Foreign-trained doctor, medical affairs director, department head: for many, the path to authorization to practice medicine in France remains a confusing string of acronyms — EVC, PCC, PACT, AEP, CNAE — whose practical stakes (contract, pay, job security) are nonetheless very concrete. Here are the key steps, in the order they actually occur.
You need to understand every step to authorization to practice in France and avoid the common pitfalls.
1. Who is concerned?
The status of PADHUE (praticien à diplôme hors Union européenne — practitioner with a non-EU medical degree) covers doctors, dentists, midwives and pharmacists who obtained their degree outside the European Union, the European Economic Area or Switzerland, and who wish to practice their profession in France. This includes practitioners still abroad as well as practitioners already present in France, sometimes for several years, under successive temporary practice statuses. Each practitioner’s administrative situation — a recent EVC laureate, a practitioner mid-way through the PCC, a practitioner awaiting a hearing before the commission — calls for very different next steps, which is why correctly placing one’s file within the process matters before acting.
2. What is the difference between the EVC and authorization to practice?
This is the most common point of confusion, even among institutions well used to recruiting PADHUE practitioners. The épreuves de vérification des connaissances (EVC — knowledge verification exams) are a competitive exam: they certify a level of knowledge comparable to that required to obtain the corresponding French degree. Passing the EVC does not, however, grant any automatic right to practice medicine in France. It is a selection stage, not a license. Authorization to practice, by contrast, is the final administrative decision — individual, permanent and full — that actually allows registration with the professional order (Ordre) and practice of the profession. Between the two lies an entire pathway, one that is often underestimated at the time of recruitment.
3. What is the procedure after the EVC?
Once the EVC has been passed, the laureate must be assigned to a post — by decision of the minister in charge of Health or, by delegation, the director general of the Centre national de gestion (CNG — National Management Centre) — in order to complete a parcours de consolidation des compétences (PCC — skills consolidation pathway) in their specialty. This pathway, currently two years full-time following the 2025 reform (down from three years previously), takes place within an approved healthcare institution, under the responsibility of a supervising practitioner (praticien référent). Only at the end of the PCC, based on a file bringing together evaluations and certificates of service, can the practitioner apply for final authorization to practice.
4. What role does the hospital institution play?
The institution is not simply an employer: it is a link in the procedure itself. It hosts the practitioner during the PCC, appoints the supervising practitioner responsible for evaluating them, and produces — via the department head, with input from the institution’s medical committee — the documents that will feed into the file submitted to the national commission. An insufficiently documented evaluation, a late opinion, or a post whose contractual footing is not properly secured can directly jeopardize the outcome of the pathway. For a medical affairs director, this means that oversight of a PADHUE file cannot be left to the practitioner alone: it engages the institution’s own liability and timeline.
5. What is the AEP?
The autorisation d’exercice provisoire (AEP — provisional authorization to practice) is an exceptional arrangement that allows certain practitioners already practicing in France — under specific conditions of professional experience or prior status — to continue practicing while their application is being reviewed, pending the opinion of a regional commission (CRAE) or the national commission (CNAE). It is neither a regularization nor a final authorization, but a transitional status that secures practice while the file is under review. Obtaining it requires a complete application filed in advance, including the required evidence of experience and prior duties.
6. What is the PACT?
The PACT (praticien associé contractuel temporaire — temporary associate contract practitioner) is the contractual status under which the skills consolidation pathway is carried out in most cases. In practice, it is a fixed-term contract of 13 months, renewable once, entered into between the assigning institution and the practitioner. It is this contract — combined, where applicable, with the AEP — that legally establishes the PADHUE practitioner’s presence within the department for the entire duration of the PCC. For the institution, how carefully this contract is drafted (post, specialty, duration, renewal terms) directly determines the security of the post the practitioner occupies, and therefore the continuity of the department’s service.
7. What happens before the commission?
At the end of the PCC — or, since the reform, sometimes before its term where the supervising practitioner has issued an early favorable opinion — the file is submitted to the commission nationale d’autorisation d’exercice (CNAE — national authorization-to-practice commission), attached to the CNG. This commission examines the evidence gathered throughout the pathway: successive evaluations, certificates of service, and the department head’s opinion. It issues an opinion that may be favorable, favorable with reservations, or unfavorable. It is on the basis of this opinion that the authorization-to-practice decision is subsequently made. Conversely, an unfavorable opinion issued during the pathway can now bring the PCC to an early end, without waiting for the two-year deadline — a development that calls for increased vigilance from the very start of the pathway.
8. What are the main grounds for a file being blocked?
Several recurring breaking points come up regularly in the files we handle: a PCC file that is incomplete or poorly documented by the institution, a PCC renewal extended without sufficient justification, a PACT contract that is irregular or poorly coordinated with the AEP, an unfavorable evaluation that was not anticipated in time by the practitioner or the department, or an unfavorable commission opinion because an appeal file was not prepared in time. Many of these blockages have nothing to do with the practitioner’s medical competence — they stem from procedural or scheduling defects, which is precisely what makes them avoidable with support secured in advance.
9. When should preparation of the file begin?
As early as possible — ideally from the moment of assignment to the PCC post, not as the two-year deadline approaches. The PACT contract should be secured from the moment of signature, interim evaluations should be tracked as they happen rather than reconstructed after the fact, and any difficulty flagged by the supervising practitioner should be addressed before it results in an unfavorable opinion or an extension. For an institution, this means bringing in legal support from the moment the practitioner is recruited, not at the point where an administrative problem threatens to cost an already-occupied post.
10. What role can a lawyer play?
Across a pathway this long, punctuated by administrative decisions — assignment to the PCC, the PACT contract, the AEP application, the commission’s opinion — a lawyer’s role is not limited to responding to a refusal. A lawyer can secure the file upstream: checking the regularity of the PACT contract and how it is coordinated with the AEP, making sure interim evaluations are properly gathered and documented, and working with the institution to identify points of vulnerability before they turn into an unfavorable opinion. Where difficulties do arise — a contestable extension of the PCC, an unfavorable commission opinion, a refusal of authorization to practice — a lawyer brings the necessary appeals (informal appeal, appeal before the administrative court) within the applicable deadlines. For an institution, having a lawyer follow its PADHUE files from the point of recruitment, rather than once a post is under threat, turns a litigation risk into a managed process.
J2M law firm supports healthcare institutions and PADHUE practitioners at every stage of this pathway — from securing the PACT contract through to following the file, and any appeals where necessary, before the national authorization-to-practice commission.