Certified Medical Accountant, Cabinet Hayot Expertise

In 2026, private doctors (general practitioners, specialists, sector 1, 2 or 3) face increasingly complex tax, social and asset challenges. Between the 2035 declaration (BNC regime), CARMF and URSSAF contributions, the transition to SELARL/SELAS, and remuneration optimization, medical accounting is no improvisation. Cabinet Hayot Expertise is the specialized chartered accountant for doctors in Paris who supports your medical practice in all its dimensions: accounting, taxation, social security, assets and transmission.

Our expertise in healthcare professions allows us to master the subtleties of the BNC regime (Non-Commercial Profits), the deduction of specific expenses (medical equipment, CPD training, professional liability insurance), and practice structures (Sole Proprietorship, SELARL, SELAS, SCM, SPFPL). Whether you are an established doctor for 20 years or a young practitioner in the start-up phase, we provide you with personalized support to optimize your taxation and secure your retirement.

An accountant for a general practitioner or specialist keeps your BNC books and files the 2035 return, arbitrates the micro-BNC scheme (EUR 83,600 receipts threshold in 2026, 34% flat allowance) against the actual-cost regime, provisions your URSSAF and CARMF contributions (base scheme at 8.73% up to 1 PASS, EUR 48,060 in 2026), secures VAT (therapeutic care is exempt, non-therapeutic aesthetic procedures are taxed at 20%) and models the switch to a SELARL with a SPFPL holding above EUR 100,000 of profit. Cabinet Hayot Expertise, registered with the Ordre des experts-comptables, supports GPs and specialists in sectors 1, 2 and 3, in Paris and across France, in English. Fees from EUR 258 excl. VAT per month, quote within 24 hours.

BNC regime and 2035 declaration#

Most private doctors practice under the Non-Commercial Profits (BNC) regime with the obligation to produce a 2035 declaration (controlled declaration regime). Although the micro-BNC regime (flat rate reduction of 34%) is applicable up to €83,600 in revenue (threshold 2026), the real regime often becomes more advantageous as soon as the practice bears significant structural costs.

When to switch from micro-BNC to the real 2035 regime?

As soon as your actual expenses (office rent, SCM costs, medical equipment, social contributions, CPD training, professional liability insurance) exceed 34% of your income, the controlled declaration regime becomes financially more attractive. A general practitioner with €100,000 in income and €45,000 in actual expenses will benefit from opting for the 2035, even if below the micro-BNC threshold.

Sector 1, sector 2, non-contracted: tax and VAT impact#

Sector 1 (regulated fees): fees are set by the agreement with CPAM and reimbursed by French social security. No VAT applies, since care for persons is exempt (FTC art. 261-4-1°). In return, part of your social contributions is subsidised by the health insurance scheme.

Sector 2 (free fees with overruns): you may charge above the regulated tariff, generally within the OPTAM framework. Fee overruns remain VAT-exempt as long as the procedure has a therapeutic purpose, but they carry higher social contributions because CPAM subsidises a smaller share of them. The balance between overruns and patient volume needs monitoring.

Sector 3 (non-contracted): fees are entirely free and patients are barely reimbursed. It is rare in general practice and more common in aesthetic specialties. Watch VAT closely: therapeutic care stays exempt, but aesthetic procedures with no medical justification (botox, peelings) are taxed at 20%, and the €37,500 small-business VAT exemption threshold can be crossed quickly. We secure the qualification of every procedure to avoid a VAT reassessment.

SCM: sharing the costs of a group practice#

A SCM (Société Civile de Moyens) lets several health professionals share the fixed costs of the practice (rent, medical secretary, utilities, shared equipment and software) while keeping full professional independence: each doctor keeps invoicing their own fees under the BNC regime. The SCM is not meant to make a profit: it recharges costs to each partner, usually pro rata to use. Those SCM charges are deductible from your own BNC (line 20 of the 2035), which lowers both your income tax and your social contribution base. We keep the SCM books, compute each partner's share and carry it into each personal 2035.

Locum doctors and first installation in France#

A locum doctor receives fee retrocessions from the practice owner: they are BNC receipts on your side, deductible on the owner's side (line 3 of the 2035). In the first year, the micro-BNC scheme (34% allowance, €83,600 threshold in 2026) is often the simplest and most favourable choice. URSSAF and CARMF registration applies from the first locum assignment, with contributions first called on flat bases and then regularised once actual income is known: we recommend provisioning about 30% of your retrocessions. Once real expenses exceed 34% of receipts, the actual-cost 2035 regime wins and we simulate both regimes every year. We also help you decide between staying a locum, buying into an existing practice or joining a group, with a cash-flow plan covering the first three years of practice.

Accounting and tax declarations#

We handle all your medical accounting: automated import of bank statements, reconciliation of fees (Sector 1, 2, surcharges), deduction of retrocessions, tracking of investments (medical equipment, IT, professional vehicle), preparation and electronic submission of the 2035 declaration within deadlines.

Real-time dashboard: via our Pennylane platform, you permanently visualize your cash flow, monthly receipts, deductible expenses, and an estimate of your future taxes and contributions.

Remuneration optimization#

The objective is to maximize your net disposable income after taxes and contributions. We arbitrate between several levers: deduction of professional expenses, Madelin law pension and retirement, PER (Retirement Savings Plan).

Example: a doctor with €120,000 BNC can deduct up to around €22,800 in Madelin retirement contributions (cap: 10% of profit plus 15% of the fraction above 1 PASS), reducing taxable profit to about €97,200, i.e. an income tax saving of roughly €9,300 (41% marginal bracket). Note that these optional contributions remain part of the URSSAF and CARMF social contribution base.

Transition to a company (SELARL/SELAS) and holding#

When to switch to SELARL or SELAS?

The transition to a company (subject to Corporate Tax) becomes interesting when your IR marginal tax rate becomes punitive, generally from €100,000 to €150,000 in net profits.

Advantages of SELARL/SELAS:

• Corporate Tax (IS): 15% up to €42,500 in profits, then 25% beyond. Much more advantageous than IR at 41% or 45%.
• Modular remuneration: you decide your salary (subject to social contributions + IR) and the amount of dividends to distribute (31.4% flat tax or IR scale).
• Protection of personal assets: in a company, your liability is limited to your contributions (except professional misconduct covered by insurance).

Our missions: evaluation of patients, drafting of SELARL or SELAS articles of association, ordinal procedures, registration, contribution of assets, implementation of IS accounting.

SPFPL: medical holding to optimize your dividends#

For doctors in SELARL/SELAS, the creation of an SPFPL (Financial Participation Company for Liberal Professions) allows you to create a holding company holding the shares of your SEL.

SPFPL advantages: parent-subsidiary regime (dividends from SELARL to SPFPL are 95% exempt from IS), reinvestment without taxation, facilitated transmission, financing of acquisitions.

Use case: a cardiologist in a SELARL generates €80,000 in dividends per year. By creating an SPFPL, they accumulate these dividends in the holding company (almost zero taxation) and finance the purchase of the premises of their practice via an SCI held by the SPFPL.

Purchase of practice premises via SCI#

Many doctors rent their practice. However, purchasing the premises via an SCI (Real Estate Company) held by yourself (and/or your spouse, children, SPFPL) allows you to: deduct loan interest from the SCI's result, collect rent from your SELARL (which becomes a tenant of the SCI), build up real estate assets that can be valued and transferred.

To manage your medical practice, here are the essential KPIs to monitor: expenses/fees ratio (target < 50%), social coverage rate (~45% BNC or 25-30% SELARL/SELAS with optimization), monthly net disposable income, equipment depreciation rate, IR/IS ratio.

Our fees start at €258 excl. VAT per month (Essentiel package) for a doctor under the BNC regime: bookkeeping, 2035 return filed electronically, Pennylane dashboard and answers within 24 hours. In practice, accounting for a private doctor costs €1,500 to €3,000 excl. VAT per year depending on the structure: a standalone 2035 costs less than a SELARL under corporate tax (annual accounts, 2065 return, yearly legal secretarial work and the 2777 return when dividends are paid) or a group practice combining a SCM and a medical secretary's payroll. One-off assignments (SELARL switch simulation, SPFPL setup, catch-up accounting) are quoted within 24 hours. See our fees for the three packages of the firm. Switching accountants costs you nothing extra: we handle the handover letter with your previous firm, recover your accounting files and take over the current financial year without any interruption to your filings.

✅ Healthcare professions specialist: BNC 2035, CARMF, URSSAF, SELARL, SELAS, SCM, SPFPL mastered ✅ Digital automation: Pennylane platform with bank import, invoice OCR, real-time dashboard ✅ 24-hour responsiveness: response to your questions within 24 hours maximum

• Costed trade-offs: flat-rate allowance against actual expenses, staying under BNC against incorporating, and how much to pay into a retirement savings plan. ✅ Asset support: SPFPL, SCI, purchase of premises, transmission

Chartered accountant for doctors Paris 8th

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For EU physicians, the path to practicing in France is governed by the EU Professional Qualifications Directive (2005/36/EC), which provides for mutual recognition but is not automatic. You must apply to the Conseil Départemental de l'Ordre des Médecins in the department where you intend to practice, demonstrate French language proficiency adequate for patient care, and prove that your qualification meets French standards. In some specialties, an adaptation period or aptitude test may be required.

Non-EU doctors face a more complex path. The PAE (Procédure d'Autorisation d'Exercice) is the main route for non-EU doctors. Candidates take standardized theoretical exams followed by a supervised hospital practice period (typically 2 to 3 years as a praticien à diplôme hors Union Européenne or PADHUE). During this period, you are employed and cannot bill private patients independently. We advise foreign doctors in their PAE phase on how to structure financially for the moment full registration is granted: setting up the corporate vehicle in advance, opening the right bank accounts, and ensuring CARMF registration is handled from day one of independent practice.

One practical point often overlooked by arrivals: your first year bills are paid in arrears by the social security system. Plan to operate for 3 to 4 months before your first substantial CPAM payment arrives. Having a French bank account with a pre-arranged overdraft facility or a personal bridge loan is standard practice among newly installed foreign doctors. We help you model this cash-flow timeline in detail.

CARMF (Caisse Autonome de Retraite des Médecins de France) is the mandatory pension fund for all private-practice doctors in France. There is no opt-out, regardless of whether you also contribute to pension systems in your country of origin. Double-contribution situations can arise and are sometimes mitigated through bilateral social security agreements (France has bilateral treaties with around 40 countries, including the US, UK, Canada, and Japan).

CARMF has three main contribution components:

Total CARMF + URSSAF contributions for a conventionné GP earning €80,000 BNC: roughly €28,000 to €32,000 annually. For a specialist earning €200,000: contributions approach €60,000.

A subtlety that trips up foreign doctors: CARMF contributions are calculated on income from two years prior (N-2 basis), then regularised. In the first two years of installation, CARMF charges a flat-rate minimum contribution (around €1,500/year), then hits you with a sharp regularisation once your actual income is reported. We model this timeline for each client so the catch-up payment in year 3 is fully provisioned.

Optimising through Madelin contributions: CARMF's pension is respectable but not generous by the standards most foreign doctors expect. A surgeon or specialist who retires from a SELARL after 30 years of contributions may receive €3,500 to €4,500 per month from CARMF, well below the replacement rate they are used to. Madelin pension contracts and PER (Plan Épargne Retraite) products fill this gap and reduce taxable income simultaneously. For a 45-year-old specialist earning €250,000 BNC, contributing €25,000 per year to a PER saves approximately €10,250 in income tax and €11,250 in social contributions annually, while building a capital that could deliver €2,000/month in additional retirement income.

A worked example built for teaching purposes, to show how the French rules stack up over the first years of practice. It does not describe an actual client of the firm and every figure is an order of magnitude. Recognition of a foreign medical qualification is a matter for the Ordre des Médecins and falls outside an accountant's remit.

Background: a foreign-trained GP relocates to Paris and, once registered with the Ordre des Médecins, opens a secteur 1 general practice in the 11th arrondissement.

Year 1 structure: enterprise individuelle (EI), BNC regime, sole practitioner sharing a SCM with two other doctors at the same address.

Year 1 financial reality: her gross CPAM income for year 1 was €67,000 (ramping throughout year as patient list built up). Under the micro-BNC regime (which she initially chose for simplicity), her taxable income would have been €44,220 (66% of €67,000). We modelled the real 2035 alternative:

• CARMF minimum year-1 contribution: €1,500
• URSSAF year-1: €4,200 (provisional)
• SCM share of premises and shared secretary: €8,400
• Professional liability insurance (RCP): €1,800
• Professional subscriptions and training: €2,600
• Home-office proportion: €1,400
• Total deductible expenses: €19,900 → taxable BNC: €47,100

In this case the réel regime gave slightly worse results than micro-BNC in year 1 (because charges were relatively modest). But by year 2, with her annual income reaching €95,000 and CARMF regularisation bringing her actual contribution to €22,000, the réel regime saved her €6,200 in income tax compared to micro-BNC.

By year 3, we recommended a transition to a SELARL. Projected BNC at €130,000. SELARL IS calculation:

• Revenue: €130,000
• SELARL manager salary (gross): €55,000 (social contributions ~45% = €24,750)
• CARMF contribution (on reduced salary base): ~€19,000
• Dividends: €31,250 (after 15% IS on €31,250 = €4,687 IS; flat tax at 31.4% on the dividend = €9,813)
• Net disposable to Dr. Emma: €55,000 salary (after IR ~€8,000) + €21,437 net dividend = €68,437
• Compared to individual BNC: net after IR + all contributions = €51,400
• Annual gain: about €17,000, and growing as her practice expands

1. Not registering for CARMF within 3 months of installation. Late registration generates back-contributions from the theoretical start date, plus interest. Register within the first week of obtaining your Ordre registration.

2. Treating UK/US pension contributions as deductible in France. Foreign pension contributions are generally not deductible from French BNC income unless covered by a specific bilateral treaty provision. We check treaty applicability for every international client.

3. Missing the CPAM conventional requirements. Doctors who are conventionnés (contracted with CPAM, the vast majority) must comply with certain billing and reporting obligations. Failing to submit required CPAM declarations correctly can result in reduced reimbursement rates or breach of the convention.

4. Confusing SPFPL and SCI. A SPFPL holds professional shares (your SELARL); an SCI holds real estate (your practice premises). They serve different purposes and can be used together, but mixing them in accounting is a common error.

Our guides and articles for private doctors:

• Chartered accounting Paris 8
• Business creation Paris
• Executive wealth management
• Holding tax Paris
• PER executive 2026: tax retirement optimization
• Chartered accountant Paris: missions and obligations 2026
• Liberal professions sector
• Physiotherapist accounting

For more, see our accountant for doctors guide for 2026: BNC, SELARL, 2035 and CARMF.

Getting the line numbers right matters, because an expense entered on the wrong line is an expense the tax office will look at. On the 2026 vintage of schedule 2035-A-SD, covering 2025 income:

This is the tax specificity of the profession, and it is regularly missed. A sector 1 contracted doctor may waive keeping actual records of certain professional expenses (entertainment, hospitality, canvassing, professional gifts, research work, laundry, short journeys) and instead deduct a flat 2% of gross fees. The two methods, actual expenses or the flat allowance, are mutually exclusive: you choose, you do not combine. Contracted doctors under the controlled declaration regime are also entitled to the so-called group III deduction and may apply, on the same base, a further 3% deduction. Each has its own box on the return. Which is more favourable, the flat allowance or actual expenses, is recalculated every year.

A frequent misunderstanding: the VAT exemption on medical care does not depend on the contractual sector. It follows the nature of the procedure, care provided to a person by a member of a regulated medical profession. A sector 2 or non-contracted doctor is exempt on the same basis for care procedures. What falls outside the exemption is care without therapeutic purpose, aesthetic procedures in particular, and expert reports prepared for an insurer, a court or a pension fund, which are taxable at the standard rate. Where both coexist, the practice becomes a partial taxable person and a deduction coefficient has to be calculated.

The cap on deductible optional health and provident contributions is single and shared between the two: 7% of the annual social security ceiling plus 3.75% of taxable profit, the total not exceeding 3% of eight times that ceiling. It is not two separate envelopes, contrary to what is often written. The retirement cap is separate: 10% of taxable profit within eight times the annual ceiling, plus 15% of the portion of that profit between one and eight times the ceiling, or 10% of the annual ceiling if that is more favourable.

The point is counter-intuitive. Professionals carrying out exclusively VAT-exempt transactions, which is the case for medical care, are not required to issue electronic invoices, nor to report transaction data to the tax authorities.

The reception obligation, however, applies to every business covered by the reform from 1 September 2026, whatever its size. In practice, a medical practice buying equipment, software or services from a supplier subject to the issuing obligation must be able to receive that invoice electronically. And a doctor with an ancillary taxable activity, expert reports or aesthetic procedures, leaves the pure exemption case for that share of the activity.

A second calendar point, often misreported: the transfer of the French Tax Code's VAT provisions to the Code on Taxation of Goods and Services, once announced for 1 September 2026, has been postponed to 1 January 2027, with the former references remaining usable until 30 June 2028.