Doctors in France: Public vs Private Salaries, How to Compare

Introduction

Before accepting a position or changing institutions, take 15 minutes to compare your “real” compensation. 1) List all your salary components (base salary, bonuses, on-call duties, standby duties, any additional activities). 2) Deduct social charges and taxes (according to your status). 3) Relate everything to the total time worked (clinical care, on-call duties, standby duties, administrative tasks). The best indicator for deciding between public hospital, private clinic, or private practice is the annual net and net hourly pay, not just the gross monthly salary.

In France, pay gaps between sectors can range from 20% to over 100% depending on status (employee vs. private practice), specialty, on-call/standby duties, and location. This article offers an operational overview for doctors in France and healthcare facility management, with a simple method and concrete examples. It is based on public benchmarks (DREES, CARMF) and on the French healthcare job market as observed by Euromotion Medical, a healthcare recruitment and physician support agency in France.

Understanding Statuses and Compensation Mechanisms

Public Hospital (Hospital Practitioner)

Compensation consists of a base salary indexed to the grade, bonuses (on-call duty, responsibilities, territorial practice, etc.), and on-call/standby allowances.
Income is more stable and predictable, with progression structured by the pay scale and roles (department head, coordination, academic).
On-call and standby duties weigh heavily in certain specialties (anesthesia, emergency medicine, obstetrics, intensive care), which significantly increase the annual net income.

Illustrative example: a hospital practitioner with an on-call duty bonus and 4 on-calls per month can see their annual net income increase significantly, but at the cost of working hours and fatigue that must be factored into the hourly calculation.

Private Salaried (Clinics, ESPIC, Groups)

Base salary is often higher to attract certain specialties, combined with activity/performance-based bonuses, and sometimes private on-call duties.
Varies depending on the region, technical facilities, and the establishment’s policy; individual negotiation is more common.
Attractive for technical specialists with regular access to the operating room or imaging.

Illustrative example: a salaried anesthetist in a clinic with a base salary plus a bonus linked to the number of operating room sessions can earn more annually than a hospital practitioner, but their net income will depend on targets and surgical scheduling.

Private Practice (Office or Private Activity in a Clinic)

Income is indexed to the volume of procedures, specialty, agreement (sector 1 vs. sector 2 with extra billing), organization (secretarial support, digital tools), and access to the operating room/technical platform.
Substantial expenses: CARMF, URSSAF, rent, staff, insurance, software, taxes; turnover is not the same as income.
High potential for technical specialties (surgery, anesthesia, imaging, interventional cardiology), more moderate but stable for general medicine, especially in underserved areas.

To place France in the European context, see the comparative analysis: In which European countries are doctors best paid?.

What Widens the Gap: Specialty, Agreement, Activity, and Location

Specialty: technical disciplines capture value better in private practice (high-value procedures, operating room, imaging). Clinical specialties without a technical platform may find a better balance between compensation (bonuses/on-call shifts) and working conditions in the public sector.
Agreement: in private practice, sector 2 allows extra billing but depends on local solvency; sector 1 offers a broader and more predictable flow, with an income ceiling linked to regulated fees.
Volume and organization: length of consultations, reserved operating room slots, telemedicine, coordination with secretarial staff; reducing administrative time directly increases net hourly earnings.
On-call shifts/standby duty: major impact in both sectors; different pay scales, compensatory rest, family constraints to consider.
Location: demographic pressure, installation incentives, competitive density. Public hospitals and private clinics adjust their packages in high-demand regions. Rehabilitation centers also value rare profiles (PM&R, neurology, geriatrics).

Useful references: DREES statistics on liberal incomes and CARMF data by specialty (www.drees.solidarites-sante.gouv.fr and https://www.carmf.fr/pages/statistiques/statistiques.htm).

Practical method: from gross to net hourly, step by step

1) List all components - Public/private salaried: annual gross base, bonuses, on-call/standby allowances, activity-related variables, benefits (housing, vehicle, training). - Liberal: projected turnover (consultations, technical procedures, locum work), agreement (sector 1/2), extra billing, fee-sharing (SCP/SEL), replacement costs.

2) Deduct expenses and taxes - Liberal: CARMF, URSSAF, supplementary pension, insurance, professional liability insurance, rent, staff, digital tools; BNC taxation (income tax) or corporate tax if SEL with salary/dividends. - Salaried: employee contributions + income tax according to your family situation. Calculate an annual net “after social contributions” then estimate the income tax.

3) Account for all actual working time - Include: patient time, on-call shifts (night/weekend/public holidays), standby duty (phone and travel), compensatory time/RTT, meetings/coordination, administrative tasks, inter-site travel.

4) Calculate two key indicators - Net annual available = (total remuneration – deductions – estimated taxes). - Net hourly rate = net annual available / total hours worked.

5) Test scenarios - High/low activity, changes in operating room schedule, addition/removal of on-call shifts, switch from sector 1 → 2, relocation to an underserved area.

Illustrative example (educational) - Offer A (public): base + bonuses + on-call = estimated net annual €92,000; total annual time 2,100 h (including on-call/administrative). Net hourly ≈ €43.8/h. - Offer B (private salaried): fixed + bonus = estimated net annual €110,000; total time 2,450 h (more targets, standby duty). Net hourly ≈ €44.9/h. - Offer C (private practice): turnover €300,000; expenses/taxes 48%; net annual available ≈ €156,000; total time 2,800 h (including management). Net hourly ≈ €55.7/h. Interpretation: despite a higher net annual income in private practice, the hourly gap depends heavily on non-clinical time and organization. For the same specialty, a well-equipped office (secretarial support, digital tools, teleconsultation) significantly improves the net hourly rate.

For international comparisons, see: Doctors’ salaries: comparison between France and Germany.

Status, taxation, and retirement: key points to watch

BNC vs SEL (corporate tax): with BNC, you are taxed under personal income tax after deducting expenses; with SEL, corporate tax applies to profits and you arbitrate between salary and dividends, with legal/social constraints. Have both scenarios simulated.
Contributions and retirement: CARMF/URSSAF/disability insurance are significant burdens (often 35–50% of turnover depending on specialty and structure). Anticipate your provisional payments.
Insurance and risks: professional liability, business interruption, cyber; do not underestimate their cost or importance.
Public sector: job security, specific retirement scheme, recurring bonuses, paid leave/RTT; these elements have an implicit monetary value over the long term.
Mixed practice: private practice in hospitals, part-time public/private, locum work; check regulatory compatibility and ceilings.

The figures published by CARMF and DREES help avoid misconceptions between “gross,” “BNC,” and “net available.”

Working Conditions, Career, and Job Market

Public hospital: university ecosystem, research, complex cases, multidisciplinarity. Limitations: capacity pressure, on-call workload. Local measures (additional time, clinician positions, recognition of permanence) exist.
Private clinic: organizational agility, quick access to the operating room/technical facilities, different patient relationship; trade-offs: activity targets, less statutory protection.
Private practice: autonomy and close relationship with patients; entrepreneurial aspect (HR, investments, quality, compliance) to be managed.
Market: public hospitals recruit and private clinics compete to attract specialists in high demand. Rehabilitation centers (PMR, neuro, ortho) offer attractive living environments. Healthcare professionals from Europe (including European physiotherapists) are increasingly considering France, where support for integration is crucial.

To learn more about the European landscape by specialty: Which European countries offer the best remuneration for specialist doctors?.

FAQ

Does a general practitioner earn more in the public sector or in private practice?

Public: stable salary (pay scale + bonuses + on-call shifts), increases with seniority.
Private practice: depends on the volume of consultations, the agreement (sector 1/2), and the location; in underserved areas, financial incentives and an immediate patient base improve net income.

Why are there large income differences among specialists?

Access to operating rooms/technical facilities and the nature of procedures (technical vs. clinical).
Status (private practice sector 2 with extra billing vs. salaried public/private).
Volume of on-call shifts, organization (scheduling, shifts, team).

How is on-call duty compensated in hospitals?

National allowances for on-call and standby duty, increased rates for nights/weekends/public holidays.
Compensatory rest and possible local variables (responsibilities, coordination).

What expenses should be anticipated in private practice?

CARMF, URSSAF, supplementary pension, disability insurance.
Office expenses (rent, equipment, secretarial services, software, telecommunications), professional liability insurance.
Taxes: income tax (BNC) or corporate tax (SEL) + social contributions/dividends.

Does Private Employment Always Guarantee a Better Salary Than Public?

The base salary may be higher, but bonuses and targets determine the net income.
Well-compensated public on-call shifts can reduce or even eliminate the gap.
Working conditions and team organization also play a significant role.

Can You Combine Public and Private Work?

Yes, under certain conditions: regulated hospital private practice, part-time work, or temporary assignments.
Check local regulations (contract, caps, compatibility) before committing.

Conclusion

Comparing doctors’ salaries between the public and private sectors in France requires a factual approach: annual total, deductions/taxes, and especially net hourly pay including non-clinical time, on-call shifts, and standby duties. Differences are mainly due to specialty, status, and location; the right decision is based on quantified scenarios and a 3–5 year career vision.

Are you recruiting or considering a career change? Euromotion Medical, a healthcare recruitment agency specializing in medical recruitment in France, supports doctors throughout the entire process: salary benchmarking, personalized simulations, negotiation, and integration into public hospitals, private clinics, and rehabilitation centers. Contact our consultants to analyze your situation and identify the option best suited to your specialty and goals.