Dr. Leo Damasco and Phoebe Gutierrez talk with Dr. Kristine Goins, board-certified integrative adult & pediatric psychiatrist, physician coach, and founder of Nomad MD. She shares how severe burnout led her to leave academic medicine, book a one-way ticket to Colombia, and build a location-independent career helping other doctors replace income remotely while living and working anywhere.
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In this inspiring episode of Telemedicine Talks, Dr. Leo Damasco and Phoebe Gutierrez welcome Dr. Christine Goins, board-certified integrative adult and pediatric psychiatrist, physician coach, and digital nomad. After years of extreme burnout (chest pain, insomnia, muscle spasms) while working in 10 clinics a week, serving as associate program director, and chairing a DEI committee, Dr. Goins realized the problem wasn’t serotonin, it was the lifestyle.
She resigned from her academic position, booked a one-way ticket to Colombia, and began designing a career around the life she actually wanted. Today she runs Nomad MD, coaching burned-out physicians on how to create remote, location-independent practices (often cash-pay) so they can work less and live anywhere.
The conversation covers the identity shift required to step away from traditional clinical roles, the financial fears that keep doctors stuck, practical realities of practicing medicine while living abroad (taxes, licensing, controlled substances), why owning your own practice gives the greatest autonomy, and how living in 17+ countries has reshaped her view of what a doctor’s life can look like.
Top 3 Takeaways:
About the Show
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine.
About the Guest
Dr. Kristine Goins is a board-certified integrative adult and pediatric psychiatrist, physician coach, and digital nomad. After experiencing severe burnout in academic medicine, she founded Nomad MD to help physicians replace their income remotely and build freedom-first careers. She has lived and worked in 17+ countries and currently divides her time between locations such as Guadalajara, Italy, South Africa, and Bocas del Toro, Panama.
Connect with Dr.Kristine Goins:
About the Hosts:
• Dr. Leo Damasco – Pediatrician and emergency medicine doctor turned telemedicine advocate, helping physicians transition to digital health.
• Phoebe Gutierrez – Former state regulator turned telehealth executive, specializing in compliance and sustainable virtual care models.
Connect with Phoebe Gutierrez:
https://www.linkedIn.com/in/pkgutierrez/
(mailto:phoebe@telemedicinetalks.com)
[00:00:00] Hey, welcome back everybody to Telemedicine Talks. I am very excited to have this guest on today. This is Dr. Christine Goins. She's a board certified integrative adult and pediatric psychiatrist, physician coach, and digital nomad. Having served in several healthcare settings in various leadership positions within academic centers, Dr.
Goins has witnessed first hand impact that burnout, stress, and work/life imbalance can have on doctors' lives. And motivated by a desire to make a difference, Dr. Goins founded Nomad MD, where she helps burnout doctors replace their income remotely and build freedom first careers working less and living anywhere.
Dr. Goins, thank you for joining us. This is amazing. I'm excited. This is right down our alley, so thank you so much.
Thank you for having me.
Yeah. No, I'm super excited. I think the first time I ran into you and your platform and what you do is, I was doom scrolling Instagram and, just looking about, like, Dr.
[00:01:00] Burnout and, just thinking about when we were starting this podcast.
Mm-hmm. '
Cause, One of the main things this podcast was built of was to help doctors get into telemedicine because of all the above. Mm-hmm. So, you know, I'd love to hear your story and how you became to be and how you found, that out
Yeah, I think the initial pieces were in childhood because I wanted to be a doctor since I was eight.
But I also grew up as a teenager reading books by a certain author, Eric Jerome Dickey, and he wrote fiction novels on Black professional polyglots. He used to travel all over the world. So in my mind growing up, I was always like, "How am I gonna live both of these lives at the same time?" I didn't really understand how I was gonna figure that out.
But, when you move into medicine, you realize pretty quickly that a lot of times that lifestyle just takes over everything else that you might wanna do. You know, [00:02:00] everything becomes so dedicated in terms of your time, your energy, your resources to that career. And so I was always, like, looking for the time where things were gonna shift, and I feel like a lot of times in training we think, "Oh, maybe it's after training.
Like, once we become an attending-" Yeah. Yeah ... then it's gonna happen. Mm-hmm. And so that was my thought. I just kinda kept moving through and I would find spaces to travel in the midst. Like, the summer after med school we had that little break and I went to Costa Rica. That was my first time ever going abroad.
I went to my fellowship program because I knew they were gonna allow me to go away, so I spent a month in like a Tibetan monastery studying meditation. so I would always try to like- Yeah ... find a way to do it, and then when I became an attending, I was like, "Okay, now it's gonna work." And I was so busy.
I was working in 10 clinics a week. I was associate program director for a fellowship. I was chairing the DI committee. I was, like, doing all these amazing things that were a part of what I felt my [00:03:00] purpose in medicine was, but I was so exhausted and burnt out and it showed up. Like, chest pains in the middle of clinics, like going from- Yeah
one to another. It showed up like headaches. All of a sudden I could barely sleep. And then I started to have spasms, throughout my body, and I ended up in a neurologist office really scared. maybe have come down with, a neurological disorder that I can't get rid of. So, 30 seconds into the appointment, I'm like, "Oh my gosh, work is so stressful.
I don't know what to do." And he just, like, cuts me off. He's like, "Look, I can prescribe you some Lexapro." And I was just so confused. I was just like, but why? It's really this job that's just driving me nuts ." And he's like, "Yeah, but you're not gonna quit, are you?" And just, like, that kind of response, especially as a psychiatrist, I was like, "No."
There's like, something else needs to change because the true imbalance is not, serotonin. It's like this [00:04:00] lifestyle that I've created, this career that I'm in. And so that's when I decided to book a one-way trip to Colombia . A one-way ticket. Sure. And give my four months to, the academic center . I was like, "No, this is not how it's gonna end up for me."
you make a few good points, right? We go into this and it's always, what's next, right? Like in med school it's, okay, it's gonna be great when you're attending," or, "Hey, once fellowship is over, I'm gonna have time."
But you're right. Once we hit the grind of, being what I call the clinical monkey, right? it's downhill from there, right? Yeah. And then after that it's like, "Oh, then when I retire," right? And it's like, wait, that's, what? 65, 75. Shoot, doctors die in clinic in the ERs, practicing.
Mm. There's never really an end. And it's awesome to hear, you know, one, I'm sorry to hear that's how you got your, revelation, while you were having somatic symptoms in the office, but not a [00:05:00] lot of us can make that connection. Or not a lot of us have the strength, or really the balls to just do what you did and be like, "Nope, I'm out.
Cut. This is what I want." So how do you approach that when you have providers coming to you and being like, "Hey I'm having anxiety attacks. I'm doing this." But they really can't see or, don't realize that this is a realistic option.
Yeah.
a lot of times docs will start with like, "Okay, what remote jobs are available?" Or, "How much do they pay?" Or, "How many licenses-" Yeah, yeah ... "do I need?" But I feel like a lot of times it's really about starting with what kind of life am I trying to build? Love that. Like what kind of career do I actually want?
And I feel like when we start with those kind of questions, we get so much closer to what we want as individuals rather than like a cookie cutter idea of what feels like it's possible or what can be given to us. We're so used to like following the algorithm, you know? And I think [00:06:00] asking ourselves those questions, like if I could design my ideal life five years from now, one year from now, two years from now, what would it look like?
Like where do you wanna wake up? How much do you want to work? What do you want your Tuesdays to look like? And I think once you design- The life, you design the career to support it
I love that. I love that. It's really shifting the focal point, right? And we talk about this all the time, but yeah.
You know, us as professionals, doctors, and not even just doctors, just professionals in total, right? Yeah. our calendars are first filled with jobs, right? What do we do? And then our whole lives, or what's left of it, right, is filled in the tiny little pieces in the periphery, in the nooks and crannies.
and sometimes there isn't any nooks and crannies, right? Yeah. So no, that's amazing. And so now looking at your bio and talking with you shortly, you've been in a lot of places, right? W- you're- Yeah ... r- right now in Guadalajara. Amazing. What,
kind of shifting focus a little, what's the favorite place that [00:07:00] you've been in, and what's the most awesomest experience that you've had since you've realized like this is what you wanna do?
Yeah. There's been a quite a few. But I would say some of my favorite places to live have been, I really loved living in South Africa.
... I'm a wine professional, so I'm like really partial to wine regions, so- ... especially ones with the ocean nearby. So, for me, South Africa is just amazing, and then also, Bocas del Toro, the archipelago off the coast of Panama. That's like one of my homes away from home. I love when you can just get in a water taxi and go spend time with dolphins, like on a regular day.
Like ... that's like the life I love
That's amazing. And you know, when people listen to this, they're like, "Oh, yeah, that's great and everything," but then how do you make it work? where do the financials come in? it's scary, right? Especially if people have, families, you know, people that depend on them.
And then also to add to that too, Leo, like how did you deal with kind of the mindset shift of like-
[00:08:00] Yeah ...
I think one of the things Leo and I have realized of working with so many doctors kind of in the same boat is there's a really weird identity shift. like you said-
Oh, yeah
since you were eight You wanna be a doctor. You have this really, really, really regimented path. What happens when you finally get your first job and you're like, "I actually don't really like this," or, I really wanna change"? It's hard. Like how did you even do not just the financial, but just like the-
Yeah
identity shift that like I kinda am stepping away from the day-to-day clinical work?
Yeah. I think for me it was really about not making my career my whole entire life. because we spend so many years in training and like when I calculate, I'm like 16 years is a long time to train to get to a certain point.
Yeah. I think in that process so much of our identity becomes about work and about our career, and I think it's about moving into the other pieces of the life that you really [00:09:00] love. Like, I think it's making space for all of that. One of the first things that I did was I made all the things that I love number one, and I put work into the cracks of that.
So wherever I could fit work I try to fit it in, but it's not everything. And I think making that flip is important, even if it means that in the beginning it's just how do I take an hour a week to go figure out what I like again, to go swimming, like to join a group, like to go back to what your passions are outside of your career.
Because I think that's what, for me, makes life more fulfilling. I enjoy work so much more when it's just one of the things that I do. It's not all of, you know, my week and all that I do. But definitely the financial piece was probably the scariest piece for me because you know, as a doctor, like we're so regimented and I'm like, "Oh my gosh, what about student loans?
What about my retirement?" Yeah. Like, all of these [00:10:00] things. And I'm like, my greatest fear was, like, I go to Colombia and then I end up, broke under a bridge, and, I can't eat or like some just radical thing- ... that doesn't make sense happens. what I did in that situation and with that fear is I decided to flip the question on its head, and I said, "Christine, what if you living this life that you wanna live is the way that you fast-track yourself to financial freedom?
Like, what if that's possible? How would that happen?" Yeah. And I think it gave my brain some work to do that was actually way more constructive, and that's what I did. I found that, moving to other countries and engaging in the cultures I wanted to be a part of and having this free time really allowed me to, one, spend the day, like, having that satisfaction and joy that actually helps you to be more effective and present when you do work.
It actually gives you the space to be more creative and innovative around how to make money. And for me, it [00:11:00] also led to me making, a similar income if not more, but my expenses cut down to less than a third of what they were living in DC. And so it was so much easier to fast-track myself to financial freedom with that path than even staying where I was.
Yeah. Yeah, no, we get that a lot. It's funny how it does flip, right? But it's that flip, that identity shift, that whole changing the construct of where you're looking at things. 'Cause it is funny. Now, personally I switched, yeah, it changed, right? And it was hard.
it was scary at first, You're like, "Oh, I'm gonna dive deep," and We don't know where the bottom is, and how's it gonna make it happen? And I think we talked, Phoebe, a lot about this, you just gotta dive head in, right? You have to go, stop thinking like a doctor sometimes, where,
Our threshold for risk is what, less than 1%, right? And just go. But that's just so hard for us sometimes, 'cause [00:12:00] we are such a risk adverse population. it's tough.
It's hard though again, we're all conditioned, right? And like, you know, Dr. Gwynne, you'll get this 'cause you're, a psychiatrist.
But like we're all conditioned from childhood to like, again you work in a certain system, you live a certain way, and so it's really scary. I'm always the one that pushes people. Like, "You guys are doctors, so if you fail, oh my gosh, you can go and get another job, I promise you. but what if you don't?
And that's where like me and Leo have seen so many, physicians. Now again, it's really easy for a physician in telemedicine to make the same mistakes that they made in clinic, and like- Mm-hmm ... take on 10 jobs, and have all- Yeah ... this work and be so burnt out. So one of the things we really tell them is like at least really try to focus on the stuff that you like to do.
don't make the same mistake, and find pleasure and enjoyment in what you're doing. But it gives you a little bit more flexibility. But again, it's still, kind of like a tricky, slippery slope.
Yeah, I think that's why it goes back to [00:13:00] that design in the beginning because you can find yourself just getting another job- Yeah
where someone is still really dictating a lot of your life, where I think deciding from the beginning like, "Okay, I only wanna do this type of work. I only wanna work this many hours, this many days a week, and the rest of my time I'm gonna be doing something else," is really about the autonomy, and I feel like that's what really gives us that sense of, satisfaction and, fulfillment even in the work that we're doing, knowing that we have that control.
Now, other doctors can argue, "Hey, you know, this is what we went into our profession for," right? "We are altruistic servers," "Of the people," right? And you see that. You see that in conversations. You see that even just in posts "Oh, you doctors make too much. You know, you should be open on the hours.
you should be working in the weekends when everybody else is off. Why aren't you like that? You guys are so selfish, thinking about yourselves and your own family [00:14:00] instead of the patients, which you have, done an oath to serve. How dare you?" how do you tell people to get over that?
This is one of the privileges of being a nomadic doctor. Like, 100% of my healthcare is outside of the US, it has been for the last five years, and out of the 17 countries I've lived in, my healthcare has been all over that. You don't learn more about a healthcare system than being a patient in there.
That's right. And as a patient in all of these different countries, one thing I've learned is that medicine is practiced so differently- Yeah ... in different places around the world. The way that a doctor will even show up, the way that they have space for the rest of their lives. Like, I remember when I was in France and I had, like, an urgent care kind of situation.
I literally looked at my phone, within five minutes I had an appointment, a tele appointment with a French doctor, and at the end of the appointment he was like, "You know, typically we don't charge each other even for taking the [00:15:00] time to help each other and see each other in medicine."
Really?
And I was just like, "What?
What if we did that in the US?" Like, this is
Like a revelation.
you know? Just 'cause you were a doctor- Just because ... they were like, "Hey, this is professional courtesy. I'm gonna see ya." That is ridiculous. Yeah. That's wild, right? That's unheard of here.
Exactly.
it's that piece has even more so just opened up my mind to recognizing that medicine is meant to be different ways. It can look different ways, and just because we've been groomed and trained in- Yeah ... one approach to how a doctor's life looks doesn't mean we have to continue that path
That's amazing.
And now, when you practice when you're in different countries, do you see patients from different countries or do you see patients back in the US?
Back in the US.
You do?
So yeah, I have a consultation business and I just see patients in the States where I'm licensed.
And, we get this question a lot is like, "Hey, I wanna do what Dr.
Goins does. I want to be somewhere else." And, ... some [00:16:00] companies don't allow you to do that, right? But how do you make it work and with the constructs of, like, basically law, right? you can't see Medicare patients, right?
No. Yeah. I only do cash-based.
Mm-hmm. Got it. Got it. And it makes it work, right?
Yeah. But I think cash-based in general is just easier. Like, there's just a lot- Oh, yeah ... less red tape in general, for me, the best way to go about it is really just to have your own business and your own practice. 'Cause that way you really get to, whether you wanna have your own patient panel or whether you wanna contract with other, you know, clinics or institutions through your own professional LLC, I think that's the best way to, maintain your autonomy, where you get to choose your compensation, where you get to choose your patients, where you get to choose your schedule and your time.
I think having full autonomy is the best way for me to practice medicine and to really show up for my patients the most, as fully as I can. And so I think for doctors even, if, [00:17:00] telework or remote work or even hybrid, if that's something that, is amenable to them and something that they wanna do just to have more time and location flexibility, then I think having your own business where you get to make those decisions for yourself rather than being an employee is the way to go.
Yeah. And now are there some areas that are better than others working when you're out? Or, you know, what other considerations do you need to have if you're gonna pack up and go and live the life of a nomad around the world?
I mean, you wanna think about taxes, things like that- Yeah
if you're gonna be spending, let's say, more than, six months a year in a particular location, you do wanna think about taxes. But I've found that living abroad is very tax favorable, ... particularly because I don't stay in places, more than six months. But I think that's probably one of the biggest concerns.
you wanna think about things like if you're [00:18:00] working for an employer, obviously, like- Mm ... what's allowed, what isn't, especially if you're gonna work with different insurance companies. Yeah. I think if you're bypassing all of those things, there's not a lot of considerations other than maybe, controlled substances or things like that, that you just wanna be, thinking about in terms of, the regulations and all of those kinds of things.
But I think if you, connect with, and I connect all of my clients with really amazing telemedicine attorneys. I think once you know you have the okay in dealing with folks who do this all the time and don't make it seem like it's, this weird thing. If you talk to other doctors who are very traditional, it's like, "What are you doing?
That doesn't make sense. That's not allowed." But when you're connecting with other professionals who do this day in and day out, and they know all the rules and regulations and, the flexibility that you really have as a physician, I think there's not a lot of things that really come up as barriers.
Actually, that's a good point as well. You know, we've talked to a lot of people and they're just like, "Hey, I was [00:19:00] told this can't happen." Or, talking about attorneys, you know. They get hooked up with just regular health attorneys, right? Yeah. And they get some of the wildest kind of advice, right?
And you're like, "No, that's not right." that's important. Yeah, Finding the right people that know what they're doing and is conducive to your lifestyle, and actually can give you the right advice. So definitely, I think that's huge. kinda going back, the boring issue about taxes and, like, six months.
Is there, a six-month kind of timeframe thatif you stay longer in a location and make money more than six months, are you kinda taxed more, or how does that work?
It really depends on the country that you're in. Like, some countries have territorial taxation- Mm
so automatically they don't tax any money that is not being made within their country, but other countries don't have that. So it really depends on which country you're in. But for the most part, most countries, that aren't gonna be territorial tax, spaces, they will tax [00:20:00] you because you become, like, a resident there after six months.
Got it.
Okay. After a specific number of time.
Got it. And now can you, leave and come back? Like, you know- Yeah ... five months and 29 days, you take off for a week, and then you're like, "Oh, I'm back," and then the clock starts-
Yeah, usually it's over the year. Got it. Like, usually they have, oh, okay, you can't be here more than 183 days- Got it
within the 365. So You don't really wanna play those-
Yeah ...
games at
the
border-
Yeah ... before you get- A true nomad ... pushed on those. You're, like, packing up and go. Right? I stepped over, I stepped around, and I'm like, "Oh, I'm back now." it's restarted. Yeah. Okay, there goes that idea.
so are you moving every six months then or are you moving so you don't meet that criteria?
I'm really moving because I like to move. Yeah. Like, I just literally within the last 48 hours came back from living in Italy, so I'm kind of jet lagged right now. Yeah. But, for me, it's a mixture of different things.
One, I like going back to the same countries every once in a while, 'cause I like [00:21:00] to deepen my relationships that I've already- Yeah ... started building there. Then I like to have a place that I explore that's new every year. And then I also, study wine, so I wanna be in certain wine regions that I haven't gone to.
And then I follow the sun, so I don't believe in winter, so then I also have to leave- ... when it gets cold so. Yeah. It's, it's a force. By force I need to leave.
That's amazing. we're running out of time. Now, you started a coaching business, right? and you obviously know what you're talking about.
This is amazing. If people wanna get in contact with you, how can they tap into your wealth of knowledge and try to get your coaching and, connect with you?
They can follow me on Instagram at The Nomad MDs. They can follow me on Facebook at The Nomad MDs and my website, thenomadmd.com.
And, what kind of services do you offer through The Nomad MD?
So I offer one-on-one coaching with doctors who are [00:22:00] looking for time and location flexibility, whether that means that they wanna get direct remote contracts with other clinics or institutions, or whether they wanna start their own location-independent businesses.
Got it. So you help them build their business?
Yeah.
Got it. So, and what I'm hearing is that, you have resources to help them connect, kind of get them jump-started. Yeah. So not just the education, but also plant the seed to get them... That's amazing.
Yes.
You know how many people would want that, and so many people talk about it and, they talk about, "Hey, I wanna go here for a few months.
I wanna go back to here." And not a lot of people know how to do that, so that's amazing. And I love your socials. It's so freeing. I'm like, "Oh, yeah, that's so cool. " and just talking to you right now, you're, like, all over the place. You know, just visiting countries and gosh, talking to so many people.
They want that, but they don't know how to get there. No. And it's a pipe dream, and you make it real, so that's amazing. One last question we always ask is, hey, [00:23:00] think about you intern day one and going back to that person. Mm-hmm. Knowing what you know now and your experiences, and really this is anything, what would you tell, you know, day one intern Dr.
Goins to do? what's the best piece of advice you could give her?
Relax, girl. Just relax. Like, you know? I think we have so much anxiety built up about, where we're going and what's next- Yeah ... and who we're gonna be in this career, and I would just tell myself that everything's gonna be fine.
I'm gonna end up exactly where I need to be, so just, like, enjoy the ride and relax.
yeah, you talk to those interns, right? And you remember- Yeah ... back in the day, the bright-eyed, doe-eyed, but very, very anxious people.
Yes.
Pockets full of everything, and it's just, you know- I was me. Right? Remember the five little books that you had, and like you were way down with your little itty bitty now the, like, bigger [00:24:00] white coat.
Right. You know, and you're like, "Oh, gosh." It was a stress ball.
it
was. And yeah. I'm stoked. one, super happy that you found kind of your life calling, and you're actually willing to share that. You know, I think a lot of people would benefit from what you have to say and your knowledge.
So thank you so much for joining us. This is great. I look forward and, to continue to follow you, and hopefully, continue this kind of discourse offline and to just connect to different people. So thank you so much. For
sure. Thank you so much for having me.
Yeah. And, for those listening out there, thank you so much.
always thankful. If you wanna get in contact with us, info@telemedicinetalks.com, leotelemedicinetalks.com. And we will also forward Dr. Goins's info so you can get in contact with her wherever she is in the world, and really just listening to her stories is amazing. So thank you so much.
Until next time, thank y'all.