Very basic questions about USA

[JumpJockey]

A fantastic job has come up in my field in Boston and I've been invited to apply. It's really a once-in-a-lifetime chance and while the kids are young (6 and 8) seems like the time to try. But I have no idea how things work with moving to the US! Does anyone know of a basic website that goes over what would be needed for relocation?

I know there are working visas etc. DH is a GP so would I imagine be able to get a job but not sure how visa situation would work. How do you cope with much less leave but much longer school holidays? How does the health care situation work? How on earth do you find somewhere to live before moving overseas? Etc etc etc... sorry that these questions are so embarrassingly basic but this is the first time a job opportunity has come up that I've seriously considered.

Your company should/will provide health care insurance for you and your family. They should help with relocation too. Finding a house - go and visit before you move to get ideas of areas you like and costs. Then when you move over there you can stay in a short term let or hotel while you sort out renting somewhere more permanent. Visas - I'm not sure it is a given your DH could work. He'd need his own work visa, I believe. He'd also need license to practice medicine in the US, I think. Lack of holiday - it sucks! Kids do camps, etc. You'll probably end up using your entire paltry annual leave (10 days, unless you can negotiate more) on trips back home.

Is the job with your current employer? And if so, have you worked there for at least 1 year? Or is it a new job with a new employer? This is important because it will determine what type of visa you'd be eligible for and the type of visa you get then determines other things e.g. whether your DH would be eligible to work (not all spouses are allowed to work).

Sounds like a good opportunity however the first thing to think about is visas. There are different types of visa, the most common, unless you have an exceptional skill, are H1 and L1

The H1 is done through an annual lottery in October, the closing date each year is April (I think). On this visa you can move straight away after the visa is issued, however your OH would not be able to work, at all.

Then there is an L1 visa. In order to get this you need to work for the company for at least a year, they can then apply to transfer you to the US office. They have to prove that they couldn't get the skill easily in the US. Your spouse can get an L2 visa based on this, which means he would be able to work, once he has get an employment card (takes about 3 months after you have your social security number).

Healthcare is a massive issue, you need to ensure your employer has a good package you can opt into. It is still expensive monthly and there are deductibles and copays on everything you do, so it adds up to a lot of money a year. Definitely something you would need to look into.

As a GP your DH won't be able to get a job as a doctor unless he's done the USMLE. This is essentially medical school finals (takes months of study), if he has that then they'll probably make him go in at internship level or apply for residency (essentially he'd be a junior doctor again). This is a separate issue from visas (which I'm afraid I know nothing about).

Essentially he won't be able to be a working doctor out there (even if he's allowed to work from a visa point of view).

OP - I'm sure you've started to do you own research but a quick Google threw this up.

www.bma.org.uk/advice/career/going-abroad/working-abroad/usa

Your DH will probably need to sit exams/retrain. Do people even use GPs over there? You may also want to explore education for you DC. In some coubtires forge in students are charged for places in state schools. Likewise some private schools charge extra.

You've had good answers regarding visas.

I don't know any British doctors over here but I know several nurses and other HCPs who've all had to retrain and sit exams to be able to apply for work.

You don't find a house in advance. What you do is research local schools and find the best one for your DC, then rent an apartment until you find a house in the right school district.

Healthcare for your family needs to be included in your package otherwise think very seriously about moving out here. Costs are astronomical.

The biggest question is whether your (new?) employer would sponsor you for a visa - it's long-winded, expensive, and a PITA for them and you.

Do people even use GPs over there?

Yes - I see a GP. Often they have other titles eg Family Practitioner, Internal Medicine Specialist, Paediatrician. But effectively they are your Primary Care Physician.

My kids have actually seen two different British GPs out here, but both had to do a fair bit of training out here.

How do you cope with much less leave but much longer school holidays?

DH and I don't have less leave than we had in the UK. In terms of longer summer holidays we either hire a nanny (often a college student home for summer) or use summer camps.

How does the health care situation work?

If you have good subsidised insurance it works really well. If you have unsubsidised insurance it still works well but is v expensive.

How on earth do you find somewhere to live before moving overseas?

There are relocation agents that will help you out, or you can rent temporary accommodation designed for people in your situation.

As you have kids, you'll want to move to a district with good schools

BTW I just spent a weekend in Boston - it was BRILLIANT :-)

In some coubtires foreign students are charged for places in state schools.

Not in the US...

Most people (that I know of, myself included) who've moved with work, tend to stay in short term apartment rentals for 1-3 months until they find something a bit more permanent

These are usually more expensive but fully furnished and serviced apartment / house type scenarios. In your case, I'd be searching areas based on school and wrap around school day needs and go from there. There are lots of companies who will help you move and find a new place but they are pricey

Healthcare you need decent insurance (any big employer should offer this) but be prepared to pay anywhere upwards of $200+ a month for a family health plan (costs will differ from provider to provider)

Holidays - you try and negotiate for more than 10 days. A lot of the big financial firms are moving to 20, other firms are 15 with extra personal days to cover religious holidays etc.

Even with 20 days its HARD once you factor in a 5-7 day trip back to the UK every year if you want / need to see family. Most families here cover gaps on school holidays and closings with family or camp (more expense)

As pp have said, your DH would need to retrain to meet US medical board standards. Its a bit different here in that we have specific doctors for specific things - i.e. my kid has a dedicated pediatrician, I have a OB-GYN for anything preggo / gynae related etc. There is a generalist Dr for the 'normal' stuff but in my experience its a more limited range than in the UK.

Its also worth noting that it generally costs a lot more to live in the US than the UK - in the cities anyway. There's lots of threads on here that touch on this, but food / groceries, utilities etc are noticeably more expensive than the UK (we live just north of NYC)

hi, in Canada but my sibling is in the US. I think your spouses's input here is v important, my consultant friend can't work in the USA, sadly they are really unwelcoming to medical people trained overseas. If partner is okay with being a trailing spouse ? I know you will be annoyed to hear this, but 8 and 6 are still young, but it could be just over 2 years till your 8 year old goes to secondary school, then if your intention is to go back, you need to start thinking of school places etc. Would you still have a job to go back to, what if your spouse hates it will they have a job to go back to? What happens if you love it and they hate it? Would you be able to come back with equivilent salary? Good websites include britishexpats.com you sound very positive but you do need to hope for the best and plan for the worst, esp in this scenario..

Looks like you have got really good advice already, just wanted to say that my GP friend wouldn't be able to practise easily in the USA so her family didn't consider a move here when relocating.

If your company sponsor your visa our experience was that it was quick and painless but the immigration lawyers did create a great deal of paperwork so the company would need to know what it was doing. (Also DH has worked for company for years so could get L1)

There are relocation agents who can show you round accommodation, help you get utilities sorted, show different schools and neighbourhoods to you again this costs so either your company or you will have to pay for this. We did a pre visit and found a house in the area we wanted but it was touch and go and we could easily have had to move into temporary accommodation first.

As miss said it is worth noting that the US is much more expensive that the UK for food and utilities, having just moved over, eye wateringly so! Also you will have no credit rating at first so have to pay outright for more things. Moving is expensive anyway moving countries more so. Nearly every electrical item you own will have to be rebought even if you ship your goods over.

We have done it and with kids so I don't want to put you off. Also having done one overseas assignment before the people you told us coming back was harder than leaving weren't wrong. Think,about how you would settle back before you go.

I have several relatives who were trained as physicians overseas then moved to the US - absolutely there are additional exams and licenses required to be qualified to practice, your husband will not be able to work as a GP simply by virtue of being one in Britain. He'd also need to find a job, there is no NHS in the US so he'd need to put out CVs to specific hospitals, clinics, and private practices. Long story short - this wil lbe a significant commitment and if this is just a short-term move it may not be worth it at all for him.

You might want to read these articles
www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html?mcubz=1

www.theatlantic.com/health/archive/2014/11/doctors-with-borders-how-the-us-shuts-out-foreign-physicians/382723/

One thing to note is how long your furniture and household goods will take to get here via container ship - it can be up to 12 weeks. Our last month's in the UK were in an empty house and then we moved to a furnished apartment here until our container arrived and our rental accommodation was available. Moving internationally is expensive so make sure you know who will be covering that cost.

As others have said the USA is not a cheap place to live. Food, clothes and utilities are all more expensive by my reckoning. Our relocation package adjusts for that but that may not be the case for you if it's a new job.

Our children are in local schools and we found places in excellent schools without any difficulty but that may depend upon state. In our state (Texas) vaccinations are mandatory before starting school, we had brought our children's records from the UK (fully up to date) but still needed approx $1000 of vaccinations to meet state requirements.

Our relocation consultant was amazing. She helped us get our social security cards, put us in touch with our realtor, gave us advice about schools and areas, helped us with things like applying for our driving licenses. Again this service was included in our package.

NB: you can only drive in your British driving license for 90 days and then you need to sit your local state theory and driving tests.

Relocation is exceptionally costly and before you even think about applying I would ask precisely what support you will be given in relocating.

Is this a full time or assignment for a few years?

Many thanks to all of you for this really helpful info. I guess the assumption that DH could get work was a risky one... it's not a a role within my company but would be a move to a new one. I'll look at all of this in detail, thank you again.

To answer a couple of questions, it's a permanent opportunity. I work in a very small field within higher education and this would be a move to a new institution so there's no chance to work in a UK based branch beforehand! I would anticipate this being a permanent move rather than a temporary one unless we all hated it. My brother relocated to Canada nearly 20 years ago so we would at least have family on the same continent...!

Thanks again - very grateful for your advice everyone.

I'd definitely look at an orientation visit before you applied.

As a Brit in the US, cost of living is state specific. Generally much lover than the U.K. Accept in Massachusetts, New York, New Jersey, Connecticut.

We relocated from Somerset to Maine. We found it didn't cost too much visas, Flights, shipping, flights and vets bills for 2 dogs. Came to £6k.

My brother trained as a surgeon in the UK and then got a job in a New York hospital for two years without having to take additional exams. I'm not sure if the fact it was time limited affected the training requirement.

Is there any chance of you being to test the water first with this organisation? If your skills are so rare that they are recruiting internationally they must be very interested. Could just you go out there for a short term eg 6 months?

Six months would be very disturbing for the kids though child.

Our children were still crying with homesickness every day at six months and we hadn't even unpacked all our boxes.

I wouldn't do it for less than two years personally, the disruption is huge (although it's been worth it for us).

I live in the Boston area.

It is a really great place to live and rear children - people are friendly, communities are lovely. I've been here more than 20 years, have never been the victim of a crime, have never seen a gun other than in a policeman's holster, and have made great friends.

But housing is very expensive and getting worse. And the commute into Boston/Cambridge can be hellish from the further-out suburbs.

When we moved we borrowed a friend's house for a week or so and then rented. Most tenancies are for a year and most are unfurnished.

There are some really excellent school districts in the Boston area - if you decide on the move, pm me and I will give you a start on some towns that might work - depends on where you are working.

Most kids do summer camps or have a summer nanny - we've done both.

You should ask the company's HR department for help - if they really want you they will help. They are probably also used to helping people relocate.

I can't advise on the visa situation but there is a whole bunch of stuff your dh will need to do in order to be able to practice in the US and it is very different to the NHS. There are also other options for him - working in biotech for example (huge industry in this area) running clinical trials etc.

The most important thing in your package (apart from the money) is imo health insurance. Massachusetts has mandatory healthcare (thank you republican governor Romney) that is currently obamacare but isn't dependent on it so healthcare position is less uncertain here than other places but it is vital you have good insurance. If you do, the healthcare is second to none. Your children will see a paediatrician for yearly well-child visits and be referred to specialists easily if needed, you can have second or third referrals easily. My dogwalkers' partner has been diagnosed with a lung disease - she was seen by a specialist and then referred on to someone who sub-specialises in this disease and is also taking part in a new clinical trial. Dental insurance is usually offered too and means you can have twice-yearly check ups, and a bit of braces covered.

Also if you are in a teaching position, make sure it is tenure track.

Cavender: sorry I wasnt clear. I didnt mean for the kids to go. More for OP to go for a short time - see it how it works out and then to move the family.

Spouse visas (or lack thereof) were a deal breaker for us.

Ah child I see, apologies I misunderstood.