Surgeon: SELARL or sole practice, the optimal tax structure

Quick answer. For a surgeon, the optimal tax structure comes down to a choice between sole practice under non-commercial profits (BNC) and a SELARL subject to corporate income tax. Sole practice is simple but taxes the whole profit at your marginal rate. The SELARL lets you steer salary and dividends, depreciate equipment and smooth the tax bill, at the cost of more formalities.

You are a surgeon and your fees are rising: the structure question returns at every year-end. Should you stay in sole practice, simpler, or set up a SELARL to steer your taxation? This choice drives your current tax, your social contributions, the depreciation of your technical platform and, in time, the transmission of your professional assets. Let us compare the two paths on concrete criteria.

The self-employed surgeon chooses between two main paths, which answer different goals.

Sole practice means working in your own name, under the non-commercial profits (BNC) regime. The profit is taxed each year at the progressive income-tax scale, at your marginal rate, whether you drew it or left it in the business account.

The SELARL (limited-liability professional practice company) places your activity in a company subject to corporate income tax. You become manager and partner: you receive a salary and, where relevant, dividends. This structure separates the company's result from what you actually receive, opening tax steering that is impossible in sole practice.

In your own name, the surgeon keeps cash-basis accounts and files a 2035 return. The net profit is added to your other income and taxed on the progressive income-tax scale, up to 45 % in the highest bracket, plus the compulsory social contributions to the CARMF and URSSAF.

The advantage is clarity: no company to run, no general meeting, lighter accounting duties. The drawback is that no lever exists to defer tax. If you generate 200,000 EUR of profit but use only 120,000 EUR, you are still taxed on 200,000 EUR. For a surgeon with high fees, this lack of steering quickly becomes costly, as we see in our business tax optimisation files.

The SELARL changes things. The company is taxed on its profit at corporate income tax: 15 % up to 42,500 EUR of profit, then 25 % beyond (CGI art. 219 I-b). Your manager's salary is deductible from the company's result, which reduces the corporate-tax base.

You then arbitrate between two channels to pay yourself. Salary bears the social contributions of a self-employed worker, but opens pension and protection rights. Dividends are distributed after corporate tax and bear the single flat-rate levy of 31.4 % (12.8 % income tax and 18.6 % social levies in 2026).

A point of vigilance specific to SELs: the share of dividends exceeding 10 % of the share capital, issue premiums and partner current-account balances is subject to self-employed social contributions, not only to social levies. The trade-off between salary and dividends must therefore be prepared carefully, as we detail for any dividend distribution.

A major change concerns all SEL partners, surgeons included. Since the taxation of 2024 income, the remuneration received for the liberal activity (the technical care activity) is no longer taxed as a salary, but in the BNC category. Only the remuneration of the management office remains taxed as wages.

In practice, the surgeon partner of a SELARL now declares technical remuneration under BNC, with the possibility of deducting actual professional expenses, but without the 10 % allowance of employees. This reclassification, from tax doctrine, requires reviewing the split between technical remuneration and management remuneration, and keeping suitable accounts. This is a matter we secure systematically in our business tax work.

The surgeon's care acts are in principle VAT-exempt. The 1° of 4 of article 261 of the CGI exempts care services to the person provided by members of regulated medical professions, where they pursue a therapeutic aim.

The trap concerns cosmetic surgery. Under tax doctrine, only cosmetic acts pursuing a recognised therapeutic aim remain exempt. Cosmetic surgery acts not reimbursed by social security, whose therapeutic use is not recognised by the French health authority, are subject to VAT at the standard 20 % rate. A plastic surgeon performing a significant share of purely cosmetic acts may therefore exceed the base-exemption threshold and become liable for VAT on that part of their activity, while staying exempt on their therapeutic acts.

Whatever the structure, surgical equipment is depreciated. An instrumentation set, an operating microscope, an imaging device or sterilisation equipment are heavy investments deducted over their useful life, often 5 to 10 years depending on the equipment.

In sole practice, these depreciations reduce the BNC profit on the 2035. In a SELARL, they reduce the result subject to corporate tax. In both cases, steering the investment and its financing (purchase, loan, leasing) directly affects the tax. This is a point we quantify with the surgeon as part of our support to health and liberal professions.

In most surgeons' files, the shift to a SELARL is justified once the profit durably exceeds the remuneration actually consumed. As long as you draw all your profit to live, sole practice stays relevant: it avoids needless formalities.

The real trigger for the SELARL is saving capacity. If each year you leave a significant share of your profit in the professional tool, sole practice makes you pay full tax on sums you do not consume. The SELARL then lets you tax that share at 15 % or 25 % corporate tax, then distribute it later, at the chosen time. The shift of technical remuneration to BNC since 2024 reduces a historic SEL advantage, but does not reverse the trade-off: steering the result remains the heart of the matter.

A surgeon we support generated 230,000 EUR of annual profit in sole practice, while consuming only 140,000 EUR for their lifestyle. The 90,000 EUR of annual savings were taxed at the marginal bracket of 41 %, nearly 37,000 EUR of tax on a sum left in the account. After setting up a SELARL, this saving was taxed at corporate rate, 15 % up to 42,500 EUR then 25 % beyond, an immediate cost far lower. The cash thus preserved financed over 3 years the renewal of the technical platform, depreciated on the balance sheet. The salary-dividend trade-off was calibrated to stay below the 10 % of capital threshold, to limit social contributions on distributions.