Sector-2 doctor: extra fees, CSG and contributions in 2026

Quick answer. A sector-2 doctor in France charges free fees: their fee overruns are fully taxable receipts, subject to social contributions and to CSG-CRDS at 9.70%. Unlike sector 1, the health insurance fund does not cover their contributions, except where they join OPTAM, which caps overruns in exchange for a share of contributions being covered.

The choice of convention sector is not just a question of the rates shown in the waiting room. For a sector-2 doctor, it governs the whole social and tax balance of the practice: the taxable base, the weight of contributions, and the trade-off around OPTAM. Pricing freedom has a counterpart that many discover at the first contribution call.

This guide details the treatment of a sector-2 doctor's fee overruns, the mechanics of CSG-CRDS and the contributions they bear, and the concrete role of OPTAM. It is intended for doctors established in sector 2 as well as those still hesitating over their convention status.

In sector 1, the doctor applies the regulated fee set by the convention. In return for this pricing moderation, the health insurance fund covers a large share of their social contributions, notably the health contribution and a fraction of the old-age benefit.

In sector 2, the doctor charges free fees: they can invoice overruns, with tact and restraint. But this freedom is paid for. Outside any specific scheme, the health insurance fund does not cover their social contributions: the practitioner bears the whole, where their sector-1 colleague benefits from co-financing.

The consequence is often counter-intuitive: at equal receipts, a sector-2 doctor outside OPTAM bears markedly heavier social charges than a sector-1 doctor. The overrun is therefore not net income: it is charged income.

The fee overrun is in no way an exempt supplement. It is a professional receipt, included in non-commercial profits, taxed like the rest of the activity and subject to the same contributions.

A doctor who invoices a consultation at 55 euros, where the regulated fee is 30 euros, does not receive 25 euros of net overrun. Those 25 euros enter their taxable profit, bear income tax at their marginal bracket, social contributions and CSG-CRDS. On a practice built on overruns, it is the gap between the displayed figure and the income actually available that surprises.

The ethics rule also frames these overruns: they must be set with tact and restraint, taking the patient's situation into account. Sector 2 is not absolute pricing freedom, but a freedom framed by ethics and, for OPTAM members, by contractual commitments.

The structure of a sector-2 doctor's levies combines CSG-CRDS, the contributions of the general self-employed scheme and the specific contributions of the doctors' pension fund. The difference with sector 1 plays out mainly on coverage.

CSG-CRDS is set at 9.70%, that is 9.20% of CSG and 0.50% of CRDS, with part of the CSG remaining deductible from taxable income. It strikes the whole of activity income, overruns included, and makes no difference between sector 1 and sector 2.

The gap comes from the coverage of health contributions and of the old-age benefit, reserved essentially for sector 1. For sector 2 outside OPTAM, these contributions remain borne by the practitioner, which markedly increases the overall levy rate.

OPTAM, the controlled-pricing option, is offered by the health insurance fund to sector-2 doctors. The principle is an exchange: the doctor commits to moderating their overruns, within contractual rates, and in return benefits from the fund covering part of their social contributions.

Membership has three concrete effects. For the doctor, part of the social contributions is covered, bringing their regime closer to sector 1. For their patients, the reimbursement base of the health insurance fund is that of sector 1, which reduces their remaining cost and makes the practice more accessible. In return, the practitioner commits to an average overrun rate and a per-act ceiling.

OPTAM is therefore not a mere formality: it is a trade-off between pricing freedom and lighter charges. For a doctor whose overruns stay moderate, the option is often favourable. For one whose activity rests on high overruns, the calculation deserves to be set out precisely.

Take a sector-2 doctor who carries out 4,000 consultations in the year, invoiced at 55 euros each, where the regulated fee is 30 euros. Their turnover reaches 220,000 euros, of which 100,000 euros for overruns, at 25 euros per consultation.

Those 100,000 euros of overruns are not net income. They enter the taxable profit, bear income tax, social contributions and CSG-CRDS at 9.70%. Outside OPTAM, the absence of coverage of health contributions and the old-age benefit weighs on the whole, overruns included, and widens the gap with a sector-1 colleague at similar receipts.

By joining OPTAM, this doctor would accept to cap their overruns, for example by bringing part of their acts closer to the regulated fee, in exchange for the fund covering part of their contributions and a better reimbursement for their patients. Over a 30-year career, the cumulative effect of this trade-off runs into tens of thousands of euros, one way or the other depending on the activity profile.

The amounts above illustrate the method and must be adjusted to your patient base and your actual fees.

The first mistake of a sector-2 doctor is to reason on the displayed fee rather than on income net of charges. An overrun of 25 euros per consultation is not a 25-euro gain: it is charged income, a significant part of which goes back out in contributions and tax. Until this reasoning is integrated, cash flow holds surprises.

Our recommendation is to cost the OPTAM trade-off case by case, weighing the shortfall on capped overruns against the saving in contributions and the added accessibility for patients. This calculation, specific to each practice, cannot be guessed: it must be set out, overrun by overrun and year by year.

A specialist established in sector 2 had built their whole practice on high overruns, without ever weighing OPTAM membership. Over the years, the weight of unsubsidised contributions had eaten into their available income far more than they imagined, and their patient base was shrinking under a deterrent remaining cost. By rebuilding their income statement and simulating the OPTAM option, the trade-off turned out more balanced than expected: a measured moderation of overruns opened coverage of contributions and widened patient access. The reflection connects to the levers described in our tax regime of the self-employed doctor.

The lesson is simple: sector 2 is not steered by the fee, but by net income and accessibility.

Beyond convention status, a high-earning sector-2 doctor often wonders about practising through a SELARL. Moving to corporate income tax allows arbitrating between remuneration and dividends, smoothing the social base and capitalising within the structure. But the interest depends on the income level, personal cash needs and the transfer horizon.

This structure trade-off overlays the OPTAM trade-off, without replacing it: convention status determines receipts and contributions, the form of practice organises their taxation. The two are decided together, never in isolation.

• Sector 2 opens free fees, but overruns are fully taxable and charged.
• The health insurance fund does not cover sector-2 contributions, except where joining OPTAM.
• CSG-CRDS is 9.70% on all activity income, overruns included.
• The old-age benefit remains fully borne by the sector-2 doctor outside OPTAM.
• OPTAM caps overruns in exchange for covering part of the contributions and a better patient reimbursement.
• The OPTAM trade-off and the choice of a SELARL are costed case by case, never on the displayed fee alone.