to hear that others have been doing this sort of thing already. I think doing a stint at an already existing clinic that caters to this sort of thing is an excellent idea. Would learn a lot about how feasable this really is. Let me know if you can recommend any good ones that you've seen...

Cruisingdad: you are right, I've seen ads for MDs in Austraila and New Zealand. It might be that you're also right about keeping it simple and just saving up to go without strings attached...trouble is, that's going to take me a long while (lots of debt from med school, residency, etc still hanging over me). Working shifts at various locales while cruising doesn't lead to the automated income goal, but it might get us living the dream sooner, and maybe with fewer complications.

Do appreciate your thoughts. This site is an excellent sounding board...
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Old 08-21-2007
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How about being one of those mailorder doctors where you consult on the phone and issue prescriptions. That way if someone needs some OxyContin and you happen to be on a broad reach you can still make some money.

I'm just joking, but it probably happens that way....
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Old 08-21-2007
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Pamlicotraveler: Ok, while I'm not much interested in being THAT kind of doc (they're easy enough to find, I think), what about this: might there not be a place for some sort of telemetric medical "consulting" service for seafarers? Perhaps this is getting hairbrained, or perhaps it already exists, but what about all those commercial (and private) vessels that have the potential to have to deal with medical issues far from land? Especially those without medical officers on board might benefit from a service (subscription based?) with docs on call for guidance, or one which provides the equipment and/or training to crew for dealing with medical issues before they leave port. Not unlike telemetry based EMS systms on land. Ok, maybe I'm getting silly here, and it's hard to imagine this really making any money, but it might be a satisfying project to pursue if only for the interest in intersecting seafaring and medicine...anyone know if it already exists? Would any of you cruisers out there subscribe to a service to know you could reach a doc for advice wherever you are sailing? No? Ok, forget it...
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