Dentist sick leave: rights and impact on the practice

Sick leave in a dental practice is handled differently depending on who is off. For an employee, the CPAM pays daily benefits from the fourth day, topped up by the employer after one year of service. For the self-employed dentist, the CPAM pays from day 4 to day 90, then CARCDSF takes over from day 91.

A work stoppage for a dentist is not limited to a medical question. For a self-employed dental surgeon, it is necessary to think at the same time about daily allowances, waiting periods, complementary or ordinal coverage, the organization of the practice, fixed costs and the relationship with patients. It is a social, financial and operational subject. The classic mistake is to discover the rules at the time of stopping.

See also: Medical office, Freelance accounting and URSSAF control.

Three different situations hide behind the same phrase, and they do not follow the same rules:

• the sick leave of an employee of the dental practice (dental assistant, dental nurse, receptionist): daily benefits from the social security, then sick pay owed by the employer;
• the sick leave of the self-employed dental surgeon: the CPAM pays from day 4 to day 90, then CARCDSF takes over from day 91;
• the sick-leave certificate a dental surgeon issues to a patient, the duration of which is capped from 1 September 2026.

Each of the three is covered below. Whatever the case, the same five questions have to be answered:

• temporary interruption of activity;
• the opening of rights to compensation;
• the payment schedule;
• the formalities to be completed;
• the continuity of the firm.

An employee's sick leave has nothing to do with the self-employed dentist's own scheme: these are two distinct mechanisms, which do not start at the same time and are not calculated in the same way. When a dental assistant, a dental nurse or a receptionist is off sick, two payments stack up: the daily benefits paid by the social security, then the top-up owed by the practice as employer.

Social security side. Article R. 323-1 of the French Social Security Code sets the starting point of the daily benefit on the fourth day of the incapacity: the employee bears a three-day waiting period. The maximum number of daily benefits an insured person may receive over any three-year period is 360. Since decree no. 2025-160 of 20 February 2025, applicable to work stoppages starting on or after 1 April 2025, the salary used as the calculation base is capped at 1.4 times the SMIC (down from 1.8): above that threshold the daily benefit no longer increases, and the practice's residual cost rises mechanically.

Employer side, the statutory floor. Article L. 1226-1 of the French Labour Code gives every employee with one year of service in the company a right to a supplementary allowance, provided the incapacity is evidenced by a medical certificate within 48 hours, the employee is covered by the social security and receives treatment in France, in the European Union or in a State of the European Economic Area. The statutory scale is set by articles D. 1226-1 and D. 1226-2: 90 % of gross pay for the first 30 days, then two thirds for the following 30 days, each period increased by 10 days per complete 5 years of additional service, and never exceeding 90 days. Article D. 1226-3 makes the compensation period run beyond 7 days of absence for non-occupational illness.

Employer side, the collective agreement. A dental practice falls under the national collective agreement for dental practices of 17 January 1992 (IDCC 1619), extended by order of 2 April 1992. Its article 4.1 lists sick pay among the guarantees owed to all employees, whether or not they hold cadre status. Its article 4.2 requires one year of service in the practice and works in net terms: pay maintained at 100 % refers only to net amounts, so that net pay during sick leave is never higher than the net pay the employee would have received while working. In the same spirit, the total of the practice's payments and the social security daily benefits can never exceed the pay the employee would have received while working; beyond that, the disability scheme provided for by the agreement takes over.

The length of the contractual top-up and the applicable waiting period must be read directly in the text of article 4.2 and in the amendment in force, rather than copied: the seniority scale it contains is drafted under the assumption of an occupational accident, which calls for a case-by-case check before a payslip is issued.

What the employer must do, in order. Receive the certificate within 48 hours, file the salary attestation that triggers payment of the daily benefits, decide whether the practice applies subrogation or lets the fund pay the employee directly, apply the contractual top-up, then monitor the total of benefits plus top-up so that it stays below net pay in activity. That last check is the easiest one to skip, all the more so since lowering the calculation base to 1.4 times the SMIC increases the share left to the practice.

A self-employed professional receives daily benefits if five conditions are met, two of which are regularly overlooked:

• be temporarily unable to continue or resume the activity;
• have a prescribed work stoppage;
• have effectively ceased the activity;
• have been affiliated for at least one year at the date of the medical finding of incapacity (art. D. 622-1 of the French Social Security Code): a practitioner set up less than a year ago has no entitlement at all;
• have an average annual professional income of at least 10 % of the average annual social security ceilings of the reference years (art. D. 622-8). Below that floor the benefit is not reduced, it is nil.

Daily sickness benefits start on the 4th day of the work stoppage, that is, after a three-day waiting period during which nothing is paid, and they run for a maximum of 87 consecutive days for the same incapacity (art. D. 622-12 of the French Social Security Code). The calculation is based on 1/730th of the average income used to calculate health insurance contributions over the three previous calendar years (art. D. 622-7), not on the accounting profit. That average income is capped at 3 times the annual social security ceiling, i.e. 144,180 euros in 2026, so the maximum daily benefit is 197.51 euros gross per day (144,180 / 730). The rule comes from the text; the figure follows the ceiling, which is revalued every 1 January.

The CARCDSF relay#

For dental surgeons, the CARCDSF can take over under certain conditions. The fund indicates that daily allowances are paid from the 91st day following the start of the incapacity to exercise, subject in particular to:

• to contribute to the scheme;
• be up to date with your contributions or regularly exempt;
• to remain registered on the roll of the Order;
• to have sent the notice of cessation of activity together with the sick-leave certificate by registered letter with acknowledgement of receipt, no later than within the ninety days following the end of the first ninety days of work stoppage.

The CARCDSF daily benefit is a flat amount: 113.22 euros per day in 2026 for a dental surgeon, whatever the practitioner's income. It is paid monthly and stops after three years, whether continuous or cumulated.

Hayot Expertise Advice: for a self-employed dentist, read the work stoppage with a cash-flow logic, but do not misidentify the risk. The two schemes follow on from each other without a gap, the CPAM from day 4 to day 90 and CARCDSF from day 91: the critical point is not an uncovered window, it is the gap between the benefit paid and usual income, plus the three waiting days and fixed costs that keep running.

A practitioner's sick leave can produce several immediate effects:

• reduction or cessation of fees;
• maintenance of certain fixed charges;
• management of the agenda and reports;
• reorganization of the team;
• recourse or not to a replacement depending on the case.

It is therefore necessary to quickly treat:

• pending collections;
• irreducible expenses;
• communication with patients;
• administrative traceability.

• wait before checking your rights;
• do not distinguish between Health Insurance and CARCDSF coverage;
• confuse the self-employed dentist's scheme with that of an employee of the practice, which is governed by statutory and contractual sick pay;
• underestimate the cash flow gap;
• do not formalise how the practice will run during the leave;
• forget the impact on recurring tax and social filings.

Anticipate the financial and administrative impact of a work stoppage on your practice

Yes. The French Social Security Code expressly lists the dental surgeon among the professionals who may prescribe a work stoppage: article R. 162-1-7-1, created by decree no. 2026-498 of 12 June 2026, refers to work stoppages prescribed by a doctor, a dental surgeon or a midwife.

In practice these are short stoppages, of a few days, following an extraction, oral surgery or an implant placement.

New rule applicable from 1 September 2026. The same article caps the duration of the work stoppages that may be prescribed.

These caps apply to prescriptions and extensions issued on or after 1 September 2026 and do not apply in Mayotte. They are expressed in days, not in months: a 31-day initial stoppage is not the same as one calendar month.

Good practice consists of providing:

• a minimum level of security cash;
• a map of fixed charges;
• a simple procedure in the event of prolonged absence;
• monitoring of rights and coverage;
• a pension review if necessary.

On these points, an accountant for dental practices quantifies the gap between usual income and the benefit actually paid, waiting period included, and sets your provisions before the leave.

For a self-employed dentist, sick leave always has two layers. The first is the Health Insurance layer, with daily allowances that begin after the waiting period. The second is the professional fund layer, which may take over depending on the CARCDSF rules. What matters for the practice's cash flow is how the two schemes fit together.

Who pays what, day by day, for the self-employed dentist#

Since 1 July 2021, there is no longer any uncovered window between day 4 and day 91: the daily benefit scheme for self-employed professionals was created precisely to fill it.

The real cash-flow issue is therefore not an empty window, it is a gap in level: three days with nothing, then a capped benefit, then a flat amount that does not replace turnover in a practice whose fixed costs keep running. Two situations also bring the entitlement down to zero: less than one year of affiliation at the date of the medical finding, and an average annual professional income below 10 % of the average annual social security ceilings of the reference years.

Health Insurance: the basic layer#

The calculation base deserves a close reading. Article D. 622-7 of the French Social Security Code refers to the income used to calculate health insurance contributions, not to the accounting profit of the year. A reducing coefficient applies where contributions have only been partly paid, and a specific calculation exists for the first three years of affiliation. A blank year, three low-income years or a recent set-up therefore weigh directly on the amount of the benefit.

In 2026, you therefore need to look at:

• the start date of the leave;
• the income used for the calculation;
• the actual return-to-work date;
• the cash impact in the current month and the following month.

CARCDSF: the key relay#

The CARCDSF trap is a calendar trap. Entitlement depends on membership of the scheme, contributions being up to date (or a duly granted exemption), continued registration with the professional board, and one precise formality: the notice of cessation of activity, together with the sick-leave certificate, must be sent by registered letter with acknowledgement of receipt within the ninety days following the end of the first ninety days of work stoppage. That deadline runs after the first 90 days, not from the start of the leave: the date to diarise is the day the registered letter goes out, not the first day of the stoppage.

When the dentist stops working, the issue is not only medical. Within hours you need to secure:

• the patient schedule;
• urgent and deferred care;
• fixed costs;
• staff wages;
• rent, loans and subscriptions;
• communication with patients and professional contacts.

A well-run practice does not wait until the following week to organize itself.

Administrative speed is often what separates a manageable leave from a disruptive one. Keep:

• the sick-leave certificate;
• proof of sending it to the fund;
• exchanges with CARCDSF;
• evidence of temporary replacement or closure;
• any documents needed to assess fixed costs.

Depending on the duration, several options are available:

• postpone some treatments;
• arrange a locum;
• hand over admin tasks to a colleague or assistant;
• prioritize urgent procedures;
• inform the accountant and insurer if the activity is heavily impacted.

Hayot Expertise advice: a dentist's sick leave should be managed like a small cash-flow crisis. The faster the preparation, the more readable the practice remains.

A dentist on sick leave should start with one simple habit: keep a trail. Keep the sick-leave certificate, proof of sending it, exchanges with the fund and any documents showing how the practice was organized during the absence. That trail matters for benefits, but also for patient relations and the return to work.

Immediate checklist#

• alert the team and assistants;
• reschedule non-urgent procedures;
• inform the affected patients;
• identify replacement constraints;
• list the fixed costs that will still be due during the leave.

A dentist's leave quickly becomes a cash-flow issue. The practice often still has rent, subscriptions, wages or loan instalments to pay. You therefore need to compare the expected allowance, fixed costs and the possibility of a temporary replacement. Private disability cover can change the balance, but it must be read before the crisis.

What to check with your advisor#

• the amount of unavoidable expenses;
• when the benefits start;
• when the professional fund takes over;
• whether there is supplementary cover;
• the conditions for a locum or temporary closure.

It helps to inform patients, referrers and sometimes the practice's partners, but without unnecessary medical detail. The goal is to protect the practice's image, organize rescheduling and preserve trust. A short, factual message is usually enough.

When sick leave repeats, the issue becomes broader than a simple administrative file. You need to look at the practice model, the dependence on the main practitioner and the site's ability to absorb absences. A one-off leave is manageable. Repeated leaves often call for a real reorganization.

Signs of a weak file#

• no planned replacement;
• late filings;
• poor fund follow-up;
• confusion between personal leave and operating obligations;
• cash flow too tight to absorb several weeks away.

Documents to keep#

• sick-leave certificate and proof of transmission;
• benefit simulation;
• proof of replacement or appointment postponement;
• fixed-cost tracking;
• exchanges with the insurer, the fund and the accountant.

The return matters as much as the leave itself. You should re-prioritize pending appointments, inform patients if the return will be gradual and check that the fund, insurer and practice have all closed the absence period correctly. A poorly prepared return often extends administrative fatigue.

Good return reflexes#

• confirm the return date;
• reclass urgent care and deferred treatment;
• update schedules and reminders;
• do a quick check-in with the accountant and, if needed, the insurer.

The simpler the return, the faster the practice gets back to a readable and profitable rhythm.

After the return, the practice should measure what the leave cost. Tracking deferred fees, postponed care and fixed costs helps prepare for a possible next absence with less improvisation.

Record#

• deferred fees;
• unavoidable expenses;
• the actual return dates;
• the warning signs to watch next time.

On the day you come back, check the agenda, the urgent cases and the cash impact of the leave. A short review with the accountant and the practice team is often enough to make the return cleaner and to avoid carrying unresolved administrative issues into the following month.

A well-managed leave is not only about compensation. It is also about making sure the practice can reopen without friction, with the same documentation trail and the same cash-flow logic still in place.

If the leave is still hard to manage after this review, the practice needs one more pass on cash, scheduling and the handover to the team.

In 2026, the work stoppage of the self-employed dentist must be managed as a global subject: rights to compensation, payment schedule, CARCDSF coverage, continuity of the practice and cash flow tension. The more the framework is prepared in advance, the less the stop disrupts the activity.

Sources: French Social Security Code, art. D. 622-1, D. 622-7, D. 622-8, D. 622-12, R. 162-1-7-1 and R. 323-1; French Labour Code, art. L. 1226-1 and D. 1226-1 to D. 1226-3; national collective agreement for dental practices (IDCC 1619), art. 4.1 and 4.2; decree no. 2026-498 of 12 June 2026; decree no. 2025-160 of 20 February 2025; CARCDSF, daily benefits page.