France is facing a medical demography crisis. Across large parts of the country — from rural départements to entire arrondissements in major cities — patients are struggling to find a general practitioner or specialist within a reasonable time and distance. This shortage is not a temporary imbalance; it is a structural challenge that French health authorities are addressing through several parallel strategies, one of the most significant being the recruitment of doctors trained outside France.
Two Very Different Pathways Into French Practice
Not all foreign-trained doctors face the same road to practicing in France. The pathway depends entirely on where the diploma was obtained.
Within the European Union, mutual recognition of medical qualifications has applied automatically since 2005. A doctor trained in Germany, Spain, Italy, or any other EU/EEA member state can, in principle, register with the French Ordre des Médecins and begin practicing without sitting additional examinations.
Outside the European Union, the pathway is considerably more demanding. These practitioners are known in French administrative language as PADHUE — Praticiens à Diplôme Hors Union Européenne. Before they can obtain the right to practice independently in France, PADHUE candidates must:
- Pass the Épreuves de Vérification des Connaissances (EVC), a national knowledge-verification examination;
- Demonstrate proficiency in French;
- Complete a skills consolidation placement (parcours de consolidation des compétences) within a hospital department; and
- Have their competencies formally validated by a national commission specific to their specialty.
It is a long and technical process — but for many practitioners, and for the French hospitals that depend on them, it is the only route to a stable, secure medical career in France.
The Scale of the Need
Roughly 8% of doctors currently practicing full-time in France were trained outside Europe — a proportion that is notably lower than in several neighboring European countries that also rely heavily on internationally trained physicians. This is despite France having one of the largest medical workforces on the continent: approximately 240,000 practicing doctors, with more than 12,000 new French-trained doctors expected to enter the profession by 2025.
Even with that domestic pipeline, French authorities recognize it will not be enough. For 2025 alone, more than 4,239 PADHUE positions were opened for competitive examination — 440 for candidates applying from outside the French hospital system (“external” candidates) and 3,799 for practitioners already working inside French establishments (“internal” candidates). The message from the administration is clear: PADHUE recruitment is not a stopgap, it is a structural pillar of France’s healthcare staffing strategy.
A System Under Reform: The Valletoux Law
Many PADHUE doctors are not new arrivals. A significant number have been working in French hospitals for years — sometimes on precarious, renewable contracts — quietly keeping entire departments and, in some cases, entire hospitals functioning. Their administrative and professional status, however, has often lagged well behind their actual contribution.
The Loi Valletoux (2023) and its subsequent implementing decrees were designed specifically to address this imbalance. The reform aims to accelerate the integration of these already-practicing physicians, streamline the validation procedure, and extend the possibilities for qualification recognition both in mainland France and in French overseas territories, where medical shortages are often even more acute.
What Rigorous PADHUE Validation Should Look Like: The National Academy of Medicine’s Five Criteria
The French National Academy of Medicine has set out a framework for how competency verification should work — for both newly arriving candidates and practitioners already embedded in French establishments — particularly for positions in areas identified as high medical need.
1. Validated Medical Knowledge
An anonymous written examination, potentially supplemented by an oral component, assesses each candidate’s scientific and clinical knowledge. The test is built on programs designed by the Conseils Nationaux Professionnels (CNP) for each specialty, ensuring alignment with the standards of French medical training.
2. French Language Proficiency
Candidates must demonstrate at least a B2 level of general French. For certain specialties, a dedicated medical-language test — written and spoken — at C1 level may also be required, to guarantee effective communication in complex clinical situations where precision is not optional.
3. Quality of Padhue Professional Practice
Evaluation of Padhue should draw on assessments from the heads of department where the candidate has worked or is completing a consolidation placement. The Academy also recommends that technical skills — particularly in surgery and interventional medicine — increasingly be assessed through simulation-based tools.
4. Understanding of the French Healthcare System
Dedicated training during hospital placements should cover how the healthcare and social protection system operates, the values underpinning the public service mission, the role of health insurance, and the importance of interprofessional collaboration in patient care.
5. A Commitment to Public Service
Doctors already working in a healthcare establishment are expected to commit to at least five years of service within an establishment carrying a public service mission, in the geographic area where they were recruited — a measure aimed directly at stabilizing coverage in underserved territories.
What Happens When a Candidate Doesn’t Pass?
Not every PADHUE candidate who has spent years contributing to French hospitals succeeds in the verification process, even after multiple attempts. The National Academy of Medicine has called for these practitioners to be supported into alternative roles that still make use of their medical knowledge — such as patient medical information roles, medical coding, or hospital hygiene functions — rather than losing their place in the system entirely.
Why Legal Guidance Matters at Every Stage
Between the EVC, the French-language requirement, the consolidation placement, the national commission’s specialty-specific validation, and — layered on top of all of it — the immigration formalities (visas, residence permits, work authorizations), the PADHUE pathway involves several administrations that do not always communicate smoothly with one another. A missed deadline, an incomplete file, or a residence permit that falls out of step with a hospital placement schedule can derail years of effort, for both the practitioner and the recruiting establishment.
This is precisely where legal support makes the difference — securing the immigration status at each professional milestone, anticipating points of friction between hospital administration and prefectural procedures, and keeping the practitioner’s file moving through a process that was not designed to be intuitive.
Learn with J2M Law Firm how to build a secure immigration pathway to France — whether you are a PADHUE practitioner planning your route to full practice rights, or a hospital medical affairs department structuring the recruitment of foreign-trained doctors.