Medical practice financial KPIs in Paris in 2026: the liberal physician's dashboard

Updated 12 May 2026. A liberal medical practice in Paris does not follow the same financial mechanics as a classic small services business. Revenues blend mandatory health insurance fees (AMO), complementary health insurance shares (AMC), pay-for-performance (ROSP), the forfait médecin traitant, possible balance-billing (sector 2), CPTS allocations, sometimes locum-tenens fees. Costs combine rent, medical assistant, secretarial staff, equipment, URSSAF PAM, CARMF, ASV and Madelin contracts. Without a monthly dashboard, the disposable income only becomes visible upon filing the 2035 return — too late to adjust. At Cabinet Hayot Expertise in Paris, we pilot this mechanic for physicians in both sector 1 and sector 2, and for SCM or SELARL groupings. This article maps the KPIs to track, their 2026 targets and the operational trade-offs that follow.

Three streams of revenue not to confuse: AMO, AMC, off-schedule#

A medical practice's revenue comes from three distinct streams. The AMO share (mandatory health insurance) covers the CCAM/NGAP conventional rate reimbursed by Social Security, typically at 70% of the base rate. The AMC share (complementary insurance) covers the patient co-payment, collected via third-party-payer complementary flows (Almerys, Viamedis, Santéclair, etc.) or directly from the patient. Off-schedule covers non-reimbursable acts, sector-2 balance-billing and non-conventional fees. On a sector-1 practice in Paris, the typical distribution we observe at Cabinet Hayot Expertise is around 60-70% AMO, 25-35% AMC, with the remainder paid directly by the patient.

ROSP, médecin traitant fee and CPTS: revenue uncoupled from acts#

Alongside acts, the médecin traitant (treating physician) receives the ROSP (Pay-for-Performance based on Public Health Objectives) — approximately €7,000 to €12,000 per year depending on patient list and achievement of HAS-defined targets — plus a forfait médecin traitant of about €46 per declared patient (indicative 2026 amount; verify on ameli.fr as it is periodically revised). CPTS (Territorial Professional Health Communities) can pay allocations to their members for care coordination, unscheduled access to care and prevention. These act-uncoupled flows often represent 8-15% of a sector-1 general practitioner's turnover and stabilise monthly income.

Sector 1, sector 2, OPTAM: three pricing grids, three practice profiles#

Sector 1 strictly applies the conventional rate — for example €26.50 for a general practice consultation in 2026 (2025 rate carried over, subject to medical convention adjustments). Sector 2 allows balance-billing with "tact and measure". OPTAM (Controlled Pricing Practice Option) caps these excesses in exchange for AMO coverage on the base rate. The financial profile differs radically: a sector-2 OPTAM cardiologist in Paris 16 can show an average fee per act 1.5 to 2 times higher than a sector-1 colleague, but with a much smaller third-party-payer share and a different DSO.

Account 706 and fee retrocessions (account 622)#

In BNC accounting, fees collected are recorded in account 706. Retrocessions paid to a locum or liberal collaborator are recorded in account 622 "Remuneration of intermediaries and fees". The "net fees" KPI is calculated as 706 − 622. It is this line — not gross fees — that serves as the basis for measuring the practice's real economic performance and productivity per practitioner. A practice generating €280,000 in 706 but €70,000 in 622 (25% of the time covered by a locum) is in reality piloting €210,000 in net fees.

2026 target for a sector-1 GP in Paris#

Based on URSSAF PAM and CARMF data, a sector-1 general practitioner working full-time in Paris typically shows €180,000 to €240,000 in annual net fees before professional expenses, i.e. €15,000 to €20,000 per month. A sector-2 OPTAM specialist can exceed €350,000 net. Below €150,000 in annual net fees on full-time activity, there is either an agenda-filling issue (KPI 2), an excessive retrocession issue, or an insufficient act-coding issue — each requiring a different trade-off.

Monthly reading: 706 flow vs actual collected cash#

Beware the trap: BNC accounting is on a cash basis (article 99 of the CGI, journal of professional receipts). Fees are recorded on the date of effective collection, not the date of the act. A 28-day month followed by a month with two public holidays can show very uneven 706 amounts without actual productivity having changed. The KPI to track is therefore "average fees collected smoothed over 3 rolling months", not the dry monthly gross.

Calculating the fill rate#

Fill rate = (slots actually consumed / slots opened) × 100. An 8-hour day with 20-minute slots offers 24 potential acts; if 21 are actually performed, the rate is 87.5%. On Doctolib or Maiia, the data is extracted directly. On paper agenda or Hellodoc, the calculation is manual but essential. A healthy target for a general practitioner in Paris sits between 85% and 92%; above 95%, the practice is undersized and the physician compensates by lengthening the day; below 80%, there is a patient-list or coding issue.

No-show: the underestimated KPI costing 4 to 12% of turnover#

The no-show rate (appointment not honoured without prior cancellation) ranges in liberal practice between 5% and 15% depending on specialty and online booking method. At 10% no-show on 24 slots/day at €26.50 each, the annual loss represents approximately €13,000 to €15,000 in unbilled fees for a practice working 200 days a year. Monthly tracking and implementing a cancellation policy (SMS reminder, no-show fees compliant with the medical convention) is one of the fastest levers to activate.

Average duration per act: a coding proxy#

Average consultation duration is a useful proxy: 15 minutes for a short GP act, 25-30 minutes for an extended or follow-up consultation, 45 minutes for an annual prevention visit. If actual average duration diverges sustainably from the billed duration (for example, long consultations billed as simple consultations), there is a coding issue to investigate, in strict compliance with the NGAP and CCAM.

Why monitor this ratio monthly#

The AMO/AMC ratio reflects patient profile and pricing structure. A sustained imbalance can signal exposure to third-party-payer risk, a patient profile shift or coding drift. Concretely, on €100 collected in sector 1 excluding balance-billing, the target distribution is around €70 AMO, €30 AMC. A month at €80 AMO / €20 AMC may reflect a suspension of complementary flow (OCAM technical issue), a temporary under-collection that will be made up the following month — but must be piloted rather than endured.

Identifying flow by OCAM and reconciling#

The operational stake is to identify the incoming flow by OCAM (Almerys, Viamedis, Santéclair, Cegedim Santé, etc.) and reconcile it with the transmitted acts. A sustained gap between transmitted acts and collected flow signals a rejection, generally for rights or coding error. Monthly reconciliation prevents accumulation of unrecovered receivables and preserves the evidential value of accounts in case of audit. For the detailed procedure and frequent accounting errors, we refer to our dedicated article common accounting errors of liberal physicians in 2026.

Sector 2: a different AMO/AMC ratio#

In sector 2, the AMO share remains capped at the base rate (for example €23 on a cardiology consultation billed at €75). The AMO/AMC ratio loses meaning in isolation: it is the "reimbursable / balance-billing" ratio that should be tracked, while monitoring the evolution of the share of patients under responsible contracts.

Standard delay and vigilance window#

Generalised third-party-payer applies short delays: 7 to 10 days in practice for transmitted AMO flow (Sesam-Vitale FSE), 10 to 20 days for AMC flow depending on OCAM. A well-managed practice's medical DSO is therefore between 8 and 15 days on a weighted average. Beyond 25 days, there is an issue — uncorrected rejections, suspended complementary flow, defective FSE. The KPI to track is therefore "third-party-payer outstanding in days of fees", calculated at the end of each month.

How to calculate your medical DSO concretely#

Medical DSO = (third-party-payer receivables at closing / average monthly transmitted fees over the last 3 months) × 30. For a practice at €18,000 in monthly transmitted fees, end-of-month outstanding of €9,000 gives a DSO of 15 days — healthy. Outstanding of €20,000 gives a DSO of 33 days and calls for immediate action: rejection extraction in the practice software, reprocessing of erroneous FSE, OCAM follow-up if necessary.

Impact on the practice's working capital#

A medical practice's working capital requirement is generally low (little inventory, few client receivables outside third-party-payer) — but becomes significant as soon as a practice employs several medical assistants or administrative staff in charge of billing. A DSO that slips from 10 to 25 days on a practice with €250,000 in annual fees represents approximately €10,000 in tied-up cash — the equivalent of one month of URSSAF contributions.

Breakdown of professional charges of a solo medical practice in Paris#

For a solo medical practice in Paris in 2026, deductible BNC professional expenses are typically distributed as follows on a volume of €200,000 in net fees:

• Rent + rental charges: €18,000 to €30,000 (25-40 m² practice in Paris 8, 15, 16, 17)
• Staff (medical secretary or medical assistant): €15,000 to €45,000 fully loaded
• URSSAF PAM contributions: ~12 to 14% of net fees (health insurance, family allowances, CSG/CRDS, FAF-PM)
• CARMF (basic pension, supplementary, ASV, disability-death): ~9 to 11% of net fees, with an annual cap
• Medical equipment (depreciation): variable, 2 to 8% depending on specialty
• Professional liability insurance, banking, accounting, practice software, training, transmission: 4 to 6%

Typical total: 35 to 45% for a solo practice, 45 to 55% for a practice with a full-time medical assistant.

Above 50%: a re-framing signal#

Above 50% of charges over fees for a classic solo practice (excluding heavy techniques), there is an issue: off-market rent, administrative over-staffing, over-equipment not properly amortised, or insufficient coding. Each calls for a different trade-off that we investigate case by case at Cabinet Hayot Expertise in Paris. The very structure of the BNC vs SELARL regime may be at stake — this is the subject of our article physician tax regime in 2026.

Medical equipment depreciation: useful lives#

Equipment depreciation is practised over the technical useful life: 5 to 7 years for an ultrasound, 8 to 10 years for an MRI or scanner, 4 years for office furniture, 3 years for IT equipment. The BNC regime, unlike corporate tax, does not allow declining-balance depreciation except by formal election; the straight-line method is the rule.

URSSAF PAM: health insurance, allowances, CSG/CRDS, FAF-PM#

Conventional liberal physicians fall under URSSAF PAM (Practitioners and Medical Auxiliaries). 2026 contributions include health-maternity insurance (rate varying by conventional sector, partially covered by Health Insurance for sector-1 and OPTAM physicians), family allowances, CSG-CRDS on activity and replacement income, the contribution to regional unions (CURPS) and the professional training contribution (FAF-PM). The overall URSSAF PAM envelope classically represents 12 to 14% of net fees for a sector-1 conventional physician — 2026 rates to be verified directly on urssaf.fr as they evolve annually.

CARMF: basic pension, supplementary, ASV, disability-death#

CARMF levies four contributions: a basic regime proportional to income (T1/T2 rates on PASS brackets), a supplementary pension regime, the Supplementary Old-Age Allowances regime (ASV) — partially financed by the medical convention for sector 1 and OPTAM — and the disability-death regime. The total represents approximately 9 to 11% of net fees on a full year, capped by the fund's parameters. CARMF calls are based on N-2 income then regularised in N+1 — a classic cash trap for the newly-installed physician who underestimates the year-3 regularisation.

Cash smoothing: provisioning 22-25% each month#

The operational KPI at Cabinet Hayot Expertise for a Paris-based liberal physician: provision monthly 22 to 25% of net fees in a dedicated social charges account. This discipline avoids the regularisation shock at 18 months and smooths cash. It is complemented by a monthly income tax provision calibrated to the probable marginal rate (24% to 41% depending on the household).

2026 Madelin retirement cap#

The Madelin retirement deduction cap for 2026 amounts (for a BNC) to 10% of taxable profit capped at 8 PASS, increased by 15% of the profit fraction between 1 and 8 PASS. The 2026 PASS is €47,100 (2025 value carried over, to be confirmed upon publication of the annual decree). The maximum theoretical Madelin retirement cap therefore stands around €85,000 on a high-profit BNC, but in practice most physicians deduct €8,000 to €18,000/year. Since 2019, the PER (Retirement Savings Plan) has absorbed part of the Madelin contracts but the cap mechanic remains comparable.

Madelin contingency and health insurance#

Beyond retirement, the Madelin contingency contract (daily allowances, disability, death) and the Madelin health insurance are deductible within specific caps. The trade-off between Madelin contributions and disposable income must be conducted each year ahead of closing, based on forecast profit — one of the most value-creating pilot acts we instruct on medical files in Paris.

Articulation with CARMF contribution gap#

Warning: Madelin contributions come in addition to mandatory CARMF contributions, not as a substitute. A physician who caps CARMF on the minimum class must be aware that mandatory pension will be under-funded, and calibrate Madelin retirement accordingly.

The 10 minimum indicators to receive each month#

At Cabinet Hayot Expertise, the monthly dashboard of a Paris-based liberal medical practice covers 10 indicators: (1) gross fees 706, (2) retrocessions 622 and net fees, (3) AMO / AMC / direct patient flow, (4) third-party-payer DSO, (5) agenda fill rate and no-show rate, (6) fixed monthly charges, (7) variable charges, (8) social charges provisioned vs called, (9) available cash and provisioned cash, (10) rolling 12-month monthly BNC result.

Rhythm and tools#

Target rhythm is monthly for financial KPIs, weekly for fill rate and no-show (Doctolib/Maiia extraction), quarterly for Madelin/CARMF/income tax trade-off review. On the tooling side, an export from the practice software (Hellodoc, Médistory, Weda, MonLogicielMédical, Maiia) combined with real-time accounting kept by your accountant is enough — value is not in the tool but in the regularity of analysis.

BNC accounting articulation#

The monthly dashboard remains consistent with BNC accounting obligations (articles 96 and 99 of the CGI): journal of professional receipts, asset register, annual 2035 return. The 2035 controlled declaration is mandatory above €78,580 in receipts in 2026 (indicative micro-BNC threshold, to be confirmed at the 2026 Finance Law), which covers the overwhelming majority of Paris-installed physicians. For the detail of VAT questions on aesthetic vs therapeutic acts, see our article physician VAT and invoicing in 2026.

Three priority KPIs we insist on#

On the liberal physician files we support in Paris, three KPIs concentrate 80% of pilot value:

1. 3-month-smoothed net fees (706 − 622): the only true productivity measure, excluding calendar effects and locum periods.
2. Professional expenses / net fees ratio: target 35-45% for a solo, 45-55% with assistant. Any sustained drift is a signal.
3. Monthly social charges provision: 22 to 25% of net fees segregated monthly. The only discipline that protects against the N+2 regularisation shock.

The classic newly-installed trap#

The recurring trap we observe at Cabinet Hayot Expertise on the first years of installation: underestimating the year-3 CARMF + URSSAF regularisation, because initial calls are calibrated on flat rates or near-zero N-2 income. Without monthly provisioning, the physician finds themselves at 18 months with a cumulative call of €25,000 to €40,000 to pay within a few months. Our outsourced CFO service intervenes precisely on this cash sequencing during the first three installation years.

Towards strategic piloting: considering SELARL at the right moment#