Practitioners and licensed medical assistants (PamC): declaration of activity and social security scheme

Verified 05 March 2026 - Entreprendre Public Service / Directorate of Legal and Administrative Information (Prime Minister)

To exercise a medical activity or a medical assistant as a liberal professional certain steps must be taken. At the social level, the activity falls within the scope of the ‘PamC’ scheme, that is to say, the social scheme for self-employed workers exercising a health profession as medical practitioners or contracted medical auxiliaries.

A “WFP” is a self-employed who carries out an activity as a health profession under the social scheme for medical practitioners and assistants under contract (PamC), attached to the general social security scheme. It contributes to theUrssaf: titleContent.

For the purposes of calculating and recovering old-age contributions, it is also covered by one of the following old-age funds: CARPIMKO, CARMF, CARCDSF

The following occupations fall under the category of practitioners :

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

The following occupations fall under the category of medical auxiliaries :

  • Midwives
  • Nurses
  • Massage physiotherapists
  • Pedicure-Podiatrists
  • Speech therapists
  • Orthoptists

Please note

Doctors in sector 2 have the right of option between the ‘PamC’ scheme and the ‘TI PL’ scheme (self-employed – liberal profession). This choice must be made during installation and is final. Pedicure chiropodists had a right of option until July 31, 2024 to take effect on July 1er January 2025. Thus, some doctors and pedicures chiropodists fall under the PamC and others under the TI PL regime.

Several steps must be taken for the installation and exercise of the liberal activity:

  • Registration of diplomas to obtain a number RPPS: titleContent
  • Registration to the CPAM: titleContent the place of practice to inform him of the installation
  • Professional Third Party Liability Insurance (CPP)

1Registration of the diploma to obtain an RPPS number

Registration of the diploma is required to obtain an identification number.

The Shared Directory of Professionals Involved in the Health System (RPPS) is the single reference directory for identifying health professionals.

The professional must apply for registration on the roll of the Order. This registration is mandatory to legally practice medicine.

The application for registration is addressed to the president of the departmental council of the Order of Physicians of the place of professional residence.

The request can be submitted directly to the departmental council of the Order concerned or be sent by registered mail with acknowledgement of receipt:

After registration on the roll, the departmental council proceeds to the registration of the diploma. It issues a certificate of registration with the Order with a RPPS number (shared directory of health professionals) and one (more) place(s) of practice.

This number is assigned to the professional for his whole life.

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

2Enrollment in the Primary Health Insurance Fund of its place of practice

The professional must contact the Health Insurance to register his private practice.

Who shall I contact

The CPAM registers the professional in the national register of health professionals (FNPS).

3Professional Third Party Liability Insurance (CPP)

All health professionals practicing in a liberal capacity, as well as the businesses they can train, must take out a civil liability insurance covering all the acts they practice.

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

The procedures for declaring the activity vary depending on whether the activity is carried out as a holder or a substitute.

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Holder/Settled

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

THEprofessional practice can be carried out under 2 main categories of legal forms: either the (EI) or the business (civil, capital, etc.). 

The application for registration must be made on the site of the Window of the formalities of the companies in the 8 days which follow the start of activity.

Window of company formalities

The Urssaf provides a handy sheet to carry out the procedures for declaring the start of activity.

This declaration makes it possible to inform all the bodies concerned by the launch of the activity (Insee: titleContent, social organizations, Urssaf: titleContentpublic finance center, etc.).

Following registration, INSEE assigns a Siret number. It is a unique national identification number that identifies the establishment. It is composed of Siren (first 9 digits) that identifies the company and the Nic (last 5), modified in particular when changing the address of the establishment.

When registering the company, INSEE also assigns 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 social organizations is not carried out.

Substitute

Alternate physician

To practice as a substitute doctor or regulatory doctor, Urssaf proposes a “ simplified offer ” which allows the declaration of the activity, the retrocessions of fees or remuneration and the payment of the related social contributions directly from a personal online space.

Under this scheme, the declaration and payment of contributions are simplified. They will be to be carried out quarterly (or monthly according to the initial choice) and only in the event of replacement and therefore effective collection of fee retrocessions, and without cash mismatch.

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

  • Replacement physicians (general practitioner or specialist)
  • Student Doctors
  • Employed doctors
  • Retired physicians
  • Medical Regulators
  • Doctors participating in a vaccination campaign

To subscribe to this simplified offer, it is necessary to gather the following conditions :

  • Perform replacements only
  • Have surrendered fees not exceeding €19,000 by calendar year
  • Not to engage in any other activity as a self-employed person

The registration process is done on the following portal:

Simplified Device for Replacement Physicians (RSPM)

Other replacements

The substitute healthcare professional is required to follow the same formalities as all healthcare professionals.

It must therefore register as soon as it is 1er replacement day.

If he does not have a fixed practice address, he must enter his home address as a business address.

On the declaration of commencement of activity, the box ‘replacement’ must be ticked to be exempted from the contribution to the Regional Unions of Health Professionals (URPS).

Thus, you must apply for your registration on the website of the Window of the formalities of the companies within 8 days of starting your activity.

Window of company formalities

Support for the creation and recovery of a company (Acre)

Acre is a scheme to promote company creation. It results in a partial exemption from social security contributions.

Warning  

The creators, liberal professionals, who opted for thesimplified offer (doctors and medical students substitutes), cannot benefit from this device.

When starting a business, an exemption from certain contributions can be applied for 12 months, subject to conditions. The creator did not benefit from the Acre during the previous three years.

The exemption covers sickness contributions, family allowances, basic pension contributions and invalidity-death contributions.

This exemption applies first to provisional contributions and is then adjusted after the tax return.

3 cases may arise:

  • When income is less than 75% the annual Social Security ceiling (PASS), i.e. less than €36,045 : the amount of the exemption is capped at 25% of these contributions
  • Where income is between €36,045 and €48,060 : a degressivity applies
  • When revenues exceed €48,060 : there is no exemption, it is withdrawn.

The creator or the buyer must make a request for exemption from the Urssaf, by filling in the form of demand.

The Urssaf provides a practical sheet for carry out the step-by-step approach.

CPAM aid

Many financial aids are proposed by the CPAM: titleContent and may be assigned according to the health professional's situation.

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

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

Please note

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

The payment of social contributions to the Urssaf is compulsory from the beginning of activity.

FYI  

In practice, the first payments are made after a minimum period of 90 days.

These contributions are obligatorily 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.
  • Or every quarter. Quarterly payment is made by direct debit, telepayment or credit card. Membership fees are due on February 5, May 5, August 5 and November 5.
Calculation of social security contributions

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

At the beginning of the activity, this income is not known. For the first two years of activity, contributions are therefore calculated provisionally on a flat-rate basis.

For a start of activity in 2026, this flat-rate calculation basis corresponds to:

  • 19% of PASS: titleContent, or €9,131, for contributions to family allowances, retirement and invalidity-death
  • 40% of PASS: titleContent, or €19,224, for sickness and daily subsistence contributions.

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

Consult the Urssaf page to learn more about the rates of contributions and contributions due from medical practitioners or auxiliaries.

The professional income must be declared annually on the website impots.gouv.fr.

Online tax account for professionals (EFI mode)

Once the elements have been declared, the trader receives a new schedule including the following information:

  • Final contributions for the year for which he reported (2026 income reported in 2027)
  • A recalculation of his contributions for the current year, calculated on the income of the previous year
  • For your information, the amounts of the first provisional installments for next year.

FYI  

If revenues are likely to change during the year, a service offered by the Urssaf allows the annual provisional contributions to be updated, based on an “income estimate”.

This approach avoids a significant regularization of contributions the following year.

Consult our fact sheet to learn more about the revaluation of social security contributions.

The Urssaf provides a practical sheet for adjust the amount of contributions.

Coverage of contributions by CPAM

By adhering to the agreement concluded between their profession and the Health Insurance, the PAMC benefit from participation of the Health Insurance to certain social contributions on the basis of the income from the contracted activity. This participation may be partial or total, depending on the convention of the profession.

Example :

For a sector 1 doctor, the sickness contribution rate is 6.5%. In the event that the latter has only agreed income, the CPAM takes over 6.4% of this contribution, only 0.10% remains to be paid by the professional. On the other hand, for non-contracted income, it is the 6.5% which is applied.

This participation may be totally or partially canceled in case 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 for the following facts: forgery and use of forgery, falsification, social security fraud, repeated invoicing of acts or services not performed, products or materials not delivered or any other breach of the rules for taking charge of an act, a benefit or a health product.

Social contributions due in respect of the activity 

The sums collected by the Urssaf are 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 retirement benefits.

  • Health insurance (AM) contribution : The sickness and maternity insurance contribution finances the benefits paid by the general social security system.
  • Family Allowance Contribution (FA) : This contribution is intended to finance benefits paid by family allowance funds.
  • Generalized social contribution (CSG) and contribution to the repayment of social debt (CRDS) : The CSG revenues finance health insurance schemes, family benefits, the old-age solidarity fund and the national solidarity fund for autonomy. The Social Debt Repayment Contribution (SDRC) was created to finance the Social Debt Amortization Fund (SDRF).
  • Daily allowance contribution (IJ) : There is a system of daily sickness benefits in case of work stoppage for medical practitioners and auxiliaries, between the 3e and 90e days off.
  • Contribution to regional unions of health professionals (Curps) : The liberal health professions are represented by regional unions of health professionals which contribute to the organization and development of the health supply at the regional level, in particular to 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 (CFP) : This contribution finances training actions, for liberal doctors through the Fund of Insurance Training of the Medical Profession (FAF-PM) and for the other professions PAM through the Fund Interprofessional Training of liberal professions (FIF PL).
  • Contribution to voluntary insurance for work-related accidents/occupational diseases (AVAT)): This optional contribution covers risks of accidents at work, occupational diseases and accidents on the way. It is to be subscribed with the CPAM and then recovered by the Urssaf.
  • Retirement contributions: In the conventional system, the Urssaf does not call for pension contributions; these will be called by the pension fund corresponding to each profession: CARPIMKO: titleContent, CARMF: titleContentCARCDSF. As part of the simplified offer for substitute physicians, the contribution rate includes CARMF contributors.

FYI  

Affiliation to risk -/occupational disease (AT/MP individual voluntary insurance) is optional but highly recommended. This insurance is to be taken out with the CPAM.

Contributions are flat-rate according to the amount chosen, depending on income. They are then to be paid to the Urssaf.

If the spouse (married, past or common-law partner) regularly participates in the company's activity, it must have a status.

It exists 3 statutes possible, depending on the legal form of the company: associate spouse, collaborating spouse, salaried spouse.

The chosen status must be declared on the website of the company formalities window.

If the spouse's professional activity is not declared, it is automatically considered to be exercised under the status of salaried spouse.

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Associated spouse

Associated spousal status is only possible if the activity is carried out in a business.

The spouse of the majority manager of the SELARLU must be associated (own shares) and participate in the company's activity.

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

Social protection

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

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

His social contributions are determined according to the terms that apply to all liberal practitioners.

They are calculated on the basis of his professional income. Each year the spouse files a tax return.

Collaborating spouse

In order for the spouse to choose this status, the practitioner must practice either in {circumflex over (EI)} or as the majority manager of SELARLU.

The spouse is not paid for his or her participation in the activity.

The spouse is insured in a personal capacity for the illness. An option is available to benefit from the Head of company scheme for entitlement to maternity or paternity benefits (birth or adoption). He is entitled to daily allowances.

By his compulsory personal contributions, the spouse acquires own rights to old-age and invalidity-death insurance liberal professionals with the Pension Fund.

Employed spouse

This status can be chosen regardless of the legal status of the company and the spouse is considered as any employee of the company.

In case of an option for this status, the following conditions must be met:

  • Pre-employment declaration (PED) of spouse, employment contract and monthly payslips
  • Salary corresponding to the qualification of the job held or, in the case of various activities or not defined by a collective agreement, a salary equal to the minimum of Smic: titleContent.

The health professional pays social contributions to each social protection organization or to the Urssaf in case of membership in the Urssaf service Tese. 

Join the service Job title service company (Tese)

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

It benefits from the protection offered to employees in terms of unemployment insurance, subject to France Travail's assessment of the reality of the employment contract.

If the practitioner decides to hire, the practitioner becomes an employer and must make the following declarations:

  • Declaration of the employee. The pre-employment declaration (PRE-EMPLOYMENT DECLARATION) is made no earlier than 8 days before the hiring. It is carried out online:

Pre-employment declaration (PRE-EMPLOYMENT DECLARATION) online

  • Registered Social Declaration (DSN). The registered company declaration (DSN) replaces the majority of social declarations with social protection bodies and is carried out monthly net-companies.fr.

Registered Social Declaration (DSN)

On the basis of this declaration, the healthcare professional who is the employer must pay social contributions (Urssaf, unemployment insurance, supplementary pension, provident insurance, etc.).

For simplify social formalities linked to the employment of employees it is possible to join the Job title company service (Tese), an online service of the Urssaf.

Join the service Job title service company (Tese)

This system allows for a single declaration for the DPAE and the employment contract. There are no pay slips to be completed: the Tese center takes care of them from the pay items entered.

Finally, the payment of social contributions to the Urssaf and income tax is deducted at source (if the employee is taxable).

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

The CPAM can take the decision to “disagree” with the liberal practitioner for a maximum duration of 3 months. This means that it can decide to suspend the effects of the agreement on the health professional.

Unloading may occur in the following cases:

  • Repeated Application of tariffs higher than conventional tariffs outside the cases provided for by the texts, or non-compliance with the nomenclature of professional acts
  • Failure to comply with the rules concerning the establishment of care sheets
  • Misuse of excess fees for special requirements.

All change of situation health professionals must be declared on the website of the company formalities desk.

For example, a transfer of head office for a business, a change of address for an independent professional.

Window of company formalities

In parallel, the Urssaf may also receive from the CPAM information indicating this change of situation supplemented by other information impacting the calculation of contributions.

The delisting formalities are different depending on whether it is a ₪ or a business.

They must be carried out on the website of the company formalities office, within one month (30 days) of the cessation of the activity.

Window of company formalities

The professional then has a 90 days for declare to the Urssaf its professional income for the year of cessation and/or the previous year.

Contributions shall be regularized:

  • In the case of a credit, the overpayment shall be charged to the additional contributions due or reimbursed.
  • In the event of a debit, the additional contributions resulting from the regularization must be paid within 30 days of the sending of the notice of appeal of this supplement.

In case of cessation of professional activity, provisional or definitive social contributions and contributions which have been deferred or staggered and which remain due shall be paid within 60 days of such cessation.

FYI  

In the absence of completion of the formalities of cessation of activity on the site of the companies' formalities window, the Urssaf continues to call contributions.