Chartered accountant for cardiologists

A self-employed cardiologist's accounting is far more than a 2035 tax return filed once a year. With an average net income of EUR 170,766 in 2024 (CARMF statistics, one of the highest in private medicine) and gross fees averaging EUR 394,403 (up to EUR 488,270 in Paris), the real stakes lie in three levers: the choice of convention status (sector 1, sector 2, OPTAM), the legal structure (sole practice, SELARL, SELAS, SPFPL) and the need to anticipate heavy social and pension contributions. Cabinet Hayot Expertise supports cardiologists across Paris and the Île-de-France region along this entire chain.

A generalist accountant treats your practice like a general practitioner's. They miss four features that directly affect your take-home income:

• Splitting your revenue by technical procedure. A cardiologist combines consultations with a significant share of technical procedures coded under the CCAM (echocardiography, stress testing, Holter monitoring). That share changes the whole analysis of your profitability and cash flow.
• The effect of convention status. Whether you are in sector 1, sector 2 or an OPTAM member, your social contribution base, your CARMF coverage and your net margin differ markedly.
• The right time to move into a professional practice company. At a cardiologist's income level, the choice between sole practice and a SELARL or SELAS can save or cost several thousand euros a year.
• The weight of the CARMF. A doctor's pension contributions can exceed EUR 30,000 a year at full charge: they must be provisioned, not endured.

Our firm masters these four dimensions and reasons on your actual disposable income, not just your taxable result.

France had 6,412 cardiologists in practice as of 1 January 2026 (CNOM source), of whom around 4,390 worked in private or mixed practice, more than two in three. That is the core audience of a healthcare-focused accountant.

A cardiologist's economics differ from a GP's on one key point: the share of technical procedures. Beyond the consultation come the electrocardiogram, echocardiography, stress test and Holter monitor, which require technical equipment (echograph, treadmill, recording systems) and generate specific revenue and depreciation. Accounting that only tracks "income minus expenses" misses the real question: how profitable is each activity line once equipment, software and machine time are factored in?

A cardiologist's turnover deserves fine segmentation. The most frequent technical procedures, coded under CCAM version 83 applicable since 1 July 2026, have very different reimbursable tariffs (sector 1 or OPTAM base):

• Resting ECG (electrocardiography on at least 12 leads, code DEQP003): EUR 14.77;
• Transthoracic echocardiography (TTE, code DZQM006): EUR 94.28;
• Stress test (code DKRP004): EUR 76.80;
• Holter ECG (ambulatory recording of at least 24 hours, code DEQP005): EUR 77.01.

Added to this is remote medical monitoring, now reimbursed: the operator fee paid to the physician is, for example, EUR 11 per month per patient for cardiac arrhythmia follow-up and EUR 28 per month for heart failure. These recent and growing flows must be tracked separately.

Rebuilding your revenue by procedure and by family (consultation, imaging, stress procedures, remote monitoring) reveals the true profitability of your activity, flags a coding gap and informs your investment decisions in technical equipment.

Convention status is a structural decision with direct accounting effects. The cardiologist's specific practice consultation (CSC) is set at EUR 47.73 as of 1 January 2026; in sector 1, the cardiologists' coordination surcharge (MCC) of EUR 4.77 brings it to EUR 52.50, the opposable tariff. 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).

Joining 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 between pure sector 2 and OPTAM is not decided on instinct: it is quantified, factoring the effect on your patient base, your contributions and your net income. We build that simulation with you.

In private 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 2035 lets you deduct your actual expenses (rent, equipment, staff, contributions, vehicle costs, royalties) and steer your result.

Our work goes beyond simply producing the return: bank reconciliation, tracking of retroceded fees (deductible subject to reporting under article 240 of the CGI), correct treatment of technical-equipment depreciation, and above all quarterly management review to avoid the double pitfall of the high-income cardiologist: income tax that climbs and cash flow that tightens under contributions called with a lag.

Above a certain profit level, operating 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 salary and steer dividend distribution, instead of being taxed personally on the entire result.

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. This recent change requires rigorous reporting.
• 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/dividend trade-off.

The choice between SELARL and SELAS, and the calibration of salary versus dividends, are decided on a quantified simulation, taking your wealth situation and plans into account.

The cardiologist contributes to the CARMF, the pension fund for private doctors. The 2026 contributions show the charge to provision:

• Basic scheme (CNAVPL): 8.73 % of income up to EUR 48,060, then 1.87 % up to EUR 240,300;
• Supplementary pension scheme (RCV): 11.80 % of income, capped at EUR 168,210, i.e. up to EUR 19,849 in contributions;
• Supplementary old-age allowance (ASV): a flat rate of EUR 5,751 (reduced to EUR 1,917 for a sector 1 doctor, two thirds of which is covered by the health insurance fund), plus a proportional adjustment share;
• Invalidity-death scheme: from EUR 626 to EUR 1,010 depending on income.

At full charge, the total is substantial and is called with a two-year lag relative to income. We provision it in your cash-flow plan to avoid unpleasant surprises, particularly in a year of sharp income growth.

Your care procedures for individuals are VAT-exempt under article 261, 4, 1° of the CGI. This exemption is not absolute: it is reserved for procedures with a therapeutic purpose. Three situations can make you partially liable for VAT:

• medical expert assessments (judicial or insurance-related), subject to VAT because they lack a therapeutic purpose (BOFiP doctrine based on Court of Justice of the European Union case law);
• collaboration royalties received from a colleague to whom you make premises, equipment and patient base available: these are taxable;
• certain comfort or off-nomenclature procedures with no care purpose.

A cardiologist who becomes liable can often stay under the VAT base-exemption threshold as long as this revenue remains below EUR 37,500 (2026 threshold for services). We secure that boundary to avoid any reassessment.

Many cardiologists practise in a clinic or share premises. These flows have precise treatment:

• The royalty paid to the clinic (provision of premises, staff, technical facilities) is in principle subject to VAT on the clinic side; on the cardiologist's side, it is a deductible expense on the 2035, provided it is justified and proportionate to the service rendered.
• The collaboration royalty you receive from a self-employed collaborator is subject to VAT.
• Fees retroceded to a locum, by contrast, are VAT-exempt (care provision), and the royalty linked to an occasional replacement benefits from a non-liability tolerance.

These distinctions, often a source of errors, are handled upfront to secure both your 2035 and your VAT position. The means-pooling company (SCM) you share with colleagues also benefits from the VAT exemption of article 261 B of the CGI on shared-cost reimbursements.

A cardiologist set up as a SELARL or SELAS can hold its shares through an SPFPL (financial holding company for the liberal professions), the holding vehicle of healthcare professions, governed by ordinance no. 2023-77 of 8 February 2023. The benefit: channelling your SEL's dividends up to the holding under the parent-subsidiary regime (article 145 of the CGI), which taxes only a 5 % share of costs and expenses, i.e. a 95 % exemption on dividends received.

This structure lets you build up lightly taxed cash to finance the purchase of your practice premises (via an SCI), a buyout of shares between partners, or to prepare your succession by optimising capital-gains taxation. It is set up at the right time, with an overall wealth view: this is precisely the accounting, tax and wealth articulation we deliver.

A sector 2 cardiologist who is an OPTAM member, based in Paris, generates roughly EUR 420,000 in fees, with a significant share of echocardiography and stress tests. In sole practice, the entire profit was taxed at the marginal rate, and CARMF contributions called with a two-year lag tightened cash flow every growth year.

After a diagnostic review, we quantify a move to a SELARL: a calibrated salary, dividends kept below the 10 % capital threshold, and the creation of an SPFPL to accumulate cash earmarked for buying the practice premises. Target outcome: a smoothed overall tax burden, provisioned contributions and professional wealth being built rather than absorbed by tax. Every situation is specific: this scheme illustrates the approach and is no substitute for prior analysis.