Ultimate Guide to Practicing Medicine in France

Why France? Well, who doesn’t want to live in France, right? From the snow-topped French Alps to the turquoise waters of the French Riviera, the patisseries, the boulangeries, and the idea that you work to live is a welcome change.  Here, Dr. Jill Arthur, a pediatric anesthesiologist, shares a guide to practicing medicine in France.

French Healthcare System

France has a system of socialized medicine (single-payer system) funded primarily by the government. This means that everyone has coverage. This also means there is a societal consciousness of the importance of health and well-being, and of fraternité, our responsibility to our concitoyens. The number of people I have met in 7 years in France who have a problem with this system is exactly zero. 

The hôpitals are all public (private hospitals are called “cliniques”). All university hospitals are public. The physical plants may differ a bit, but you can get excellent medical care in both. You can also buy top-up insurance (“mutuelle”) for things like better vision, prescription, and dentistry coverage, but this is much less expensive than we are used to (anywhere from 30 €/month to 140 €/month, depending on what you want to be covered.

Medical License/Registration

It turned out that France was a much harder nut to crack than I had anticipated. I arrogantly thought that my US education and training would be recognized here. Or at least it would make getting a medical license in France easier. I couldn’t have been more wrong!  n a separate post.

Équivalence

This is how the French government will recognize your medical license. I detail the 8 Steps to Obtaining a French Medical License in a separate post.

You cannot have your credentials evaluated by some committee you imagine should be doing this for docs coming from the US. You cannot call the Conseil de l’ordre des médecins. You cannot even call the CNG (the organization responsible for bringing in foreign docs). There is no one answering the phones. Don’t try emailing them, either. You won’t get an answer. It doesn’t matter how many Ivys you have on your CV, or how much of an expert you are in your field. For better or worse, everyone has the same chance. Additionally, France only grants equivalence for MDs, not DOs.

There are basically two ways for foreign doctors to get a license to practice medicine in France, and it depends on where you were educated and trained: EU vs non-EU. 

If you received your medical education and did your residency in the EU, you will get a French medical license with no exams. 

But if you went to medical school and did your residency outside the EU, you must go through the same process I did. This is: 

• Get a diploma in French proficiency at a B2 level, which you will need to register to take the medical exam (you can do this at an Alliance Française in the US, and it is a combined written and oral exam),
• Register to take a concours (a French style of exam where if there are 100 places in your specialty for this year, you will have to score in the top 100) called the épreuves de vérification des connaissances (EVC). This is given once a year, in person, in Paris, is long-hand and specialty-specific, 
• Work for two years in a university hospital (Centre Hospitalier Universitaire, CHU) “under the supervision of the Chair,” where you will work as an attending but be paid more like a resident, 
• Apply to the CNG to approve you for the next and final step which is :
• Applying to the Conseil de l’ordre des médecins for your RPPS (Répertoire Partagé des Professionnels intervenant dans le système de santé) which is the equivalent of a state license combined with a DEA.

I have discovered in the fullness of time that the way France organizes its medical system is not at all like ours; it’s like a parallel universe. Aside from the differences in medications available and nosocomial infections, the way they divide their workload and their medical specialties is not like in the US. 

For example, cardiologists do all their ECGs and echos themselves. Vascular is a subspecialty of medicine. Dermatologists don’t do Mohs surgery (which I discovered after an American dermatologist contacted me asking where he could set up shop in France). Hospitalists are a new concept (2014). Anesthesiologists really are perioperative physicians (see all preop patients in the clinic, manage all post-op patients as well as a high acuity step-down unit where surgeons are consultants and manage only surgical things).

Their version of an ICU (réanimation) is extremely high-acuity (only intubated patients or those on pressors), where patient stay is more often measured in hours instead of days.

 

Finding a Job

They need doctors so badly that essentially the job will find you. People started to contact me on LinkedIn after the results of the anesthesiology exam were published on the CNG website. I was solicited multiple times on LinkedIn. I continue to be contacted by French headhunters looking for anesthesiologists. But in my case, I had already been in contact with the Chair at the Children’s Hospital of Bordeaux, so it was there that I did my two years.

Salary

Whereas in the US, we talk about gross yearly salary, the people in France only ever think about or conceptualize their salaries in terms of what they take home or net salary per month. During my first two years of working under supervision, I took home about 4,500 € a month. But after this probationary period, in anesthesia with my level of experience (20 years), I could take home about 180 000 € per year working in the public system.

In general, one can earn more working in the Cliniques (private hospitals). A private practice anaesthesiologist (not available until after the 2-3 year probation period) makes about 20,000 €/month gross. For anesthesia, it’s the same eat-what-you-kill system we have in private practice in the US, but the hours can be longer. 

When comparing salaries between France and the US, it’s important to remember the difference in overhead, especially malpractice and personal health insurance. If you work in a university hospital, you won’t have to buy malpractice insurance. If you’re working in private practice, the amount you pay in malpractice reflects your clinical activity (the more you work, the more you pay). But it runs for anesthesia on the order of 4 000 € per year if you’re super busy clinically. Regarding personal health insurance, if you’re a human living in France, you will be covered by their single-payer healthcare system for free. Top-up (“mutuelle”) insurance runs from 30 € a month to 140 € a month grand maximum.

A 2019 physician compensation survey indicated that the average salary for a French physician was 108,000 USD (converted from Euros). Notably, the average annual cost of medical school in France, whether private or public, was 800 USD. 

Work Culture

Everything is just slightly different. I’d describe it as a parallel universe. For example, they don’t have the same medications available here that we have in the US, and in the US we don’t use the medications they use in France. A physician always works with a CRNA, mostly one-on-one, plus residents when they are not in lecture. They don’t rely on residents to run their system, and they cap the work hours for attendings at an average of 48 hours per week.  

As an anesthesiologist, your hours are split between the preop clinic, the OR, and the floor (anesthesia follows all postop surgical patients and surgeons are consultants), and the Unité de Soins Continus, a sort of super high acuity step-down.

The famous French 35-hour workweek doesn’t apply to doctors. It certainly wouldn’t be possible in anesthesia. But what they do is compensate you with time off. I got 9 weeks of vacation per year as soon as I started. For anesthesia, we work “on average” 48 hours per week. But if you need to take a medical leave (one colleague broke an arm and a leg in an accident and was out for 10 weeks), you will be paid your normal salary for at least the first few months.

As a physician, you are treated with respect. By nurses and other support staff, but also by patients. There is no Dr Google. You’re actually respected as a doctor by patients and colleagues.

A lot of my education in French happened after I started working at the hospital, where none of the colleagues or support staff spoke one word of English. Things like rhinitis (rhinite) are easy to figure out, but no one in French school taught me how to ask parents if their child had a runny nose (the expression in French is a “flowy nose”). It was a steep learning curve.

For many of my anesthesia colleagues, me joining their group was difficult at first. They had never met a doctor from outside the EU or who was new to speaking French (most of the non-EU laureates of this process grew up in countries where French was the language used in education, if not their first language). 

While most of the colleagues were patient and kind, some of them didn’t know what to do with me and rudely mocked my accent and disrespected my years of expertise. I’m not sure how much of it was professional jealousy (being dependent on a Cochran review system for all your information and unable to read and understand primary sources), or just old-fashioned ethnocentrism. But there were those who were decidedly unkind, unwelcoming, and unhelpful.

Immigration

You will need a visa to stay in France for longer than 90 days at a time – you will need a visa de long séjour. 

The visa de long séjour costs 225 €  per year. You can apply for the first one while still in the US. There are basically three ways to qualify for this extended tourist visa:  by being married to a French citizen, having a French child, or having 12x their minimum monthly wage (which at the time of writing is 1,801.80 €) in a bank account anywhere in the world.. They want reassurance you won’t wind up in their welfare system. This will need to be renewed annually. Once you are ready to start working, you will be responsible for changing this to a working visa de long séjour, for which you will need a letter of employment from the hospital.

Soon after you arrive, you will need a French bank account. This can also be a challenge since overseas banks have to file a bunch of paperwork with the IRS and there aren’t a lot of them willing to do this. I bank with BNP Paribas since they do business on both continents. I recommend opening an account with a branch in the US, as it will be easier to subsequently open a bank account in their French branch. You can find short-term apartment rentals through any number of agencies, but you won’t be able to rent a place on your own until you open a French bank account.

 

Bottom Line

I feel incredibly fortunate to live in France and incredibly lucky to be able to work here. The food is much higher quality than what we have in the US. The healthcare system is unmatched in the world. The lifestyle is gentle, and the societal emphasis on learning, engagement, and responsibility to the community and environment agrees with my values. There is an emphasis on quality of life that I’m still trying to get used to (it took me the better part of 3 years to really begin to get over the burnout).

I would do it again in a heartbeat. But if I had the information I shared in this series, I think I could have shaved about 2 1⁄2 years off the process.

Jill F Arthur, MD FAAP is a pediatric anesthesiologist who has been in practice for 20 years, 19  of which have been exclusively pediatric. After a fellowship at Boston Children’s, her wide-eyed plan was a career in academia. Attending positions that followed included some at big-name institutions with long-standing reputations in research and academics, but the exigencies of practicing in a system that increasingly stresses money over the advancement of knowledge brought that dream quickly (and sadly) to an end. Hope sprang eternal anyway, for the next dozen years, believing she could actually change the system. But in the end, its abuse and the burn-out it caused just made the decision to leave her country and find a way to practice in France easier. Learn more about Dr. Jil Arthur’s story here.

 

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Updated March 12, 2025

Originally published February 14, 2022