Selecting a language will automatically trigger the translation of the page content.

Medical Practitioners and Assistants (PAM): Activity Statement and Social Plan

Verified 07 December 2022 - Directorate for Legal and Administrative Information (Prime Minister)

You wish to settle for a medical activity or a medical assistant as a liberal. You must complete certain formalities to create your business. At the social level, you are covered by the "PAMC" system, that is, by self-employed workers engaged in a health profession under the social regime of the Conventional Medical Practitioners and Auxiliaries.

A "MAP" is a self-employed person engaged in a health occupation under the Social Plan of Licenced Medical Practitioners (PAMC). He contributes to the Urssaf.

It also reports to one of the following old-age funds for the calculation and recovery of old-age contributions: CARPIMK, CARMF, CARCDSF

The following occupations are in the category practitioners ::

  • Doctors (general practitioners and specialists)
  • Surgeons and dentists
  • Medical Students Replacing a Medical Doctor
  • Medical Laboratory Directors and who are also doctors

The following occupations are in the category medical ::

  • Midwives
  • Nurses
  • Masseurs-kinesitherapists
  • Pedicures-Podologists
  • Speech
  • Orthoptists

Please note

Sector 2 physicians and podologist pedicures have the right of option between the "CAP" and the "TI PL" (self-employed - liberal profession). Thus, some physicians and podologist pedicures fall under the CAPs and others under the TI PL regime.

This choice must be made at the time of installation and is final.

You must take a number of administrative steps to settle and practice your profession as a liberal:

  • Register your diplomas to obtain an Adeli number or an RPPS number
  • Sign up for the Primary Health Insurance Fund at your place of practice to inform them of your facility
  • Subscribe professional indemnity insurance (PCA)
1. Register your diploma to obtain an ADELI or RPPS number

You must register your diploma and obtain an identification number. Depending on your profession, this is either an "Adeli" number or an "RPPS" number.

The Shared Directory of Healthcare Professionals (SPPP) is the single reference directory for identifying healthcare professionals.

Please note

All Adeli professionals will be progressively integrated into the RPPS repository during 2023

Répondez aux questions successives et les réponses s’afficheront automatiquement

RPPS Number

You must first request your registration in the College Board.

It's mandatory to legally practice medicine. You must apply to the Departmental Council of the Order where you plan to practise.

After you have entered the table, the departmental council will register your diploma. He or she shall issue you a certificate of registration with your RPP NumberS (shared directory of healthcare professionals) and your place(s) of practice.

This number is assigned to you your whole life.

Your Health Professional Card (CPS) is automatically sent to you by the Agency for Shared Health Information Systems (ASIP Santé) responsible for the manufacture and issuance of CPS cards.


You must register with the Territorial Delegation (DT) ofRegional Health Agency (DTARS) to register your diploma(s) in the National Identification Directory of Adeli Health Professionals.

This registration must be completed within one month of taking office.

This gives you an Adeli number.


Nurses do not have to register with regional health agencies. They are no longer registered in the Adeli directory but in the RPPS (shared directory of healthcare professionals).

2. Enrol in the Primary Health Insurance Fund of your place of practice

You need to contact Health Insurance to register your liberal exercise.

Who shall I contact

CPAM saves you in the National Health Professionals File (FNPS).

3. Subscribe professional indemnity insurance (PCA)

All health professionals who practice in a liberal capacity, as well as the businesses they can train, must subscribe to liability insurance covering all the acts they practise.

Failure to do so may result in criminal and disciplinary sanctions.

Répondez aux questions successives et les réponses s’afficheront automatiquement


The rules applicable to the creation of any liberal activity apply to the creation of a medical activity or a medical auxiliary.

You have a choice to practise your profession under 2 main categories of legal form: individual business or business (civil, capital, etc.). 

This means you have to apply for your registration at Window company formalities within 8 days of starting your business.

Company formalities window


From 1to January 2023, it is no longer possible to make your paperwork in a company Formalities Centre (CFE). You have to make them on the website of company formalities window.

This statement informs all the organisations involved in launching your activity (INSEE, social organisations, Urssaf, centre for public finance...).

Following your registration, the INSEE assigns a Siret number. This is a unique national identification number that identifies the establishment. It shall consist of Siren (first 9 digits) which identifies the company and the Nic (last 5 digits) which changes notably when the address of the establishment is changed.

When registering the company, the INSEE also assigns a APE code corresponding to the activity of this company.


Obtaining the Siret number allows the user to carry out his activity even if his registration with the social organisations is not carried out.



If you are a replacement doctor or a medical regulator, the Urssaf offers a simplified offer "which allows you to report the activity, the retrocessions of fees or remuneration and to pay the related social contributions directly from an online personal space.

In this scheme, the declaration and payment of contributions are simplified. They will be performed quarterly (or monthly depending on the initial choice) and only in case of replacement and thus actual collection of fee retrocessions, and without cash lag.

This device is reserved exclusively for doctors acting as alternates and in the following cases:

  • Alternate physicians (general practitioner or specialist)
  • Student Doctors
  • Employed doctors
  • Retired Doctors
  • Regulators

To subscribe to this simplified offer, you have to gather following conditions ::

  • Perform overrides only
  • Have retroceaned fees not exceeding €19,000 by calendar year
  • Do not engage in any other activity as a self-employed person

The registration process is carried out on the following portal:

Other replacements

As a replacement, you are subject to the same formalities as all health professionals.

You must therefore register from your 1to replacement day.

If you do not have a fixed exercise address, you must enter your home address as your business address.

On the start of activity return, you must check the "replace" box to be exempt from the contribution to Regional Health Professional Unions (RPSUs).

This means you have to apply for your registration at Window company formalities within 8 days of starting your business.

Company formalities window


From 1to January 2023, it is no longer possible to make your paperwork in a company Formalities Centre (CFE). You have to make them on the website of company formalities window.

Company Creation and Recovery (ACRE) Help

The Acre is a mechanism for encouraging company creation. It consists of a partial exemption from social security contributions. When you start your business, you will be exempt, under conditions, for 12 months from certain contributions. You must not have been a beneficiary of Acre for three years.

You may be exempt from sickness and family benefits contributions, as well as from basic pension and disability-death contributions.

Note that this exemption is applied to the instalment contributions and is then reviewed following the filing of the tax return.

3 cases may arise:

  • When your income is less than €30,852 : exemptions may apply in full
  • When your income is between €30,852 and €41,136 —a degressivity applies
  • When revenues exceed €41,136 : there is no exemption, it is withdrawn.

For the MAP (Practitioners and Medical Assistants) plan, there is no application to receive the Acre. The contribution exemption is applied automatically.

CPAM aid

Many financial assistance is offered by the CPAM and can be allocated to you depending on your situation.

In parallel, there are also lump-sum payments made by sickness insurance (aid for teletransmission, compensation for further training, installation premium, etc.).

The support portal for healthcare professionals (health) contains all the relevant information, from training to stopping the activity.

Please note

This aid must be declared and therefore reinstated in the basis for calculating compulsory social contributions.

From the date of your start of activity, you must pay social contributions to the Urssaf.

These contributions obligatory online payment. You can choose to pay in one of the following ways:

  • Or every month. The monthly payment is made on the 5th of each month (or the 20th on option) by direct debit.
  • Either every quarter. The quarterly payment is made by direct debit, by electronic payment or by credit card. Contributions are payable for February 5, May 5, August 5 and November 5.
How are your social contributions calculated?

Social contributions are calculated on the basis of your income from self-employment.

When you start your business, this income is not known. Thus, for the first 2 years of employment, contributions are calculated, on a provisional basis, for the time you file your first income tax return, on a lump sum basis identical to all self-employed workers (€8,358 for 2023).

These contributions will then be adjusted according to the actual income reported the following year.

The contributions and contributions are then calculated (and adjusted) on the basis of your self-employed income reported each year.

You must reportyour business income on the site

Online tax account for professionals (EFI mode)

After taking into account the reported items, you will receive a new schedule with the following:

  • Your final contributions for the year you reported (2022 income reported in 2023)
  • The recalculation of your current year contributions, calculated on the previous year's income
  • For your information, the first instalment amounts for next year.


If this amount is far from your actual income, it is recommended that you perform an "estimate of income". This is a service offered by the Urssaf that allows you to recalculate your contributions based on the amount of income you provide.

This approach avoids a significant adjustment of contributions in the following year. You can make this request via your online space on (online service "Moduler mes revenues").

What are the contributions paid by the CPAM?

By entering into the collective agreement between your profession and Medicare, the MCAPs benefit from the participation of Medicare in certain social contributions on the basis of the income of the activity under contract. This participation may be partial or total, depending on the agreement of your profession.

Example :

For a licenced area 1 physician, the health premium rate is 6.5%. In the event that the latter has only agreed income, the CPAM shall 6.4% of this contribution, only 0.10% remains to be paid by the trader. On the other hand, for non-contractual income, it is the rate of 6.5% which is applied.

What are the social security contributions to pay?

The money collected by the Urssaf is returned to the social protection funds.

They are intended, in particular, to finance the benefits offered by the general scheme: reimbursement of medical care, payment of workers' compensation, family benefits and pensions.

  • Health Insurance Contribution (PA) : The sickness and maternity insurance contribution funds the benefits paid by the general social security system.
  • Family Allowance Contribution (FA) : This contribution is intended to finance the benefits paid by the family allowance funds.
  • Generalised Social Contribution (GSA) and Social Debt Repayment Contribution (SDRC) : The income from the CSG finances health insurance schemes, family benefits, the old-age solidarity fund and the national solidarity fund for self-government. The Social Debt Repayment Contribution (SDRC) was created to fund the Social Debt Depreciation Fund (Cades).
  • Daily Allowance (DI) : There is a daily sick leave for medical practitioners and assistants between the 3e and 90e days off.
  • Contribution to Regional Health Professional Unions (Curves) :: The health professions are represented by regional unions of health professionals who contribute to the organisation and evolution of health care provision at the regional level, including the preparation and implementation of the regional health project. These unions are funded by the Curps, which is due only by settled health professionals.
  • Contribution to Vocational Training (PSC) : This contribution funds training actions for liberal doctors through the Medical Profession Training Insurance Fund (FAF-PM) and for other PAM professions through the Interprofessional Training Fund for the Professional Professions (FIF PL).
  • Contribution to voluntary occupational accident/sickness insurance (AVAT)): This voluntary contribution covers risks of accidents at work, occupational diseases and accidents along the way. It is to be subscribed to your CPAM and then recovered by the Urssaf.
  • Pension contributions: In the conventional pension plan, the Urssaf does not call pension contributions; these will be called by the pension fund corresponding to your profession: CARPIMKO, CARMF, CARCDSF. As part of the simplified offer for replacement physicians, the contribution rate includes CARMF contributors.


Risk affiliation accident at work/occupational disease (individual voluntary insurance AT/MP) is optional but highly recommended. This insurance can be purchased from your CPAM.

Contributions are lump sum based on an amount you choose, based on your income. They are then payable to the Urssaf.

If your spouse (married or married) or partner regularly participates in the company's activities, it must have a status.

There are 3 statuses: partner, salaried spouse, collaborating spouse.

You must choose a status and declare it on the website of the company formalities window.

Répondez aux questions successives et les réponses s’afficheront automatiquement


The Chief Executive Officer of SELARL is associated with and participates in the company.

He must have the necessary qualifications to practise the same profession.

Social protection

The associate spouse is a self-employed person. He/she shall personally contribute to the following organisations:

  • Urssaf (Family Allowance contribution, CSG-CRDS, Curps, contribution to vocational training, maternity health insurance) for your contracted activity,
  • Pension fund corresponding to the occupation practised for basic and supplementary retirement and invalidity.


Its contributions are determined in the manner that applies to all liberal practitioners.

They are calculated on the basis of your professional income. You file an annual income tax return.

Worker Spouse

The head of company must have opted for individual business, be the sole associate manager of EURL or be the majority manager of a SELARL.

The spouse is not paid for this activity.

Sickness and maternity benefit The spouse is insured on a personal basis. An option is available to benefit from the Head of company’s scheme for entitlement to maternity or paternity benefits (birth or adoption). He is entitled to Daily Allowances.

Disability/Death Pension Benefit  : Through his or her mandatory personal contributions, the spouse is entitled to the old-age, invalidity and death insurance of liberal professionals with the Pension Fund.

Employee Spouse

Regardless of the legal status of the company, the following conditions must be met:

Pre-Employment Declaration (PFA) of the spouse, employment contract and monthly pay slips.

Salary corresponding to the qualification of the job occupied or, in the case of various activities or not defined by a collective agreement, a salary equal to the minimum wage at the smic.

The spouse pays social contributions to each social protection agency or to the Urssaf in order to join Urssaf service Tese

Company Service Job Title (Tese)

An employed spouse is covered by the general scheme of employees in return for social security contributions and employer contributions.

It benefits from the protection offered to employees with regard to unemployment insurance, subject to Pôle emploi’s assessment of the reality of the employment contract.

When you become an employer, you are subject to certain reporting obligations.

You must make the following declarations:

  • Employee Statement. Pre-Employment Declaration (PSEA) is completed no earlier than 8 days prior to hiring. It is carried out online:
  • Nominal Social Declaration (DSN). The registered social declaration (DSN) replaces the majority of social declarations with social protection organisations and is made monthly

    From this declaration, as an employer, you pay social contributions (Urssaf, unemployment insurance, supplementary pension, pension...).

For simplifying the social formalities associated with the employment of employees you can join Company Job Title (Tese), an online service of the Urssaf.

Company Service Job Title (Tese)

This allows for a single declaration for the EPAAD and the employment contract. There are no more pay slips to be completed: the Tese centre handles them from the remuneration elements entered.

Finally, a payment to your Urssaf for compulsory social protection contributions and for income tax is deducted at source (if the employee is taxable).

The DSN and certain annual returns are made by your Tese centre (tax certificate...).

Health care professionals must complete a formality at the company Formalities Office in the event of a change in their situation. For example, it is a transfer of head office for a business, change of address for an independent professional.

All situation changes must be declared on the site ::

Urssaf CFE: change and discontinuation formalities

In parallel, the Urssaf will receive information from the CPAM indicating this change of situation, together with other information affecting the calculation of contributions.

The CPAM may decide to "disqualify" the liberal practitioner for a maximum 3 months. This means that it may decide to suspend the effects of the agreement on the healthcare professional;

It may take such a decision in the following cases:

  • Repeated application of higher tariffs than conventional tariffs, except in cases provided for by the texts, or non-compliance with the nomenclature of professional acts
  • Non-compliance with rules on care sheet requirements
  • Misuse of overflow for specific requirements.

In order to cease your activity, you must complete the following within one month (30 days) of the cessation of your activity: cancellation at:

Urssaf CFE: change and discontinuation formalities

You then have a 90 days for report to the Urssaf your business income for the year of termination and/or the previous year. 

Contributions are subject to regularisation. 

If you receive a credit, the overpayment is charged to the additional contributions and contributions due, or is refunded to you. 

If you are a debtor, the additional contributions and contributions resulting from the settlement must be paid within 30 days of the sending of the notice of appeal of this supplement. 

In the event of termination of employment, the provisional or final social contributions and contributions which have been deferred or averaged and which remain due shall be paid within 60 days of such termination.


In the absence of completion of the separation formalities, the Urssaf continues to call the contributions. 

Who can help me?

Find who can answer your questions in your region

To small and medium-sized and micro-entreprises, do you have a business project, a difficulty or a question ?

Quick and simple public service: you will be contacted over the phone by one of our experts.

Speak with an advisor on Place des Entreprises