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 recognised here. Or at least that it would make getting a medical license in France easier. Wrong. Here I outline the eight steps to obtaining a French Medical License.
Step One: Learn French
First, you will have to learn to speak French and get a diploma in it at a B2 level (this is a system of standardisation all across Europe), which you need in order to register for the medical exam. The French are very proud of their language, which is really very precise and very beautiful. Alliance Française in the US can do this for you, if moving to France isn’t an option yet. They are licensed by the French government to do it.
I quit my job (and started doing locums) and moved to France in January of 2018 to begin the process of becoming fluent. The best way to learn to speak a foreign language is to live in the country and immerse yourself in it. For three and a half years, I lived about half the time in France and worked locums jobs in the US the other half of the year. I enrolled in an intensive, immersive program in a language school when I first moved here.
Step Two: Specialty Specific Exam
Registration for the exam is usually open for one calendar month roughly 6 months before the exam. The exam is free, but registration has to be done via snail mail. You will need a translated copy of your medical diploma (by a state-sanctioned translator), a copy of your B2 French Language diploma, a copy of your passport, and your carte de séjour if you have one. Send it registered mail, return receipt.
The Specialty-Specific Exams
The good news about the licensing exams is that they are specialty-specific. None of that USMLE, redo all the basic sciences of medical school business. And you won’t have to redo residency. But the exams are concours, which means they are a road-race, a competition. Passing isn’t enough. This year, they needed 120 anesthesiologists. So I had to score in the top 120. The exams are given once a year, in French, long- answer (not multiple choice), in person, in Paris.
Step Three: Study
There are no study guides and they publish old exams without answers. I prepared for the exam by searching online (in French) for what they were looking for. I read resident handbooks and study guides. I studied the French anesthesia society recommendations and protocols and I found some anesthesiology textbooks in French.
In anesthesia at least, their system is very protocol-driven. Their society of anesthesiologists has their own “Cochrane review” style system. Because the country is small enough, they are able to come up with guidelines that are by and large followed by everyone. They are much less ‘cowboy’ than American physicians.
Step Four: The Exam
Don’t be arrogant. I was an experienced attending, having had 15 years in academia, having just been re-boarded a few years previously, so I took it cold the first time, and failed. Barely, but still. I’ve heard of other American docs who did the same thing here but then gave up after the first time (an American ENT here in Bordeaux). The second time I took it, I passed but wasn’t in the top 80 (they only took 80 that year). The third time, I got it. The test was postponed twice due to COVID-19. I created my own study guide, which I am willing to share in case there is anyone out there interested in anesthesia in France.
Step Five: Find a Job
This is easy. People started to contact me on LinkedIn after the results of the anesthesiology exam were published. I had already been talking to the Children’s Hospital of Bordeaux about working with CHOP (Children’s Hospital of Philadelphia) to help the Bordeaux Hospital build a pediatric anesthesia fellowship program, something that doesn’t exist yet in Europe. So I knew I had a job with them, but I was solicited multiple times on LinkedIn.
Step Six: Work Under Supervision
For two to three years, depending on your specialty, you will work in a public hospital under the supervision of the Chair. This is not a residency. They are orienting me now and I am treated as a colleague who is learning a vastly different system in a new language. They are kind and patient. And respectful. But I am an attending.
Step Seven: Final Exam
There is a final exam after the two years of working under supervision, which I am assured is perfunctory. There are no more recertification exams after this, for life.
Step Eight: French Medical License
After the above exam, you will receive a French medical license number giving you the ability to practice medicine anywhere in France. You can work in a public hospital or in a private practice hospital (which is called a Clinique , a bit confusingly).
Bottom Line
One of the things I both love and find frustrating about the medical system in France is its socialism and egalitarianism. France and other EU countries recognise each others’ licensed docs. At least for France, anyone coming from outside the EU, the process is much more difficult. But if I had the information I just listed here, 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 17 years, 15 of which have been exclusively pediatric. After 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 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 her story here.
