Setting up a medical practice in France: status, tax and management in 2026

Quick answer. Setting up a medical practice in France in 2026 involves three structural decisions: the legal status (sole practitioner under the BNC regime, SELARL, SELAS, SCM or SISA inside a multi-professional health centre), the conventional sector with the French health insurance (sector 1 or 2) and the accounting organisation (form 2035 or corporate income tax). Moving from a BNC to a SEL (liberal professional company) usually becomes worthwhile around 135,000 to 150,000 euros of annual non-commercial profit, subject to simulation. Medical acts with a therapeutic purpose are exempt from VAT under article 261, 4, 1° of the French General Tax Code (CGI).

A French medical practice is not an ordinary commercial business. The activity is governed by the Public Health Code, supervised by the National Council of the Order of Physicians and bound by a specific contractual framework with the national health insurance. Professional secrecy, independence of practice and the prohibition of commercial profit-sharing shape the way the practice can associate, communicate, invest and bill.

Several 2026 developments add to this baseline: the progressive rollout of electronic invoicing for non-medical operations, the steady growth of SISA structures and CPTS networks, a 0.5 percent increase in the CARMF basic pension contribution and an additional adjustment around 1.8 percent announced, and the continuation of the reform on the taxation of remuneration paid to SEL partners. Steering a medical practice in 2026 therefore combines liberal taxation, corporate law of professional companies and the medical convention.

At Hayot Expertise we regularly work with doctors at set-up, restructuring or incorporation stages. Our approach is consistent: secure the legal and tax framework and give the practitioner back protected clinical time.

The legal status drives the tax regime, the liability profile, the ability to associate and the patrimonial strategy. Five structures dominate French liberal medical practice in 2026.

The BNC regime under form 2035 remains the natural entry door for a doctor starting alone. The SELARL and SELAS are liberal professional companies framed by the 31 December 1990 law and the Public Health Code, which require the majority of capital to be held by practitioners actually exercising. The SCM does not share fees: it only pools costs. The SISA is the legal vehicle that supports multi-professional health centres (MSP).

The decision is primarily a tax and patrimonial one. Under the BNC regime, the full profit is taxed at the progressive income tax scale and bears the liberal social contributions. Inside a SELARL, the profit is taxed at corporate income tax (15 percent up to 42,500 euros and 25 percent above), and the doctor then chooses the portion paid as management remuneration and the portion retained or distributed as dividends.

Our observation, across recent files, is that below 135,000 euros of stabilised BNC the saving rarely justifies the extra cost of bookkeeping, balance sheet and payroll. Above that threshold, and especially between 180,000 and 250,000 euros of profit, the combined tax and contributions saving can reach 8,000 to 15,000 euros per year. For a clinic surgeon with strong income and a holding strategy, the SELAS often takes the lead thanks to its statutory flexibility and salaried-equivalent social treatment.

Transferring a BNC into a company can rely on the deferral regime of article 151 octies of the CGI on the contribution capital gain. The deferral applies, subject to conditions, until the shares are sold for non-depreciable assets, while capital gains on depreciable assets are reintegrated into the corporate result over five years (fifteen years for buildings). Our dedicated article on the BNC-to-SELARL move details the step-by-step procedure.

Hayot Expertise tip. Never switch to a SELARL or SELAS on the basis of a single exceptional year. Stabilise the average over three financial years, simulate two or three remuneration scenarios (pure management salary, salary-dividend mix, holding structure) and quantify the exit cost in case of activity cessation. SELARL manager remuneration in 2026 requires yearly arbitrage, not a one-off setting.

The conventional sector shapes both fees and contributions. In sector 1, the doctor applies the agreed contractual tariffs; in exchange, the CPAM (local health insurance fund) covers approximately two thirds of the ASV pension contribution through the fixed and proportional parts, and contributes to the doctor's health insurance contributions. In sector 2, the doctor charges free fees, fully bears the social contributions and can join the OPTAM scheme (controlled-fee option) which restores a part of the patient coverage.

Sector 3 (non-conventional) remains marginal and exposes patients to very limited reimbursement. For most installations in 2026, the meaningful arbitrage lies between sector 1 (with OPTAM-CO when relevant) and sector 2 with OPTAM, depending on the specialty, the location and the target patient profile.

The liberal doctor is affiliated with the CARMF for pension and disability-death coverage, and with the URSSAF for family allowances, CSG-CRDS, the CFP training contribution and the PAMC health insurance regime. The CARMF runs three pension levels:

1. Basic regime: proportional contribution capped at 8.23 percent then 1.87 percent above the annual social security ceiling (PASS), with a 0.5 percent increase announced for 2026.
2. Supplementary pension: proportional to non-salaried income, capped at 3.5 times the PASS.
3. ASV (supplementary old-age allowance): fixed part of around 5,750 euros and a proportional part of 3.8 percent of the contractual income of year N-2, capped at 5 PASS. For sector 1 doctors, the CPAM covers approximately two thirds of this contribution.

A full proportionality option is open to doctors whose 2024 contractual income is below 63,900 euros, with the contribution reduced to 3 percent of income for sector 1 doctors. Add to this the mandatory disability-death cover, which is essential to protect against a prolonged work stoppage.

Care provided to individuals by doctors, dentists, midwives and contracted paramedical professionals is exempt from VAT under article 261, 4, 1° of the CGI. The BOFiP (the official French tax doctrine database) recalls that the exemption requires a therapeutic purpose: prevention, diagnosis, treatment or cure. Aesthetic procedures without therapeutic purpose and not reimbursed by the health insurance fall on the contrary under the standard 20 percent VAT rate. The exemption comes at a cost: VAT incurred on professional purchases (equipment, premises, supplies) cannot be recovered.

A BNC doctor files form 2035 and carries the result to the 2042-C-PRO personal income tax return. Membership of an accredited management association no longer grants the 25 percent uplift since 2023 but remains useful as a prevention tool against tax audits. A SELARL files the 2065 corporate tax return and deposits its accounts at the commercial court. Manager payroll, company-car taxation and CFE complete the filing calendar. Our French-language guide to the BNC 2035 return for 2026 details each line and each adjustment.

Several profiles deviate from the standard pattern.

• Locum doctor: practice under the BNC regime without a dedicated structure, mandatory replacement contract (article R. 4127-65 of the Public Health Code), simplified registration with URSSAF and CARMF from the first act.
• Multi-professional health centre (MSP): health project validated by the regional health agency (ARS), SISA status to collect the ACI forfait payments, pooled coordinator, shared digital tools and team-fee billing.
• SCM: useful between practitioners who share premises and secretarial support without pooling fees; capital calls must be properly documented to avoid the SCM being reclassified as a practice company.
• SPFPL holding: the financial participation company in liberal professions, holding the shares of one or more SELs; relevant for doctors with multiple associates or transmission plans, framed by profession-specific decrees.

For associations between doctors, the drafting of the articles of association, the shareholders' agreement and the practice contracts is a topic in its own right. Our legal advisory engagements for medical practices accompany this structuring beyond simple incorporation.

Five issues recur in the files we take over.

1. Underestimating CARMF contributions in year two, when the regularisation on real income kicks in.
2. Mixing professional and personal expenses, especially on vehicles, telephony and training costs with a mixed purpose.
3. Premature switch to SELARL, decided on an exceptional year, that generates more administrative cost than tax saving.
4. Forgetting to monitor the 151 octies deferral, when the schedule must be attached to each annual return until the shares are sold; an omission triggers immediate taxation of the deferred capital gain.
5. Under-equipped bookkeeping, with late data entry that prevents any meaningful steering of cash and investments.

Liberal profession accounting demands a simple but constant discipline: monthly bank reconciliation, document filing, monitoring of collected fees and provisioning of income tax and contributions.

A SELARL surgeon recently asked us to take over the books of a fast-growing practice. The doctor had spent four years on BNC with profit rising from 110,000 to 220,000 euros. The previous switch to SELARL had been carried out without simulation, on the back of a verbal recommendation. The result: management remuneration set too high, dividends barely used, no cash-flow steering inside the SELARL and the 151 octies deferral forgotten at the contribution date.

Our work covered three priorities. Rebuilding the contribution capital gain and regularising the 151 octies schedule, redesigning a salary-dividend arbitrage that reduces the global tax and social cost by about 11,000 euros per year, and installing a monthly dashboard tracking turnover, fixed costs and available cash. Over two financial years, the cumulative saving covered several times the cost of the engagement.

The takeaway is straightforward: in a medical practice the tax advantage is never the only criterion. It must be combined with income visibility, the practitioner's social protection and the ability to invest in equipment and digital tools without draining cash.

Hayot Expertise tip. Before any status change or heavy investment, ask for a quantified simulation over three scenarios. The right status is not the one that saves the most tax in a given year, but the one that secures income, retirement and transmission over a ten-year horizon. Our Paris 8 chartered accountant engagement systematically starts with that documented comparison.

• The choice of status (BNC, SELARL, SELAS, SCM, SISA) drives taxation, social contributions and the ability to associate.
• The switch to a SEL becomes economically worthwhile around 135,000 to 150,000 euros of stabilised BNC, to be confirmed by simulation.
• Medical acts with a therapeutic purpose are exempt from VAT (CGI art. 261, 4, 1°), with no VAT recovery on purchases.
• The CARMF runs three pension levels and the ASV is partly covered by the CPAM for sector 1 doctors.
• A SEL contribution can benefit from the 151 octies deferral, which must be monitored each year.
• A SISA enables a multi-professional health centre to collect health insurance forfait payments after ARS validation of the health project.