To practice the profession of doctor, you must have one of the following nationalities :

• French nationality
• Nationality of a Member State of the European Union (EU) or party to the Agreement on the European Economic Area (EEA)
• Andorran citizenship
• Moroccan or Tunisian nationality

However, the person who has not one of these nationalities may still practice the profession of doctor when any of the following :

• She has a French State diploma as a doctor of medicine.
• It is authorized to exercise by an individual order of the Minister of Health after having requested a individual authorization to practice (AE).

Conditions vary depending on the person's nationality:

The Ordre national des médecins includes all doctors (except military doctors) authorized to practice medicine in France, regardless of their mode of practice.

Registration on the register of the Ordre des médecins is compulsory in order to legally practice as a doctor in France.

Exception: the national of the EU or the EEA who wishes to practice in France temporary or occasional (freedom to provide services - LPS) should only make a statement prior.

The liberal activity may be exercised in a dwelling room. This may be the doctor's principal residence or an independent office. Before doing so, it must be verified that the lease of a dwelling and the ownership rules do not prohibit the exercise of an activity.

Physician activity involves receiving patients. You also need to get a assignment change authorization office with the mayor in the cities of more than 200,000 inhabitants, in Paris, as well as in the municipalities of the little crown of Paris.

The activity may also be carried out in office space :

• Business premises or mixed-use premises (i.e. residential and business premises)
• Commercial premises: allows you to benefit from the advantages of the commercial lease, in particular: 9-year lease term, right to renewal at the end of the lease
• Subletting of premises already occupied by another trader

The site “Cartosanté - Where to settle in liberal with a click” provides a set of indicators in each territory to target the location of installation:

Cartosanté - Where to settle as a Liberal with a click

The doctor must declare his activity with the Primary Health Insurance Fund (CPAM) of his place of practice, with a certificate of registration in the Order's table.

The Liberal physician must choose when its first installation between several types of exercise for different fees:

• Sector 1 (so-called contracted sector): The tariffs are set by the national convention. In return for compliance with these tariffs, the doctor benefits from partial reimbursement of his social contributions (sickness, retirement, etc.). If the patient has a health supplement, the latter reimburses him the part of the amount of the consultation not covered by the social security.
• Sector 2 (so-called contracted sector): Fares are free in accordance with medical ethics. For example, simple advice or advice given to a patient by telephone or mail-in correspondence may not give rise to any fee. The patient is then reimbursed fees on the basis of the tariff set by the medical agreement (tariffs applicable to doctors in sector 1). If he is a member of a health insurance company, the latter pays the excess of fees according to a contractually defined rate: 100%, 200%, 300%
• Sector 3 (outside the conventional system): Rates are free: the patient is reimbursed on the basis of a so-called authority rate by the health insurance (from 0.43 euro to 0.61 euro for a general medical consultation).

The website “Doctor: your liberal installation” of the Health Insurance allows you to file a file and make an appointment with a counselor:

General practitioner, installation in liberal: registration with Medicare

During the interview, the CPAM proceeds with the membership of the health insurance scheme of licensed medical practitioners and assistants (CMAP). The doctors in Sector 1 contribute to the Urssaf under this scheme. On the other hand, doctors in sector 2 have the right of option between the ‘PAMC’ scheme and the ‘TI PL’ scheme (self-employed person - liberal profession). Thus, some doctors are covered by the CMAP and others by the TI PL scheme.

The general practitioner may exercise his activity in one of the following legal forms:

• Individual business in the following order: the general practitioner is then an individual operator.
• Business: the clinician may choose to create an exercise business alone or to team up. Creating an exercise business optimizes the tax burden by providing different options for allocating revenue among partners. Options can reduce income tax (IR) or business tax (SI) and payroll taxes.

If they wish to practice business, the primary care physician must choose one of the following business options:

• SEL (business of liberal practice) which allows members of the liberal professions to carry out their activity in the form of capital businesses
• SELARL (business of liberal practice with limited liability), in SELARLU (business of liberal practice with single-person limited liability)
• SELAFA (anonymous liberal exercise business), in SELAS (simplified liberal share exercise business)
• SELASU (single-person simplified liberal share business)
• SELCA (Liberal limited partnership business)
• SCP (professional civil business) allows several professionals to practice their profession together
• SCM (civil business of means) allows pooling with other means (personnel, material)

Registration must be done online on the website of the company Formalities Office in the 8 days after start of activity :

Company Formalities Window

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

Insee shall assign 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 is modified in particular when the address of the establishment is changed.

When registering the company, the Insee also attributes to the doctor his EPA code. For the activity of general medicine, the APE code is 8621Z.

All doctors practicing as a liberal have the obligation to take out professional indemnity insurance (CPR) before starting to practice.

The SPC guarantees the damage caused to third parties in the course of the activity: choice of the wrong treatment, poor follow-up of the patient, etc. It offers support in the search for an amicable solution, a covering of legal and procedural costs, as well as compensation for the damage.

The doctor substitute is solely responsible for his mistakes. He is also required to take out insurance to cover his civil liability.

Businesses must also comply with this obligation.

Failure to comply with that insurance obligation shall be punishable by a fine of €45,000.

Liberal practitioners also face a additional penalty prohibition of practice.

The businesses shall be fined €225,000.

From the date of commencement of activity, the general practitioner pays social security contributions to the Urssaf. They are calculated on the basis of realized income.

These contributions are must be paid online 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.

For more information on the social contributions of the general practitioner: see the sheet Social protection for the liberal professional.

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

The primary care physician should adhere to the Caisse Autonome de Retirement des Médecins de France (CARMF) within one month of commencement of business. Membership is compulsory for all doctors practicing in the liberal profession: installation, replacements, in the business of liberal practice.

Membership shall be pronounced on the first day of the calendar quarter following the beginning of the self-employed financial year.

The Liberal physician contributes to the following plans:

• Three pension schemes :
  
  • Basic scheme: operates in insurance points and quarters, part of the contributions of doctors in sector 1 is paid by the sickness funds;
  • Supplementary old-age scheme: managed on a provisioned basis and operated in points;
  • Supplementary Old Age Allowance (SSA) plan, if you have a contract. It works in points. Two thirds of the contribution of doctors in sector 1 is financed by the health insurance funds.
• A provident scheme : disability-death plan.
• A voluntary scheme : Capitalized Capimed, Pension Savings Plan (PER)

The Code of Medical Ethics is binding on all doctors practicing in France, whether they are registered with the Ordre or whether they are nationals of the European Union or parties to the Agreement on the European Economic Area, providing a service in France on a temporary or occasional basis.

It is also mandatory for replacement medical students.

In particular, the doctor should adhere to the following principles:

• Principles of morality, probity, and dedication essential to the practice of medicine
• Medical confidentiality
• Patient information and consent
• Assistance to anyone in danger.

Code of Medical Ethics

National College of Physicians

Pour en savoir plus

The Council of the College of Physicians itself exercises disciplinary authority in cases of breaches of the code of medical ethics.

There is one Disciplinary Chamber of First Instance per region, attached to the Regional Council of the Medical Association. They can impose professional sentences: warning, reprimand, temporary ban from practicing, removal from the Order’s register, etc.

The accused doctor may appeal to the National Disciplinary Chamber.

The combination of the practice of medicine with another activity must respect the principles of professional independence and dignity.

For example, professions that are subject to self-benchmarking are prohibited. Self-compounding is the act of profit from prescriptions or medical advice. As a result, a doctor cannot do the following:

• Manufacturer or vendor of medical devices
• Optician
• An ambulance attendant or an ambulance business manager
• Owner or manager of a hotel for patients, a fitness room, a treatment facility, a center for advice on aesthetics, hygiene or dietetics, a fitness center, a spa, a massage room, a beauty institute, etc.

Similarly, a doctor is prohibited from using an elected, political or union mandate or administrative function to increase his client base.

In addition, an associate doctor of a liberal practice business (SEL) may exercise his activity only within that business. He cannot combine with a liberal activity outside this business. On the other hand, he may develop paid employment.

Doctors must justify to the national council of the college, over a period of 3 years, their commitment to a coursemultiannual continuing professional development . This route aims to:

• evaluate professional practices
• updating knowledge and maintaining skills
• improve the quality and safety of care.

All actions performed by doctors as part of their continuing professional development obligation are traced to a specific document on the website of the national agency for continuing professional development, certifying compliance with this obligation. The commitment of doctors to an accreditation process is a commitment to continuous professional development.