Self-employed cardiologist: BNC, excess fees and the move to a SELARL

With an average net income of EUR 170,766 in 2024 according to CARMF statistics, and gross fees averaging EUR 394,403 nationally (up to EUR 488,270 in Paris), the self-employed cardiologist is among the practitioners for whom management decisions carry the most weight. At this income level, a poorly chosen structure or a badly arbitrated convention status does not cost a few hundred euros: it costs thousands of euros every year. Three decisions shape your actual disposable income: the choice of convention status (sector 1, sector 2, OPTAM), the investment policy for your technical equipment and the legal form of your practice. This article reviews them, from the starting BNC framework through to the move into a SELARL.

In sole practice, your fees fall under non-commercial profits (BNC) and the 2035 return, under the controlled-declaration regime. At a cardiologist's revenue level, the micro-BNC regime is almost always ruled out: the controlled declaration lets you deduct your actual expenses (rent, equipment, staff, contributions, vehicle costs, royalties) and steer your result instead of enduring it.

Two points deserve particular attention from this stage onwards:

• Retroceded fees. If you work with a locum or a collaborator, retrocessions are deductible subject to reporting under article 240 of the CGI. A reporting omission can call the deduction into question.
• VAT. Your care procedures are exempt under article 261, 4, 1° of the CGI, but the exemption is reserved for procedures with a therapeutic purpose. Medical expert assessments and collaboration royalties received from a colleague are taxable. As long as this ancillary revenue stays below EUR 37,500 (the 2026 threshold for services), the base exemption spares you from charging VAT, but the boundary must be monitored.

Finally, the real difficulty of high-income BNC is not the return itself: it is the lag between the year you collect and the year tax and contributions are called. Without a management review during the year, cash flow tightens precisely when activity grows.

A cardiologist's economic model differs from a general practitioner's in the share of technical procedures. Beyond the consultation come the electrocardiogram, echocardiography, the stress test and the Holter monitor, which rely on technical equipment: an echograph, a treadmill, recording systems. This equipment has two direct accounting consequences.

First, it is depreciated. Each piece of equipment is capitalised and deducted over its useful life, which smooths the expense over time but requires rigorous tracking of fixed assets: commissioning dates, depreciation periods, asset disposals on renewal. Poorly calibrated depreciation distorts both your taxable result and your view of profitability.

Second, it calls for reading your turnover by activity line. Technical procedures coded under CCAM version 83, applicable since 1 July 2026, have very different opposable tariffs: EUR 14.77 for the resting ECG (DEQP003), EUR 94.28 for transthoracic echocardiography (DZQM006), EUR 76.80 for the stress test (DKRP004), EUR 77.01 for the Holter ECG (DEQP005). Remote monitoring fees are added, for example EUR 11 per month per patient for arrhythmia follow-up and EUR 28 for heart failure.

The management question is therefore not "how much did I collect?" but "what does each family of procedures yield once equipment, software and machine time are factored in?". This breakdown is what allows you to decide rationally on renewing an echograph or opening a new activity line such as remote monitoring, rather than investing on instinct.

Convention status is the most structural decision of your practice. In sector 1, you apply the opposable tariffs: the cardiologist's specific consultation (CSC) is set at EUR 47.73 as of 1 January 2026, brought to EUR 52.50 with the coordination surcharge (MCC) of EUR 4.77. In sector 2, your fees are free: in 2024, 30.6 % of cardiologists practised in sector 2, with an average excess-fee rate of 21.6 % nationally, and up to EUR 143,393 in average excess fees per practitioner in Paris.

Between the two, the OPTAM (controlled-tariff practice option) commits you to a capped excess-fee rate and a minimum share of activity at the opposable tariff, in exchange for a better reimbursement base for your patients and partial coverage of your contributions by the health insurance fund.

The trade-off cannot be reduced to comparing headline tariffs. You must factor in the effect on your patient base (out-of-pocket costs influence patient recruitment and loyalty), on your social contribution base and on your final net income. A higher excess fee in pure sector 2 can be partly absorbed by less well-covered contributions; conversely, the OPTAM can secure a volume of activity at the price of a cap on excess fees. This decision is quantified through simulation, not instinct, and is revisited when your activity or patient base changes.

Above a certain profit level, practising through a professional practice company (SELARL or SELAS) becomes a genuine lever. The principle: the company is subject to corporate income tax (15 % up to EUR 42,500 of profit, 25 % beyond), you pay yourself a calibrated salary and you steer dividend distribution, instead of being taxed personally, at your marginal rate, on the entire result.

The right indicator is not a magic turnover threshold: it is the lasting gap between your profit and your living needs. As long as you consume most of what you earn, the company brings little. As soon as you generate a significant surplus each year that you do not use, the SELARL lets you capitalise it at corporate tax rates rather than see it absorbed by the personal income tax scale.

Two points of vigilance, often mishandled:

• Since the taxation of 2024 income, the technical remuneration received by SEL partners for their private activity is taxed as BNC, no longer as salaries, with a dedicated 2035 return per partner. Moving into a company therefore does not take you out of BNC: it adds a reporting layer that must be organised from the first year.
• A SELARL majority manager has self-employed (TNS) status. The share of dividends exceeding 10 % of share capital (premiums and current account included) is subject to TNS social contributions, which changes the salary versus dividend trade-off.

Further down the line, for the cardiologist already in a SEL, the SPFPL (governed by ordinance no. 2023-77 of 8 February 2023) allows dividends to flow up under the parent-subsidiary regime of article 145 of the CGI, with a share of costs and expenses of only 5 %, i.e. a 95 % exemption. The cash thus accumulated can finance the practice premises via an SCI or prepare a transfer of the practice. But the SPFPL is a second-stage building block: it only makes sense once the SEL is in place and the cash surplus is proven.

The cardiologist contributes to the CARMF, the pension fund for private doctors, and the burden is heavy: at full charge, a doctor's pension contributions can exceed EUR 30,000 a year. Above all, they are called with a two-year lag relative to income. In practice, in the year your activity grows sharply, you are still paying contributions based on earlier, lower income; two years later, the catch-up arrives, often when you no longer expect it.

The answer is an accounting one before it is a tax one: provision the CARMF in the cash-flow plan in the year the income is earned, not the year the call arrives. This is especially true in transition phases (setting up, changing sector, moving into a SEL), when contribution bases shift. Convention status also affects this item: part of a sector 1 doctor's contributions is covered by the health insurance fund, which must feed into the sector 1 / sector 2 / OPTAM trade-off discussed above.

Some situations justify not facing these decisions alone: setting up or joining a group practice, a contemplated change of convention status, a heavy investment in technical equipment, a profit that lastingly exceeds your living needs, a plan to buy the practice premises or a transfer to prepare. In each of these cases, the right answer depends on your own figures, not on a general rule.

A chartered accountant for cardiologists provides exactly that: the breakdown of your revenue by procedure, a documented trade-off on convention status, a simulation of the move to a SELARL and the provisioning of contributions in a cash-flow plan. Cabinet Hayot Expertise, based in the 8th arrondissement of Paris and working on Pennylane, supports self-employed cardiologists along this entire chain, with a response within 24 to 48 hours. The right time to ask these questions is not at year-end closing: it is now, while the decisions are still open.