The Expert Radiology Guide to Moving to Puerto Rico for Radiologists
Could Puerto Rico fit your life and practice?
A practical guide to Act 60, bona fide residency, licensing, family fit, island infrastructure, and a 90-day relocation plan for radiologists.
Table of Contents
Moving to Puerto Rico is not a tax strategy with palm trees. It is a life relocation that can reshape a radiologist’s work, household, finances, and sense of home.
Avery J. Knapp Jr., MD, moved in 2017 with his wife and young children. He still reads MRI most days. The financial case mattered, but it could not make residency real, keep the reading room online, build friendships, or tell the family whether they wanted to stay.
This guide puts those questions in the order they deserve. Start with the household and the work. Then understand residency, incentives, compliance, infrastructure, and the exact places you might call home.
Dr. Knapp’s Puerto Rico story
We came for the math. We stayed because it became home.
The tax rate opened the door. The people made us stay.
For a high-income remote physician, a properly structured move can materially change after-tax cash flow. That is the obvious part of the story. The less obvious part is that a tax-only plan is fragile.
You still need a household that wants the move, work that can be performed and sourced cleanly, and a life you are willing to relocate for real. The part Avery did not expect was the community: radiologists, entrepreneurs, builders, and families who had all made a deliberately unusual choice.
“The tax was the wedge, but it is not why I am still here nine years later.”
Avery J. Knapp Jr., M.D.
Puerto Rico put the family on a different trajectory than the one they had in Florida. They arrived because the math deserved a look. They stayed because it became home.
The rules changed in 2026
Act 60 is two different conversations, not one automatic outcome
Most serious radiologist conversations involve two separate decrees. One concerns qualifying export-service business income. The other concerns qualifying investment income. Neither decree, by itself, creates federal exclusion or settles residency, source, licensing, contract, or malpractice questions.
Act 38 extends the resident-investor program while changing the treatment for applications beginning in 2027. If timing matters, ask Puerto Rico counsel which submission, completeness, and effective-date rules control your facts. Do not plan around a last-day filing.
Your practice: export services
An eligible Puerto Rico business may receive a 4% Puerto Rico rate on qualifying exempt business income from services performed in Puerto Rico for customers outside Puerto Rico.
- It requires a real Puerto Rico operation, entity, records, contracts, and qualifying activity.
- Dividend treatment can differ from salary and other compensation.
- Some qualifying Nueva PYME businesses may receive a lower introductory rate. It is not an automatic “under $3 million” rule.
Your portfolio: resident investor
This separate decree addresses qualifying interest, dividends, and capital gains for bona fide Puerto Rico residents. Act 38 changes the rate structure for applications beginning in 2027.
- Pre-move and post-move appreciation are not treated as the same thing.
- Annual reports, a $5,000 annual compliance fee, and qualifying charitable donations are part of the current program.
- Primary-residence ownership rules apply and vary with timing.
The whole ballgame
Bona fide residency is three tests, every year
The decree is only one layer. Federal law looks at presence, tax home, and closer connection. The facts need to tell one consistent story: you actually live and work in Puerto Rico.
- Presence
Many people plan around 183 Puerto Rico days because it is clear and trackable, but federal rules include other pathways and exceptions. Model your actual travel with counsel.
- Tax home
Your principal place of business generally needs to be Puerto Rico. Reading from a mainland hotel, hospital, or second home can change the source analysis for that work.
- Closer connection
Housing, household, banking, driver’s license, voter registration, physicians, belongings, community, and daily routines should support Puerto Rico as home.
Two minutes, no email gate
Would Puerto Rico be a good fit for you?
This is not a tax-eligibility calculator. It is a fast way to surface the household, work, travel, and operating questions that decide whether the move deserves deeper investigation.
Is your household genuinely interested in island life?
The move tends to work when the household chooses it together, not when one person is dragged along by a spreadsheet.
This quiz is a conversation starter. It does not determine tax eligibility or replace legal, tax, licensing, or financial advice.
The boring version is the durable version
A 2026 Government Accountability Office review found gaps in how Puerto Rico and the IRS shared data and handled referrals. The report’s recommendations point toward better data, clearer procedures, and more taxpayer education. That is a reason to make your facts easier to defend, not a reason to take shortcuts.
The durable plan is unglamorous: track every workday and travel day, maintain a real office and real books, separate pre-move and post-move gains, and file federal, Puerto Rico, decree, and annual reports on time.
Read GAO-26-107225Model, do not market
Run your own money math
The attractive headline is the spread between a high mainland marginal rate and a qualifying Puerto Rico rate. Your answer depends on far more than annual compensation, and a sample savings number can be dangerously persuasive when the assumptions are wrong.
Bring to your CPA
- W-2, 1099, partnership, and entity income by source
- Expected salary and qualifying business profit
- Workdays performed in and outside Puerto Rico
- Portfolio basis, unrealized gains, and expected sales
- Current federal, state, local, and self-employment tax
Subtract honestly
- Applications, annual reports, and decree fees
- Attorney, CPA, payroll, bookkeeping, and compliance systems
- Required charitable giving and residence obligations
- Backup power, connectivity, insurance, and travel
- Household disruption and options you give up by moving
The best model includes a downside case: lower reading volume, more mainland travel, a delayed decree, a different source determination, and higher compliance costs. If the move only works under perfect assumptions, it does not work yet.
The reading room still has to work when the island does not cooperate
Keep the state licenses required where patients are located. Then verify the Puerto Rico side rather than assuming the export-services tax framework answers a medical-practice question.
Puerto Rico’s Department of Health publishes separate information for physician licensing and telemedicine certification. The right answer can depend on patient location, your physical work location, contract language, payer requirements, malpractice coverage, and each licensing board. Avery obtained a Puerto Rico license as the conservative practical choice.
- Patient-state licenses
- Puerto Rico license review
- Contract and payer approval
- Malpractice confirmation
- Backup fiber or carrier
- Generator or battery
Rent first
Four very different versions of daily life
Neighborhood choice shapes the experience. Visit on ordinary weekdays, work a full shift, tour schools if relevant, test internet providers, and drive the routes you expect to use. A long rental is information, not delay.
Metro and beach life
San Juan
The widest range of city rhythms lives here, from dense Condado and Old San Juan to residential Ocean Park and the business core of Hato Rey.
- Who should look here
- Start here if your household values restaurants, airport access, beach proximity, and the option to learn the island from an urban home base.
- What to test
- Rent for an ordinary workweek. Test parking, noise, school routes, internet, storm backup, and the exact block after dark.
Not a resort, not a hardship post
What nobody should discover after the move
Power and storms
Outages and hurricanes are real operating constraints. Choose housing and a reading setup with resilience, water, communications, and a tested emergency plan.
Schools and healthcare
Quality varies by school and specialty. Tour in person, talk to families, and identify where you would go for routine and serious care.
Language and belonging
You can function in many professional settings in English. Learning Spanish and engaging with the island make the move more respectful and more rewarding.
Cars and logistics
Shipping a vehicle can trigger freight, port, excise, and registration costs. Price the exact VIN and compare it with selling and buying locally.
The household vote
A partner’s isolation, distance from family, or shrinking sense of opportunity can end the experiment. Treat the move as a joint decision and test it with a rental.
Community
Find professional, parent, hobby, volunteer, and neighborhood communities early. The network can become one of the biggest returns on the move.
A plan you can take with you
Build your 90-day relocation brief
Check off the investigations you have completed. Your progress stays in this browser, and you can email, copy, share, or print the brief through your own device.
Start with household alignment and your real numbers.
Weeks 1 to 2
Decide whether the life can work
Weeks 3 to 6
Test the island as a working adult
Weeks 7 to 12
Build the operating system
Year one
Make residency real and repeatable
Email it through your own mail app, copy it into a notes app, share it, or print it as a PDF.
Your selections stay in this browser. These actions use your device, and Expert Radiology does not receive your plan.
The move works when the life and the facts line up
Act 60 can be a legal path to a materially different tax structure, in exchange for actually moving your life to Puerto Rico and maintaining the compliance. Teleradiology makes the work portable, but it does not make residency, sourcing, licensing, or household fit automatic.
Puerto Rico is a real place with infrastructure problems, deep culture, beautiful days, and unusually interesting people. Avery’s kids are growing up here. That was not the plan when the family first came for the math. It is the reason they stayed.
Verify the current rules
Start with the law and government guidance, then hire professionals to apply them to your facts.
- IRS Publication 570Tax Guide for Individuals With Income From U.S. Possessions
- GAO-26-107225Puerto Rico tax incentives and federal compliance review
- Compiled Act 60Puerto Rico Incentives Code, as compiled by the government
- Act 38 of 20262026 amendments to the Puerto Rico Incentives Code
- Puerto Rico Department of HealthPhysician licensing information
Media notes
The hero and redundant-reading-room images are representative editorial visualizations. Avery’s family photograph was supplied directly by Avery. Place photography is credited with each image, and the two video chapters are official films from Discover Puerto Rico and Visit The USA.
Important disclaimer
This guide is for general informational and educational purposes only. It is not legal, tax, financial, investment, accounting, licensing, employment, or insurance advice. Reading it does not create a professional-client relationship. Laws, regulations, fees, guidance, licensing rules, incentive programs, and individual facts change. The guide reflects sources reviewed in August 2026. Avery J. Knapp Jr., M.D. is a radiologist, not a tax attorney, CPA, financial advisor, or your legal counsel. Consult qualified professionals licensed in the relevant jurisdictions before acting. Expert Radiology and Dr. Knapp disclaim liability for actions taken in reliance on this guide.
