Medical practitioners and auxiliaries (PAM): declaration of activity and social security scheme

Verified 01 January 2024 - Legal and Administrative Information Directorate (Prime Minister)

You wish to settle to perform a medical or auxiliary activity as a Liberal. You must complete certain formalities to create your activity. At the social level, you are covered by the "PAMC" scheme, that is to say, a self-employed person engaged in a health profession activity covered by the social scheme of the Practitioners and Medical Assistants under the Convention.

A ‘PAM’ is a self-employed person engaged in a health-care occupation covered by the social security scheme for members of the Medical Practitioner and Auxiliary Committee (PAMC). In this capacity, he contributes to the Urssaf.

It is also covered by one of the following old-age funds for the calculation and recovery of old-age contributions: CARPIMKO, CARMF, CARCDSF

The following professions are in the category of practitioners :

  • Doctors (general practitioners and specialists)
  • Dental surgeons
  • Medical students replacing a medical doctor
  • Laboratory Directors of Medical Analyzes and who are also doctors

The following professions are in the category of medical auxiliaries :

  • Midwives
  • Nurses
  • Physical therapists
  • Pedicures-Podologists
  • Speech-Language Pathologists
  • Orthoptists

Please note

Sector 2 doctors and pedicure doctors have the right of option between the ‘PAMC’ scheme and the ‘TI PL’ scheme (self-employed person - liberal profession). Thus, some doctors and pedicurists fall under the CPAP and others under the TI PL regime.

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

You have to go through a number of administrative procedures to settle and practice your profession as a Liberal:

  • Register your diplomas to obtain an Adeli number or an RPPS number
  • Register with the Primary Health Insurance Fund at your place of practice to inform them of your facility
  • Take out professional indemnity insurance (CPR)
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, it's either an “Adeli” number or a “RPPS” number.

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

Please note

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

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RPPS Number

You must first request your registration on the Order's board.

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

After your registration on the board, the departmental council registers your diploma. He issues you a certificate of registration on the Order's board with your RPP numberS (shared directory of healthcare professionals) and your place(s) of exercise.

This number is assigned to you for all your life.

Your Health Professional Card (HPC) is automatically sent to you by the Shared Health Information Systems Agency (ASIP Santé) responsible for manufacturing and issuing HPC cards.

Adeli Number

You must register with the Territorial Delegation (DT) of theRegional Health Agency (DTARS) to register your diploma(s) in the national Adeli Healthcare Professional Identification Directory.

This entry must be made within one month of taking up office.

This gives you an Adeli number.

Warning  

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

2. Register with the Primary Health Insurance Fund at your place of business

You must contact Health Insurance to register your current fiscal year.

Who shall I contact

CPAM records you in the National Health Professional Register (NHPF).

3. Take out professional indemnity insurance (CPR)

All healthcare professionals working in a liberal capacity, as well as the businesses they may train, must subscribe to civil liability insurance covering all the acts they practice.

Failure to comply with this insurance obligation may result in criminal and disciplinary sanctions.

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Holder/Settled

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

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

You must apply for your registration at the Counter formalities of the companies within 8 days of starting your activity.

Company Formalities Window

Warning  

Since 1er january 2023, it is no longer possible to carry out your procedures in a company Formalities Center (CFE). You must make them on the website of the company formalities office.

This declaration is used to inform all the bodies concerned by the launch of your activity (Insee, social organizations, Urssaf, public finance center, etc.).

Following your registration, Insee assigns a Siret number. This is a unique national identification number that identifies the establishment. It is composed of Siren (first 9 digits) which identifies the company and the Nic (last 5 digits) which changes in particular when the establishment changes its address.

When registering the company, Insee also grants a EPA code corresponding to the activity of that company.

FYI  

Obtaining the Siret number allows the user to carry out his activity even in the event that his registration with the social agencies is not carried out.

Substitute

Alternate physician

If you are a substitute doctor or a regulatory doctor, the Urssaf offers a simplified offer which allows the activity, the retrocession of fees or remuneration to be declared and the related social contributions to be paid directly from an online personal space.

Under this scheme, the declaration and payment of contributions are simplified. They will be carried out quarterly (or monthly according to the initial choice) and only in the case of replacement and therefore of actual receipt of fee retrocessions, and without cash-flow lag.

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

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

To subscribe to this simplified offer, you need to bring together following conditions :

  • Perform only overrides
  • To have retroceded fees not exceeding €19,000 by calendar year
  • Not to engage in any other activity as self-employed

The registration process is available on the following portal:

Simplified offer for replacement doctors

Other Substitutes

As a substitute, you are required to follow the same formalities as all healthcare professionals.

You must therefore register as of your 1er replacement day.

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

On the declaration of commencement of activity, you must tick the “substitute” box to be exempt from the Contribution to the Regional Health Professionals Unions (URPS).

You must apply for your registration at the Counter formalities of the companies within 8 days of starting your activity.

Company Formalities Window

Warning  

Since 1er january 2023, it is no longer possible to carry out your procedures in a company Formalities Center (CFE). You must make them on the website of the company formalities office.

Company Creation and Recovery Assistance (Acre)

The Acre is a mechanism to encourage the creation of company. It consists of a partial exemption from social security contributions. When you create your business, you will be exempt from certain contributions for 12 months, subject to conditions. You must not have received the Acre for three years.

You have the possibility to be exempt from sickness and family allowances contributions, as well as from basic pension and invalidity-death contributions.

Note that this exemption is applied to provisional contributions and then it is revised after the tax return has been provided.

There may be 3 cases:

  • When your revenues are less than €34,776  €: the exemptions may apply in full
  • When your income is between €34,776 and €46,368 : a degressivity applies
  • When incomes exceed €46,368 : there is no exemption, it is withdrawn.

For the MAP (Practitioners and Medical Assistants) plan, there is no claim to qualify for the Acre. The exemption on contributions is applied automatically.

Aid from CPAM

A lot of financial assistance is offered by CPAM and can be allocated to you according to your situation.

At the same time, there are also flat-rate payments paid by health insurance (aid for teletransmission, compensation for continuing training, installation premium, etc.).

The Healthcare Professional Support Portal (paps.health) contains all relevant information, from training to discontinuing the activity.

Please note

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

From the date of your start of business, you have to pay social security contributions to the Urssaf.

These contributions are must be paid online. You can choose to pay in one of the following ways:

  • Either 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 security contributions calculated?

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

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

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

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

You must declare your professional income on the impots.gouv.fr website.

Online tax account for professionals (EFI mode)

After accounting for the reported items, you receive a new schedule that includes the following:

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

FYI  

In the event that this amount is remote from your actual income, it is recommended to make an “income estimate”. This is a service offered by the Urssaf that allows you to recalculate your contributions on the amount of income you fill in.

This avoids a significant adjustment of contributions the following year. You can make this request via your online space on urssaf.fr ( Modulate my earnings ").

What are the contributions paid by CPAM?

By signing the collective agreement concluded between their profession and the health insurance, the CMAPs benefit from a participation of the health insurance certain social contributions on the basis of the income from the contracted activity. This participation can be partial or total, it depends on the agreement of your profession.

Example :

For a contracted doctor in sector 1, the sickness contribution rate is 6.5%. In the case where the latter has only agreed income, the CPAM will take charge of 6.4% of this contribution, only 0.10% remains payable by the trader. However, for uncontracted income, it is the rate of 6.5% which is applied.

Such participation may be fully or partially canceled in the event of fraud. This means that the healthcare professional must reimburse this contribution when he has been the subject of a financial penalty or a conviction, in particular for the following facts: forgery and use of forgery, falsification, social security fraud, repeated billing of unperformed acts or services, of products or materials not issued or any other failure to take charge of a health act, benefit or product.

What are the social contributions payable?

The sums collected by the Urssaf are repaid 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 retirement benefits.

  • Health Insurance Contribution (MA) : The sickness and maternity insurance contribution finances the benefits paid by the general social security scheme.
  • Contribution of family allowances (FA) : This contribution is intended to finance the benefits paid by the family allowance funds.
  • Generalized Social Contribution (CSG) and Social Debt Repayment Contribution (CRDS) : CSG revenue finances health insurance schemes, family benefits, the old-age solidarity fund and the national solidarity fund for autonomy. The Social Debt Repayment Contribution (CRDS) was created to finance the Social Debt Repayment Fund (Cades).
  • Contribution of daily allowances (IJ) : There is a sickness benefit scheme for medical practitioners and auxiliaries in the event of a work stoppage, between 3e and 90e days off.
  • Contribution to regional health professional unions (Curps) : The health professions are represented by regional health professionals’ unions which contribute to the organization and evolution of health provision at regional level, including the preparation of the regional health project and its implementation. These unions are funded by the Curps, which is due only by settled health professionals.
  • Contribution to vocational training (MFF) : this contribution finances training measures for liberal doctors through the Medical Profession Training Insurance Fund (FAF-PM) and for other MAP professions through the Interprofessional Fund for Training of Liberal Professions (IFF PL).
  • Contribution to voluntary accident at work/occupational disease insurance (AVAT)): This voluntary contribution covers risks of accidents at work, occupational diseases and accidents on the way. It is to be subscribed to your CPAM and then recovered by the Urssaf.
  • Pension contributions: Under the traditional system, 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 substitute doctors, the contribution rate includes CARMF contributors.

FYI  

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

The contributions are fixed according to an amount you choose, based on your income. They are then to be paid to the Urssaf.

If your spouse (married or former) or common-law partner regularly participates in the company, it must have a status.

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

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

If the professional activity of the spouse is not declared, this activity is considered to be under the status of employed spouse.

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Associate spouse

The majority manager of SELARL is associated with and participates in the activity of the company.

They must have the necessary qualifications to practice the same profession.

Social protection

The partner spouse is self-employed. He personally contributes to the following organizations:

  • Urssaf (contribution of family allowances, CSG-CRDS, Curps, contribution to vocational training, sickness and maternity insurance) for your contracted activity,
  • Pension fund corresponding to the occupation exercised for basic and supplementary retirement and invalidity death.

Contributions

Its payroll taxes are determined on the same terms and conditions that apply to all liberal practitioners.

They are calculated on the basis of your professional income. You file a tax return every year.

Contributing spouse

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

The spouse is not paid for this activity.

Sickness and maternity benefit The spouse is insured in a personal capacity. 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 a daily allowance.

Disability/Death Pension Benefit  : By means of his compulsory personal contributions, the spouse acquires specific rights to the pension fund for old age, disability and death insurance for liberal professionals.

Employed spouse

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

Spouse pre-employment declaration (PETA), employment contract and monthly pay slips.

Wage corresponding to the qualification of the job held or, in the case of various activities or activities not defined by a collective agreement, a wage equal to the minimum wage.

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

Company Service Job Title (Tese)

The employed spouse is covered by the general scheme for employees in return for social security contributions from employees and employers.

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

By becoming an employer you are subject to certain reporting obligations.

You must make the following declarations:

  • Employee Declaration. The pre-employment declaration (PED) shall be made at the earliest within 8 days prior to employment. It is conducted online:

Online Pre-Hire Declaration (PSTD)

Nominative Social Declaration (DSN)

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

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

Company Service Job Title (Tese)

This allows for a single declaration for the EAPD and the contract of employment. There are no more pay slips to be processed: the Tese center handles them from the compensation elements entered.

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

The DSN and certain annual declarations are made by your Tese center (tax certificate...).

Healthcare professionals must complete a formality with the company Formalities Window in case of a change in their situation. For example, a transfer of registered office for a business, a change of address for an independent professional.

All changes in circumstances must be declared on the site cfe-urssaf.fr :

Urssaf CFE: formalities for modification and cessation of activity

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

CPAM may make the decision to "disagree" with the Liberal practitioner for a maximum duration of 3 months. This means that it may decide to suspend the effects of the agreement with regard to the health-care professional;

It may take such a decision in the following cases:

  • Repeatedly applying tariffs higher than conventional tariffs outside the cases provided for in the texts, or failing to comply with the nomenclature of professional acts
  • Non-compliance with the rules on care sheet requirements
  • Misuse of exceedance for special requirements.

In order to cease your activity, you must complete, within one month (30 days) of the cessation of your activity, the cancelation formalities at: www.cfe.urssaf.fr

Urssaf CFE: formalities for modification and cessation of activity

Then you have a 90-day period for to declare to the Urssaf your employment income for the year of termination and/or the previous year. 

The contributions are subject to adjustment. 

If you receive a credit, the overpayment is credited to or refunded to the contribution supplement due. 

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

In the event of cessation of professional activity, provisional or definitive contributions and social contributions which have been deferred or spread over time and which remain due must be paid within 60 days of such cessation.

FYI  

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

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