Practitioners and medical assistants under contract (PamC): affiliation and social regime

Verified 17 June 2026 - Entreprendre Service Public / (Prime Minister)

Practitioners and medical assistants under contract carry out their professional activity under an agreement concluded between their profession and the Health Insurance. This particular status determines their modalities of exercise, but also their affiliation. At the social level, the activity of medical practitioner or auxiliary falls within the scope of the ‘PamC’ scheme, that is to say, the social scheme for self-employed workers exercising a health profession as Contract Medical Practitioners or Auxiliaries.

A « WFP » is a self-employed who carries out an activity as a health profession covered by the social scheme for licensed medical practitioners and assistants (PamC), attached to the general social security scheme. In this respect, it contributes to theUrssaf: titleContent.

For the calculation and recovery of 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 Analytical Laboratory Directors and who are also doctors

The following occupations fall under the category of medical auxiliaries :

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

Please note

Doctors in sector 2 have a 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 podiatrists fall under the PamC and others under the TI PL regime.

The payment of social contributions to the Urssaf is mandatory 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, as follows:

  • 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. Contributions are due on 5 February, 5 May, 5 August and 5 November.

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. The first 2 years of activity, contributions are therefore calculated, provisionally, on a flat-rate basis.

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

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

These contributions will then be regularized according to the real income declared the following year.

Visit 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 items have been declared, the trader receives a new schedule including the following information:

  • His final contributions for the year for which he reported (2026 income reported in 2027)
  • A recalculation of the amount of his contributions for the current year, calculated on the income of the previous year
  • For your information, the amounts of the first provisional maturities 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, on the basis of an « income estimate ».

This 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 handy sheet for adjust the amount of contributions.

CPAM contribution support

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

Example :

For a sector 1 contracted physician, if the sickness contribution rate is 6.5% and that the doctor has only agreed income, the CPAM takes care 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, forgery, 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 service or a health product.

Social contributions due for the activity 

The funds collected by the Urssaf are paid 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 accident at work allowances, 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 (FA) Contribution : This contribution is intended to finance the benefits paid by the family allowance funds.
  • General welfare contribution (CSG) and contribution to the repayment of social debt (CRDS) : CSG revenues support health insurance schemes, family benefits, the old-age solidarity fund and the national solidarity fund for self-reliance. The Social Debt Repayment Contribution (CRDS) was set up to finance the Social Debt Amortization Fund (Cades).
  • Daily allowance (DI) contribution : 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 the 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 owed only by established health professionals.
  • Contribution to vocational training (CFPS) : This contribution finances training actions, for private doctors through the Medical Profession Training Insurance Fund (FAF-PM) and for other PAM professions through the Interprofessional Fund for the Training of Private Professions (FIF PL).
  • Contribution to the voluntary accident at work/occupational disease insurance (AVAT)): This optional contribution covers accident at work risks, occupational diseases and commuting accidents. It is to be subscribed with the CPAM and then recovered by Urssaf.
  • Retirement contributions: In the traditional system, the Urssaf does not call pension contributions; these will be called by the pension fund corresponding to each profession: CARPIMKO: titleContent, CARMF: titleContent, CARCDSF. As part of the simplified offer for substitute physicians, the contribution rate includes CARMF contributors.

FYI  

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

The contributions are flat-rate according to the amount chosen, depending on the income. They are then payable to the Urssaf.

Steps in case of change or cessation of activity 

The health professional must declare any change in his situation on the site of the company formalities window, competent for all procedures for declaring the creation, modification and termination of company.

The information entered is then transmitted to the Urssaf, which may also receive information from the CPAM indicating this change in situation and other information impacting the calculation of contributions.

In case of cessation of professional activity, the trader shall have 90 days for declare to the Urssaf its professional income for the year of termination and/or the previous year.

Contributions shall be regularized:

  • In the case of a credit, the overpayment is charged to the additional contributions due, or is refunded.
  • In a debit situation, 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 activity, the provisional or definitive social contributions and contributions which have been deferred or staggered and which remain due must 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 company formalities window, the Urssaf continues to call contributions.

If the spouse (married, entered into a civil partnership or cohabiting) regularly participates in the company's activity, it must have a status.

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

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

To know how declare the chosen status, consult the sheet Practitioners and licensed medical assistants (PamC): declaration of activity.

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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

Their payroll taxes are determined according to the terms and conditions that apply to all private practitioners.

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

Collaborating spouse

In order for the spouse to choose this status, the practitioner must practice either as an individual business (EI) or as a majority manager of SELARLU.

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

The spouse is insured in 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 mandatory personal contributions, the spouse acquires own rights to old-age and invalidity-death insurance Liberal professionals working 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:

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

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

Join the service Job title company service (Tese)

The employed spouse is covered by the general scheme for employees in return for employee and employer contributions from 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 he decides to hire, the practitioner becomes an employer and must make the following declarations:

  • Declaration of the employee. - on hiring (DPAE) is carried out at the earliest within 8 days prior to hiring. It is carried out online:

Notice of hiring (DPAE) on the Net-companies website

  • Registered company 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 company 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 simplifying social formalities related to the employment of employees it is possible to join the Job title service company (Tese), an online service of the Urssaf.

Join the service Job title company service (Tese)

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

Finally, social security contributions from the Urssaf and income tax are deducted at source (if the employee is taxable).

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