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. Wrong.
Here, I outline the eight steps to obtaining a French Medical License if you come from outside the EU.
(Looking for the Ultimate Guide to Practicing Medicine in France? Click here)
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 standardization all across Europe), which you need to register for the medical exam. The French are very proud of their language, which is very precise and very beautiful. Alliance Française in the US can do this for you, if moving to France isn’t an option yet. The French government licenses them 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 and immerse yourself in the country. For three and a half years, I lived about half the time in France and worked locum 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: Register For The Medical Exam
Registration for the exam is usually open for one calendar month, roughly 6 months before the exam. The exam is free. You will have to choose a region in France where you want to live and practice because the exams are funneled through the regional boards of health (Agence régionale de santé, or ARS) for correction and distribution of doctors. Registration is done via their website.
If you don’t speak French, you will need someone with you who can help you navigate their website. 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. For more information, visit their website.
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-hand (not multiple choice), in person, in Paris. Old exams are published on their website, but not with the answers. There are support groups on social media for several specialties, but unfortunately not for anesthesia.
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.
But what helped me the most was the study guide I wrote. I went through the last 6 years of old exams and searched online for the answers. I am happy to share this with any anesthesiologists looking to move to France.
In anesthesia, at least, their system is very protocol-driven. Their society of anesthesiologists has its own “Cochrane review” style system. Because the country is small enough, they can 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 and having 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). I passed the second time I took it 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. But because of COVID-19, they decided anesthesiologists were of value and nearly doubled the number of spaces for us.
Step Five: Find a Job
This is easy. France needs doctors. But if you have a specific place you think you’d like to live, especially if it’s a highly desirable place to live like Paris or Bordeaux, I’d suggest contacting the Chair of the department you’d like to join to see if they have any positions.
People started to contact me on LinkedIn after the results of the anesthesiology exam were published by the CNG. 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. I continue to be solicited by headhunters on LinkedIn.
Step Six: Work Under Supervision
For two to three years, depending on your specialty, you will have to work in a public hospital under the supervision of the Chair, specifically as a Praticien Attaché Associé. This is not a residency. And quite frankly, I never saw the Chair very often. This is more of what we used to think of as an audition rotation in the 4th year of med school. They vet you, ensuring you have an appropriate fund and breadth of knowledge.
When people come from different systems from all over the world, there is no other standardized way to evaluate them. You will be acting as an attending but paid much like a resident. The good news is you will get 9 weeks of vacation every year. During this time, I used 4 weeks every year to work a locum job in the US. At the end of the two years, you can choose to be a PC (praticien contractuel) or work in the same capacity while awaiting your passage to PH (praticien hospitalier), which can take another 6 months to a year.
Step Seven: Practicien Contractuel vs Practicien Hospitalier
A final exam is required to pass on to PH, which I am told is a perfunctory oral exam. There are no more recertification exams after this, for life. Why PH? PH allows you to have what amounts to tenure in the university system and allows you to earn a better salary in the private sector.
Step Eight: French Medical License
Whether you choose to continue as a PC or to continue to PH, you will need to upload all your documentation (attestation that you finished your two years in good standing, all your identity docs, all your residency and med school docs, etc) into the CNG website. Once they are satisfied, you can apply to the Conseil de l’Ordre des Médecins for your license number (RPPS, répertoire partagé des professionnels de santé). The license costs 300€ per year.
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 recognize 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 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 burnout it caused just decided to leave her country and find a way to practice in France e easier. Learn more about her story here.
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Updated March 12, 2025
Originally published February 14, 2022
