# American physician locums in NZ



## yankeeinkiwiland

Greetings! I am an American physician presently in New Zealand for a year as a locum tenens. It was a long process to get to this and I am very happy to help any newcomer interested in working as a physician in New Zealand. I have been here only three weeks and scheduled for a 12 month period. I will not reveal my name and specialty and location except to say that I am in a small city (<50,000 population). As time goes by, I will probably leak out more information , I am sure, but for now I would like to remain as anonymous as possible.

I am willing to answer questions about the process and what to expect when you get here. I wish I knew to look on a forum such as this, it would have helped alot. Even those physicians who had been here, 'forgot' to tell me some important facts that would have been helpful to myself before I left the States.


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## Eleisha

Greetings to you too!

Three weeks hey! how are you finding it? 

What are these important facts? 

Talking about "leaks" I've just been reading the latest round of wikileaks for New Zealand.

Apparently pharmac place restrictions on the availability of some drugs and how they are funded, how does that affect you and your patients? Do you ever get frustrated that you can't prescribe the drugs you used to be able to back home?


http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10695113


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## topcat83

Hi and welcome to the Forum. We'll be interested to hear how you find it over here. Most Americans find it very different.


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## ERdoc

YankeeinKiwiLand:

I have some questions for you. I am board certified in Emergency Medicine and am considering spending some time practicing in New Zealand or Australia. I am in the early stages of this process. All I really know so far is that its a great place to live. I have been learning about medical officers, specialists... I can't seem to find much about any of this. What are these different positions? What would I be? How does the ER work? Working on my own for a while now, it would be weird having someone overseeing me. Similarly, I work in a community hospital without residents; would I be supervising 'residents' or their equivalent primarily as a "specialist" (if that is what I would qualify as)? And how does the pay compare? I would appreciate any insight you have into this.

Thanks,
ERdoc


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## topcat83

ERdoc said:


> YankeeinKiwiLand:
> 
> I have some questions for you. I am board certified in Emergency Medicine and am considering spending some time practicing in New Zealand or Australia. I am in the early stages of this process. All I really know so far is that its a great place to live. I have been learning about medical officers, specialists... I can't seem to find much about any of this. What are these different positions? What would I be? How does the ER work? Working on my own for a while now, it would be weird having someone overseeing me. Similarly, I work in a community hospital without residents; would I be supervising 'residents' or their equivalent primarily as a "specialist" (if that is what I would qualify as)? And how does the pay compare? I would appreciate any insight you have into this.
> 
> Thanks,
> ERdoc


Hi ERdoc - welcome to the Forum.
I'm no doctor but we have (unfortunately) seen more than we would like of NZ hospitals recently! It might be an idea to contact a couple of the hospitals attached to medical schools. The two that spring to mind are Auckland (Faculty of Medical and Health Sciences), Christchurch (Welcome to the University of Otago, Christchurch (UOC), University of Otago, Christchurch, University of Otago, New Zealand) and Dunedin (Dunedin School of Medicine, New Zealand). Not because you need the training  but because they are associated with the bigger hospitals and are more likely to be able to tell you about the structure of the NZ health service, positions, etc.

PS all our emergency ambulances are run by St Johns Ambulance over here (http://www.stjohn.org.nz/). They might be able to give you some more info on ER work.


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## Eleisha

What made you guys chose NZ in preference to Australia? I hear the standards of medicine and clinical practice are higher here, as are the salaries and benefits for locums.

I was just looking at some ads on the Australian jobs site Seek.com.au, specialists can earn $2,000 a day right down to juniors earning $100 an hour. For example SEEK - Locum doctor/locum specialist/locum medical practitioner Job in Gladstone & Central QLD 

This is the general search: SEEK - Job Search - Find jobs using multiple job search options

NZ and Australia are so physically close that it's worth looking at both places.


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## tvolm

What is the tax situation?

I am considering moving there, but read that the NZ tax is 33% and US citizens also have to pay US taxes as well.

Thank you for the help.


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## escapedtonz

Hi,

Yes there is a top tax bracket of 33% but one only pays this level when you reach the threshold. Have you an idea of likely salary ?
If so I can give you a full approx breakdown.
Yes you will still have to pay tax back in the US depending on your earnings. I have a colleague from US and he pays tax back in the US which he isn't happy about but rules are rules.

Cheers


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## tvolm

I would be paying in the highest tax bracket in the USA and there, approx. 60% of my salary. I am a doctor.


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## escapedtonz

tvolm said:


> I would be paying in the highest tax bracket in the USA and there, approx. 60% of my salary. I am a doctor.


Ok some examples of what you will pay in NZ :-

If you earned $200k in NZ:

Rates as of 1st April 2012:
Tax Rate Taxable Income	Tax Element	Remaining
Bottom (10.5%) $14000.00 $1470.00	$12530.00
Low (17.5%) $34000.00 $5950.00	$28050.00
Mid (30%) $22000.00 $6600.00	$15400.00
High (33%) $130000.00 $42900.00	$87100.00
Totals: $200000.00 $56920.00	$143080.00

ACC Levy (1.70%) on $113768 (Maximum Chargeable Level): $1934.06 

Total available to spend: $141145.94
Monthly:	$11762.16
4 - Weekly:	$10857.38
Fortnightly:	$5428.69
Weekly:	$2714.35

If you earned $300k in NZ:

Tax Rate Taxable Income	Tax Element	Remaining
Bottom (10.5%) $14000.00 $1470.00	$12530.00
Low (17.5%) $34000.00 $5950.00	$28050.00
Mid (30%) $22000.00 $6600.00	$15400.00
High (33%) $230000.00 $75900.00	$154100.00
Totals: $300000.00 $89920.00	$210080.00

ACC Levy (1.70%) on $113768 (Maximum Chargeable Level): $1934.06 

Total available to spend: $208145.94
Monthly:	$17345.50
4 - Weekly:	$16011.23
Fortnightly:	$8005.61
Weekly:	$4002.81

All payment amounts are approximate, due to specific rounding amounts used by IRD which vary depending on payment frequency. Rates are correct as of April 2012 - March 2013 tax year but are subject to change. This should only be used as a guide. 

You would have to file a US tax return each year and pay the necessary amount, which I am unsure of and I also don't know how it is collected.
There are ways to reduce how much tax you pay back in the US - or another way to say it - there are ways to increase the amount you can earn overseas before you have to pay tax back in the US.
You would probably benefit from talking to the IRS and/or an accountant.

Disclaimer:
I do not offer any professional advice. 
The figures quoted are from experience and an approximation. 
You should seek the advice of a suitable professional, authorised to give financial advice if these are the answers that you seek.
For any matters relating to migration into NZ please see www.immigration.govt.nz


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## MrsRose

tvolm said:


> the NZ tax is 33% and US citizens also have to pay US taxes as well.



 Seriously? I haven't heard anything about this, and now I'm curious. So if a US citizen moves to NZ they have to continue to pay taxes to the US? Is this just until you've been out of the US for a full tax year? Or until you become a resident or a citizen of NZ? Or forever?


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## topcat83

MrsRose said:


> Seriously? I haven't heard anything about this, and now I'm curious. So if a US citizen moves to NZ they have to continue to pay taxes to the US? Is this just until you've been out of the US for a full tax year? Or until you become a resident or a citizen of NZ? Or forever?


My understanding from a friend who is a US citizen but living in the UK is that it's a case of 'if you want to remain a US Citizen then you carry on paying'. 
However I'm no US tax expert.


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## topcat83

escapedtonz said:


> ...
> Disclaimer:
> I do not offer any professional advice.
> The figures quoted are from experience and an approximation.
> You should seek the advice of a suitable professional, authorised to give financial advice if these are the answers that you seek.
> For any matters relating to migration into NZ please see Immigration New Zealand


Lol - just seen this on your post, escapetonz. 

But pretty understandable, when you read the posts on some other sick forums that threaten others with 'being taken to court for giving misleading advice' when it's pretty obvious to sensible people that we're all amateurs on here trying to give sensible advice and share our experiences as real people, and not one of us makes any profit from what we do!


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## escapedtonz

MrsRose said:


> Seriously? I haven't heard anything about this, and now I'm curious. So if a US citizen moves to NZ they have to continue to pay taxes to the US? Is this just until you've been out of the US for a full tax year? Or until you become a resident or a citizen of NZ? Or forever?


Colleague is from the US and in a nut shell if you emigrate to anywhere else in the world you still have to file a tax return in the US and pay tax there - forever.
All depends how much you earn overseas of course and as I say there are ways to increase how much you can earn before tax but it all has to be done through the IRS.
Maybe this will stop if a US citizen gives up US citizenship but don't really see how you can if the US is your birth country. Giving it up doesn't stop an American being an American ?
Luckily the UK doesn't have a similar rule. Now I'm resident here in NZ I don't pay any tax in the UK


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## escapedtonz

topcat83 said:


> Lol - just seen this on your post, escapetonz.
> 
> But pretty understandable, when you read the posts on some other sick forums that threaten others with 'being taken to court for giving misleading advice' when it's pretty obvious to sensible people that we're all amateurs on here trying to give sensible advice and share our experiences as real people, and not one of us makes any profit from what we do!


Ha ha yeah tis a classic statement. Must remember to add it on whenever any advice I pass through anything to do with finances or Immigration 
Can never be too careful eh!!!


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## jsharbuck

The only thing keeping us from considering giving up our US citizenship is the Social Security $$$s which our government keeps even while we have earned it, having paid into it. As well if we make any $$ in Kiwisaver, it is deducted from our US benefits.
A $2,000 a month US social security benefit and let's say a $750 Kiwisaver benefit, would forfeit that $ 750 from your social security check. It's hard to feel grateful being American right now


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## Addicted to NZ

I would suggest that any doctors looking to work in NZ, should contact NZ Locums vs a placement agency. Not just for placement but for any questions a GP would have about virtually anything and everything. If they don't know the answer they will direct you to someone who can answer the question.

"NZLocums is a rural general (family) practitioner recruitment service that recruits doctors to work in rural general practice in New Zealand.

NZLocums is a not-for-profit organisation. It is the only recruitment scheme of its kind funded by the Government to ensure rural New Zealanders have access to quality health care."

As for paying US taxes forever....Try searching over in the Canadian area of expatforum. I remember seeing a few threads about the IRS going after US citizens in Canada.


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## maijajo

*Help!!*

My husband and I are working with a recruitment agency and have been offered a placement near Dunedin ... very rural town. Anything we should watch out for? My husband his a GP and is very eager to move, but I want to make sure we are making the right decision.


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## pcrial

escapedtonz said:


> Hi,
> 
> Yes there is a top tax bracket of 33% but one only pays this level when you reach the threshold. Have you an idea of likely salary ?
> If so I can give you a full approx breakdown.
> Yes you will still have to pay tax back in the US depending on your earnings. I have a colleague from US and he pays tax back in the US which he isn't happy about but rules are rules.
> 
> Cheers


Hello escapedtonz,

The US tax situation isn't quite as ominous as it sounds at first. For example, the first $92,000 earned doesn't get any US tax assessed.

There are treaty forms you can fill out, to exclude portions of your income if a treaty specifies. For example, some of my US income is excluded from US taxation because of a treaty between the US and Australia covering that type of income.

Then when you get down to the USA IRS form 1040, you might be assessed tax on the income that 1. goes over the $92,000 mark, or 2. has a higher USA tax rate than NZ. and then 3. AMT or Alternative Minimum Tax might impose taxes, will be a bigger problem when filing 2013 (in 2014) than previous, because the "fiscal cliff" (deal) stiffens the AMT formula, to capture more taxes.

The forms and the rules are quite complex, especially when you are filing tax documents to USA and NZ. Requirements and rules will have differential and there is just no substitute to reading and understanding the rules. Properly applied, USA taxes should be minimal. The real pain in the tush is just doing all the forms.

Cheers,


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## ala001

*NEw updates?*

I am currently in the process of possibly taking an assignment for 9 months in Hastings as a physician. I have done a little research into things (i.e. cost of living, taxes, etc) but was wondering to those who have done this? Would you do it again? I had wanted to do this years ago but for this type of work, most places want experience. NOw that I am 5 years out from training, it is a good time and I have yet to join another practice in the US for the long term. Seems like the best time for me to try it is now and Australia/NZ has been on my bucket list for quite some time............

I know the taxes will be quite a bother and am prepared for that (have to pay both US and NZ eventually since assignment >6 mo) but I would just like to hear from others what their experience has been. On one hand I am excited about it and the other I am nervous since I could potentially losing money in the long run (selling house here, loss of income since less there, etc)

Advice?
:fingerscrossed:


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## jsharbuck

Follow your heart. My husband took a 40 % in pay from the US but we have more money. It's the experiences that are priceless.


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## ala001

thanks for the reply......

I think that is what I am going to do......
take a loss and a chance. You are correct - experience is priceless


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## jsharbuck

As we say here, good on you.". What's your speciality ? Our family doctor here in Rotorua, just happens to be American who just became a Kiwi. Dr. Ron Vail. Might be good to get perspective former US doc.


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## ala001

I am a general surgeon.......that would be great to chat with someone from here just to get the take on things.


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## jsharbuck

I know that there is a severe shortage in areas outside of Auckland and Wellington. You get extra points on immigration for taking work outside Auckland. Are you thinking North or South Island ?


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## ala001

It would be in Hastings .


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## Rainbow2013

*Considering working in NZ*

I am considering re-locating to NZ. Is it too unrealistic or is it do able? I lived only in U.S. Can you help.


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## Rainbow2013

*MD in NZ*

How is the process and how long will it take. What to study/ how to proceed???


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## jsharbuck

There was an interesting article in the New Herald last week that talked about the job market for physicians from overseas is drying up. In fact it might be taken off the critical skills list. Graduating doctors here are having problems finding jobs upon graduation due in part to the flux of doctors from overseas.
That said, the article did not take into account specialists and experience level. If you think you want to come over, and work, contact a medical recruiter or HR at a medical center, they can give you details what they require .

Best of luck


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