006: I’m Too Hands-On — Can Procedural Doctors Do This?

In this episode, Dr. Kristine explores how doctors in high-paying, hands-on specialties like surgery, anesthesiology, and emergency medicine can leverage their expertise remotely. She emphasizes that your specialty is not a constraint—your context and how you use your skills are the real limits. Learn practical ways to transform your medical expertise into income streams that offer location independence, without sacrificing the work you love.

Key topics:

• Challenging common beliefs that only certain specialties can work remotely
• How physicians can utilize skills such as decision-making, risk assessment, and pattern recognition remotely
• Examples of remote opportunities for surgeons, anesthesiologists, and emergency physicians
• The importance of hybrid models blending in-person and remote work for flexibility
• How to shift your mindset about income and value outside traditional hospital settings
• The role of adaptability in future-proofing your medical career in the age of AI
• Steps to repackage existing expertise into scalable remote income streams

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Transcript

SPEAKER_00 0:01

You're listening to Doctors Abroad, the podcast for doctors who want to build remote income and create location independence. I'm Dr. Christine Goins, founder of Nomadem D. I've exceeded my hospital income while working part-time and living abroad. And on this show, we break down how to make hospital income optional. Let's get started. There is this belief that so many doctors carry, especially if you are in a surgical or procedural specialty, or perhaps emergency medicine. And it sounds like I would love to work remotely, but I'm an anesthesiologist. Or I'm in emergency medicine. So those options are not available to me. Or I'm a surgeon. My work is literally hands-on. And for most physicians, the idea of this is not just about the work, it's about the income. Because these are some of the highest paid specialties in medicine. And so the real fear isn't just can I actually do something different? It's am I going to lose my income if I do? And because of that, a lot of physicians make a decision very early that this doesn't apply to me, or these options do not exist for me. But what if the issue isn't your specialty? What if it's how you've been taught to use it? And what's interesting is that this belief doesn't usually come from evidence, it comes from what we've most often seen, or more accurately, what we haven't seen. Because if you don't see surgeons regularly working remotely, or anesthesiologists or procedural specialists working remotely, it's really easy to assume that option must not be for me. But often what's most common and seen, and what we're most often trained to do in medicine, is not the same thing as what's actually available or possible. Right? So your specialty is not your constraint, your context is. And so today we're going to break down why that is and what options are actually available. How to look at your current role differently. Because right now, many of us think it's the hospital, the operating room, the clinical structure that we've trained in. That is what has shaped how we use our skills. But your actual expertise, your actual value, it does not live in a room or in a building across town. Your ability to make high-stakes decisions, recognize patterns quickly, solve complex problems, guide outcomes under pressure, those are critical skills that belong to you. And once you understand that, the questions start to shift from can I work remotely to how can my expertise be applied differently? So instead of speaking about this in general terms, I want to walk through this by using a few specialties as examples so you can actually see what this looks like. Let's start with surgeons, because this is usually where the strongest resistance can come up. Many times the belief is I operate. So if I'm not in the OR, then I don't have income. But surgery is not just right about the procedures. It's also decision making, case selection, planning, risk assessment, post-operative management. So here's what I've seen surgeons do: pre-op consults and second opinions remotely, post-op follow-ups and recovery management, consulting for medtech and surgical device companies, advising startups on surgical workflow and innovation, teaching surgical techniques through courses or international programs, expert witness work. And here's what's important to understand: these aren't side gigs or hobbies, right? These are high-value applications of surgical expertise. Because the value itself is not just the procedure, it's the judgment behind the procedures that you do. So, no, you might not be operating remotely, though, if we're being honest, there are surgeons doing telesurgery and telerobotic surgery. But even if you're not, you can still use your surgical expertise in ways that generate income. Now let's talk about anesthesiology. Because this is another specialty that I've worked with, where people often think my job is entirely in the OR. But anesthesia is fundamentally about risk, stratification, physiology, perioperative management, critical decision making. And so what I've seen anesthesiologists do, preoperative assessments remotely, consulting for outpatient facilities and surgical centers, advising, monitoring device companies, pain management consultations, medical legal consulting, protocol development for clinics and healthcare systems, not just the act of administering anesthesia and keeping the patient alive during surgery, but also that ability to manage complexity and risk in those roles are often compensated based on your expertise, not your physical presence, which means that your income is no longer tied to you being confined to the OR, a hospital, or a schedule. It's tied back to your ability to solve complex problems. Now, emergency medicine is another example because often, and physicians feel, you know, my skill set only works in very high acuity in-person settings. But emergency medicine is one of the most adaptable specialties. You are trained in triage, in rapid decision making, acute care. And some options that I've seen and physicians thrive in are teleurgent care, contracting with clinics or healthcare systems that need expertise in triage and acute care protocols, and even creating niche telemedicine practices that are focused on urgent or acute care needs. And I've seen people even do that in the area of travel, not as a downgrade in terms of skill set, but as a different application of those skills that can still generate strong income without that same level of physical and emotional strain. So I want to pause here for a second because there is often an assumption underneath this kind of work that I want to challenge. And it's the idea that if you explore remote work, that you have to give up maybe a part of medicine that you really love. That it's either you stay fully in the hospital and the hospital system, or you leave completely and you go non-clinical. And that's not actually how most physicians make this transition. What I see far more is physicians actually building hybrid models where they combine some in-person work with remote income streams in a way that actually gives them more control. So let's say you're a surgeon, you might still want to operate because you enjoy it, because it's meaningful to you. You love it, it's what you do. But instead of doing it full time, you get to do it on your own terms. If you're an emergency medicine, maybe you still want to work shifts part of the year, but maybe you want to spend the rest of your time doing telemedicine, consulting, or teaching. If you're an anesthesiologist, you might want to combine in-person work with pre-op evaluations and advisory roles, right? You don't have to choose between doing the work that you love and having the lifestyle you want. You can design and build a structure that allows for both. And this is also how physicians start creating location flexibility, right? So they might work in person for part of the year, their procedural part of the year, and then live or travel abroad the rest of the year, or reduce their schedule enough that they're no longer tied to one place. So freedom doesn't have to come from leaving medicine, but rather having the control, having the autonomy over how you get to practice it. So, yes, you can still practice the type of medicine you love, whether that's surgical procedures, doing your intubation, chest tubes, whatever it is that turns you on. The only difference is now you are doing it in a way that gives you freedom and flexibility and control. And it doesn't stop with these three examples. Um, I've worked with anesthesiologists and hospitalists and subspecialists, primary care docs who all started in this same place of I don't see how remote work actually applies to me. And then they realized it was not their specialty that was limiting them. It was the structure they were working inside. Remote work is not about taking your exact job and day-to-day routine and then trying to drag it online, it's about translating your expertise into a different format. And so ask yourself if you didn't have to practice your specialty in only one way, what would you want your schedule and day-to-day life to look like? Just consider that. And let's talk about the income piece directly because I think it's a part that most physicians we won't always talk about out loud because we're not supposed to care about money, right? We were basically taught to work for free. But a big fear that comes up around this transition to working more remotely is I've worked too hard to build this income. I cannot afford to lose it. And that's really valid. But here's where the misunderstanding is. The assumption is that your income only exists in one form. In when you work in person, in you doing procedures, in being hospital-based. But that's just the structure that you were trained in. It's not the only way, right, that your expertise can have value. So in this transition, you are not losing your income. You are learning how to earn it differently. And when physicians start to shift into these models, they're not starting from zero. They're starting with years, sometimes decades, of high-value expertise, which means you're not starting from scratch. You are repositioning skills and assets that already have immense value. And so the question isn't, can I make money outside the hospital? The real question is: am I willing to explore other ways my expertise can generate income? And sometimes even the consideration of making a change tugs on our identity and how we see ourselves. Thoughts will start to come up, questions. If I'm not doing my work the way that I've always done it, the way that I was trained to do it, am I even still a doctor? And the answer is yes. No matter what you do, you're never going to leave behind your expertise. But you will expand how you practice it and how you use it. There is no specialty that is limited to one way of working. What changes is not what you know, it's how you apply it. Because let's face it, in the age of AI and advanced technology, the future does not belong to the most specialized, but to the most adaptable. Your skills are more flexible than you've been taught, your expertise is more valuable than you've been shown, and your career has more options than you've been given. If you want help identifying what freedom and flexibility could look like for your specialty by building a remote or hybrid income stream that works for your life, you can book a one-to-one freedom consultation at theNomadMD.com. Thanks for listening to Doctors Abroad. If this episode was helpful, share it with a colleague who's been thinking about building more freedom and flexibility in medicine. And if you're ready to make hospital income optional, book a one to one freedom consultation at thenomadmd.com. I'll see you in the next episode.