Raquel Correia, a Chief Medical Officer and practicing M.D., recently shared something that made me stop scrolling: "My parents had one passport. I have two. The kids have three. That’s not lifestyle. That’s strategy." She followed it with an even sharper warning: many physicians still plan their careers like it’s 1980 - train, settle, stay, and hope the system behaves.

That framing is uncomfortable on purpose, and it is also increasingly accurate. Whether you love the idea of mobility or hate it, the environment around medical careers is changing faster than most career plans.

"Governments tighten taxes. Healthcare budgets shrink. Borders close. Licensing rules change overnight." - Raquel Correia

In this post, I want to expand on what Raquel is really pointing to: doctors are high-skill operators in a volatile, policy-driven market. If you build your entire life around a single system, a single regulator, and a single payer environment, you are taking concentrated risk without getting paid for it.

The real shift: medicine is stable, systems are not

Physicians often choose medicine for its perceived stability. The clinical skill set is stable. The demand is stable. But the system you practice inside (reimbursement, taxation, immigration rules, licensing pathways, workforce politics) is not.

Raquel’s point lands because it reframes passports, licenses, and income structure as risk management, not luxury. When a government changes marginal tax rates, clamps down on private billing, limits visas, or modifies specialty recognition, your options can narrow quickly if you built everything in one place.

This is not doom-and-gloom. It is simply acknowledging that policy risk is part of the job now, just like malpractice risk or payer risk.

Portability beats prestige (when you zoom out)

Raquel advises younger physicians to "pick a specialty that’s portable" and to "train where your diploma unlocks multiple countries." That idea can sound like you are trading aspiration for pragmatism, but it is often the opposite.

A portable specialty does not mean an easy one. It means your skills and credentialing pathways travel reasonably well across borders and practice settings. In practice, portability can come from:

Broad demand (for example, primary care, anesthesia, psychiatry, radiology, emergency medicine)
Settings flexibility (hospital, outpatient, telemedicine, occupational health, industry)
Procedural versus cognitive balance that fits multiple systems
Clearer international equivalence pathways (or at least predictable ones)

Prestige is local. Optionality is global.

A useful test

Ask yourself: if reimbursement drops 20% in your current country, or licensing changes, could you credibly rebuild in another jurisdiction within 12 to 24 months? If the answer is no, you have concentration risk.

Second citizenship is not a status symbol, it is an option

"Think about second citizenship before you think about a mortgage" is one of Raquel’s most provocative lines. Many people hear "citizenship" and assume it is only for the ultra-wealthy. In reality, for internationally mobile professionals, it can function like an insurance policy:

It can reduce immigration friction when relocating for training or work
It can protect family mobility if borders tighten
It can expand where you can legally reside, invest, or start a business

Important caveat: citizenship and residency are complicated, and the right move depends on your existing nationality, family situation, and long-term plan. The deeper point is simpler: do not lock yourself into illiquidity (a house, a single employer, a single license) before you have built options.

Geo-arbitrage for doctors: earn here, live there (legally)

Raquel summarizes geo-arbitrage cleanly: "earn where reimbursement is strong, live where your life makes sense." In medicine, this is becoming more feasible because the ways doctors create value have expanded beyond traditional employment.

Some examples of legitimate geo-arbitrage patterns physicians use:

Working in a high-compensation market for a defined period, then relocating to a lower-cost region
Combining local clinical work with remote telemedicine where allowed
Short-term locums in higher-paying regions while maintaining home base elsewhere
Advisory work for healthtech or pharma based in one country while living in another

This is not about gaming the system. It is about acknowledging that compensation, cost of living, schooling, safety, lifestyle, and proximity to family do not all have to come from the same map pin.

The taboo topic: multi-system income and tax leverage

Raquel calls out a cultural gap: "Multi-system income is normal in business. Why is it taboo in medicine?"

Many doctors are taught that having one job, one hospital, one paycheck equals professionalism. But from a financial resilience standpoint, one paycheck is one point of failure.

To stay within both ethics and the law, the goal is not secrecy. The goal is structure and clarity:

Understand tax residency rules (these can differ from citizenship)
Learn what tax treaties apply to your situation
Separate income streams cleanly (employment vs contracting vs business income)
Keep documentation and local professional advice as non-negotiable

Raquel’s line about "paying full freight without studying tax treaties" is a reminder that the default outcome is rarely optimal. You do not need aggressive schemes. You need literacy and good advisors.

FIRE as leverage, not escape

Raquel brings the conversation to FIRE (Financial Independence, Retire Early) and makes a key distinction: the point is not necessarily to retire at 40. The point is to "negotiate without fear."

That resonates because medicine can trap people in golden handcuffs: expensive training, delayed earnings, lifestyle inflation, and then a narrow set of local options. Financial independence changes the tone of every conversation:

You can walk away from a toxic department
You can reduce clinical hours without panic
You can say no to unsafe conditions
You can invest in training that increases portability

In other words, FIRE is career autonomy.

Practical ways to build portability (without burning your life down)

If you are under 40 (or simply in a growth phase), here are pragmatic steps that align with Raquel’s strategy while staying realistic:

1) Map your optionality stack

List your current anchors: license, board certification, employer, visa status, language, spouse career constraints, kids schooling. Then list what would increase options: another language, a second license pathway, a telemedicine credential, a business entity, or savings runway.

2) Choose one portability lever per year

Trying to do everything creates noise. Pick one:

Licensing pathway exploration in a second jurisdiction
Telemedicine competence and compliant setup
A niche advisory skill (AI in clinical operations, value-based care, quality, medical writing, medico-legal)
A financial runway goal (for example, 6 to 12 months of expenses)

3) Build multi-stream income ethically

Start small. A few hours a week of advisory, teaching, or consulting can diversify income and build a network that is not tied to one hospital.

4) Get professional guidance early

Cross-border tax and licensing mistakes are expensive. Spend on competent help before you need it.

The uncomfortable truth, and why it helps

Raquel ends with a line that frames the whole post: "Hospitals optimize for survival. Governments optimize for revenue. You? You optimize for leverage."

I read that as permission for doctors to think like strategic adults, not like passive employees waiting for policy to be kind. Leveraging your skill set does not mean abandoning patients or treating medicine like a hustle. It means respecting reality: you have a rare, portable capability, and you can structure your career to protect your family, your finances, and your professional integrity.

If nothing else, take Raquel’s opening seriously. Multiple passports are not the goal for everyone, but multiple options should be.

This blog post expands on a viral LinkedIn post by Raquel Correia, Chief Medical Officer | Practicing M.D. | Using AI, VBHC, and Education to improve Patient Outcomes. View the original LinkedIn post →