PADHUE in France: EVC, PACT, PCC, AEP, ATE, FFI & DFMS – a complete Guide

What Is a PADHUE in France?

PADHUE stands for Praticien à Diplôme Hors Union Européenne.

The term generally refers to a doctor, dentist, midwife or pharmacist whose professional degree was obtained outside the European Union and who wishes to practice or undertake clinical training in France. France does not have one single PADHUE status.

Several professional pathways may apply depending on:

• where the practitioner’s degree was obtained;
• whether the practitioner is an EU or non-EU national;
• whether the practitioner has already passed the EVC;
• whether an AEP or ATE has been issued;
• whether the practitioner is seeking definitive authorization to practice or additional training;
• whether a French hospital is prepared to recruit or host the practitioner; and
• the practitioner’s existing administrative situation.

This distinction is important because the EVC is not necessarily the first step for every PADHUE.

Some candidates enter the French healthcare system through training pathways such as stagiaire associé, fellowship or FFI/DFMS/DFMSA, while others follow the authorization-to-practice pathway involving AEP, PACT, EVC and PCC.

Which PADHUE Pathway Applies to You?

Not sure? Take the test and we will tell you.

The first question should be:

What do you want to do in France?

If your objective is additional or specialized training, 
You may, instead of taking the EVC exam immediatly, be looking at:

• Stagiaire associé
• or Fellowship → ATE
• or DFMS / DFMSA → FFI

These are not simply steps on the EVC pathway. They are distinct training arrangements with their own eligibility requirements and regulatory frameworks.

If your objective is to obtain definitive authorization to practice

The principal pathway is:

AEP → PACT → EVC → Associate Practitioner → PCC → CNAE → Definitive Authorization

In this pathway, the practitioner obtains an AEP, practices under the applicable PACT framework and takes the EVC during this period.

Passing the EVC allows the practitioner to move into the associate-practitioner/PCC stage, subject to the applicable conditions.

If you are a non-EU national but your professional degree was obtained in the EU

A separate I bis procedure may apply, subject to the applicable conditions and quota.

The key distinction: Not every PADHUE enters France through the EVC. The appropriate pathway to practice medicine in France depends on the candidate’s objective and existing situation.

PADHUE Pathways at a Glance

This table should be understood as a starting point. A candidate’s precise eligibility must be assessed against the applicable regulatory framework.

Pathway A: You Want to Train in France

A PADHUE may come to France for structured clinical or specialized training without necessarily entering immediately into the definitive authorization pathway.

The main possibilities identified in this framework are:

• Stagiaire associé
• Fellowship with ATE
• FFI through DFMS or DFMSA

These pathways should be considered separately from the AEP/PACT/EVC/PCC route.

Stagiaire Associé

The stagiaire associé pathway is available to PADHUE practitioners seeking supplementary training under an international cooperation agreement.

The placement generally lasts:

• six months;
• renewable once at the same institution;
• with a maximum overall period of two years in France.

The trainee participates in clinical activities under the responsibility of a named fully authorized practitioner.

Activities may include:

• prevention;
• diagnosis; and
• care.

Cooperation agreement: The cooperation agreement must be prepared sufficiently in advance and approved by the prefect of the host department. It identifies matters including: the practitioner’s administrative status, training objectives, institution selection criteria, supervising practitioner, host structure, dates and duration, practical content, and funding arrangements where applicable.

Legal basis: Article L.6134-1 and Article R.6134-2 1° of the Public Health Code; Order of 16 May 2011, as amended by the Order of 9 February 2024; relevant interministerial circular.

Fellowship and ATE

A PADHUE may also undertake further training through a fellowship-type arrangement under an international cooperation agreement.

This pathway is associated with a Temporary Authorization to Practice (ATE) issued by the CNG.

The framework is similar to the associate-trainee pathway:

• six months;
• renewable once at the same institution;
• maximum two years in France;
• supervised clinical activity;
• up to 10 half-days per week within the applicable 48-hour framework.

Documents for the ATE application: The application may require: a commitment or promise of placement from the host hospital, proof of identity, professional degree, certification from the competent authorities in the country of origin that the degree permits lawful practice of the specialty there, training project, CV, criminal-record documentation, French Bulletin No. 3 where applicable, and evidence of French-language proficiency.

FFI, DFMS and DFMSA

The FFI (Faisant Fonction d’Interne) route is particularly relevant to PADHUE practitioners undertaking specialized medical training.

It is associated with:

• DFMS — Diplôme de Formation Médicale Spécialisée, for practitioners still specializing; and
• DFMSA — Diplôme de Formation Médicale Spécialisée Approfondie, for practitioners who are already specialized.

Each year, a ministerial order establishes the number of available positions by: discipline, specialty, inter-region, and subdivision. Successful candidates are appointed as FFI by the director of the host institution for the duration of the placement.

When does the FFI pathway occur?

The important point for this article is: FFI/DFMS/DFMSA is a separate training pathway. It is not presented as a mandatory step before the EVC. A PADHUE pursuing specialized training through this route does not necessarily follow AEP → PACT → EVC → FFI. Instead, FFI can arise from the specialized-training route.

Duration:

• DFMS: two to six semesters — approximately one to three years.
• DFMSA: one to two semesters — approximately six months to one year.

Applications are generally submitted in December of the year preceding the placement. There are two principal recruitment mechanisms described in the framework: a national route centralized through the University of Strasbourg, and cooperation-agreement routes involving universities and hospitals.

Legal basis: Articles R.6153-41 to R.6153-44 of the Public Health Code; Order of 3 August 2010 on DFMS and DFMSA; relevant interministerial circulars.

Pathway B: You Want Definitive Authorization to Practice in France

For a PADHUE seeking definitive authorization to practice in France, the principal sequence described in the current framework is:

AEP → PACT → EVC → Associate Practitioner → PCC → CNAE → Definitive Authorization

The EVC therefore sits between the initial provisional practice stage and the consolidation stage.

AEP: Provisional Authorization to Practice

The AEP (Autorisation Provisoire d’Exercice) is the provisional authorization that allows qualifying PADHUE practitioners to begin supervised practice within the applicable framework.

The AEP is issued by the regional health agency (ARS) following review by the relevant PADHUE commission.

The source framework indicates that a candidate must generally demonstrate:

• three years of full-time professional experience;
• at least one year of that experience within the preceding three years;
• a commitment to sit the EVC;
• the ability to practice under the supervision of a health establishment;
• good civic standing;
• physical fitness for practice; and
• valid residence status.

The AEP is valid for 13 months and may be renewed once. The limited duration of the AEP makes forward planning important.

PACT: Temporary Associate Contractual Practitioner

What is PACT status? PACT is the status under which certain PADHUE practitioners can begin supervised clinical practice while progressing toward the EVC. The PACT pathway therefore provides an important bridge between provisional authorization, examination, skills consolidation, and definitive authorization.

What can a PACT practitioner do? While the AEP is valid, the practitioner may perform activities including: diagnosis, treatment, emergency care, on-call and standby duties alongside residents, and participation in continuity of care. The activities take place within the applicable institutional and supervision framework.

Important: PACT is not the same as definitive authorization. PACT allows practice within a provisional and supervised framework. It does not by itself give the practitioner unrestricted authorization to practice independently in France.

Legal basis: Articles L.4111-2-1 and L.4221-12-1 of the Public Health Code; Decrees No. 2024-1190 and 2024-1191 of 19 December 2024; Order of 16 January 2025.

When Does a PADHUE Take the EVC?

This is one of the most important points for candidates to understand.

In the PACT pathway, the EVC is taken after the AEP and during the PACT period.

The sequence is:

1. AEP obtained
2. PACT supervised practice begins
3. Candidate takes the EVC
4. If successful → Associate Practitioner status
5. PCC
6. CNAE review
7. Definitive authorization

The candidate must sit the EVC before the AEP expires. The EVC is therefore not something that takes place after the PCC; it is the examination that opens the way to the associate-practitioner/PCC stage. The EVC follows its own annual registration calendar published by the CNG, so candidates should monitor the examination schedule carefully.

But the EVC is not necessarily the entry point for every PADHUE. A PADHUE who comes to France for supplementary or specialized training may instead enter through stagiaire associé, fellowship, FFI, DFMS, or DFMSA. Those training pathways should not be presented as mandatory preliminary steps before taking the EVC.

Associate Practitioner Status

What happens after the EVC? A candidate who has passed the EVC may enter associate practitioner status if the applicable conditions are met and the candidate is recruited by a public hospital or a nonprofit private hospital (ESPIC).

The associate practitioner then enters the PCC — Parcours de Consolidation des Compétences. The practitioner performs care, diagnostic and prevention activities under the responsibility of a fully authorized practitioner. Working time is subject to the applicable limits, including a maximum of 10 half-days per week and the relevant 48-hour limit over a rolling four-period.

Duration: The PCC generally lasts two years for doctors and pharmacists, and one year for midwives and dentists.

PCC: Skills Consolidation Pathway

The PCC (Parcours de Consolidation des Compétences) is the supervised practical stage following successful completion of the EVC.

Its purpose is to allow the practitioner to demonstrate the clinical, interpersonal and organizational competencies necessary for autonomous practice. The EVC laureate must enroll in initial training at the university UFR corresponding to the profession and specialty and connected to the assigned placement.

The PCC is therefore both a period of supervised clinical practice and a formal component of the professional authorization process. Candidates should begin looking for a suitable placement institution before EVC results are published, as the PCC can only begin once an appropriate hospital has agreed to host the candidate.

CNAE and Definitive Authorization

After the relevant consolidation process, the file is reviewed by the CNAE (Commission Nationale d’Autorisation d’Exercice).

The CNAE may:

• grant authorization to practice and permit registration with the relevant professional order; or
• require an additional PCC.

The ultimate objective is therefore: EVC → PCC → CNAE → definitive authorization to practice. Passing the EVC alone does not mean that the practitioner has obtained unrestricted authorization to practice independently.

Pathway C: You Have an EU Degree but Are a Non-EU National

A separate procedure may apply to certain practitioners who: are nationals of a non-EU country, but hold a professional degree obtained in the EU.

This is commonly referred to as the “I bis” procedure. It may apply to doctors, pharmacists, dentists, and midwives.

The procedure is subject to applicable conditions and is quota-based. Without a ministerial order opening the relevant number of positions for a given year, the CNG cannot process applications under this route. Where the quota is open, authorization may be granted on a renewable basis.

Legal basis: Articles L.4111-2 I bis and L.4221-9 of the Public Health Code and the applicable ministerial order.

What Is the ATE and When Is It Used?

The ATE (Autorisation Temporaire d’Exercice) is a temporary authorization mechanism applicable in specific circumstances.

It may be relevant to PADHUE practitioners who are:

• waiting for an AEP;
• on an EVC supplementary list and waiting for a placement; or
• waiting for CNAE review and, where appropriate, professional-order registration.

The recruiting institution requests the ATE from the ARS through the applicable online procedure. The ATE can therefore serve as a bridge between stages of the professional process. It should not, however, be confused with definitive authorization to practice.

Legal basis: Instruction DGOS/RH2/2025/107 of 30 July 2025 concerning temporary and derogatory measures authorizing certain foreign medical and pharmacy practitioners holding non-EU degrees.

What Happened to the PADHUE Stock Procedure?

The former PADHUE Stock procedure is closed to new applications.

It was an exceptional route for PADHUE practitioners who had practiced in France during specified historical periods and who satisfied the applicable conditions. New applications can no longer be filed.

However, practitioners who entered the procedure during the relevant period may still be progressing through the legacy process. Some candidates remain waiting for a hospital placement in order to complete their PCC. For these practitioners, the CNAE may grant definitive authorization, refuse authorization, or require a PCC. The legacy PADHUE Stock procedure should therefore be distinguished from the current pathways available to new candidates.

How Long Does Each PADHUE Pathway Take?

There is no single PADHUE processing time. The timeline depends heavily on the pathway.

For the authorization pathway, planning should begin well before the EVC. The source specifically recommends monitoring the national EVC calendar and beginning the search for a placement institution before EVC results are published.

How to Determine the Right PADHUE Pathway for Your Case

A useful initial assessment should answer five questions:

1. Where was your professional degree obtained? Outside the EU? You may fall within the standard PADHUE framework. Inside the EU? If you are a non-EU national, the I bis procedure may need to be considered.
2. What is your objective? Definitive authorization to practice? Look at the AEP/PACT/EVC/PCC/CNAE pathway. Additional or specialized training? Consider stagiaire associé, fellowship, FFI, DFMS or DFMSA.
3. Have you already passed the EVC? No: You may need to determine whether the AEP/PACT/EVC pathway applies. Yes: The associate-practitioner/PCC stage may be relevant, depending on recruitment and other conditions.
4. Do you already have a French hospital? A host or recruiting institution is central to several PADHUE pathways. Hospital placement should therefore be considered early rather than after the administrative process is complete.
5. What is your current status in France? The professional right to practice and the immigration right to stay in France are separate legal questions. A PADHUE may need to address both.

PADHUE Frequently Asked Questions

• What does PADHUE mean? PADHUE stands for Praticien à Diplôme Hors Union Européenne. It generally refers to a doctor, dentist, midwife or pharmacist whose professional degree was obtained outside the European Union.
• Does every PADHUE have to take the EVC? No. The EVC is central to the pathway toward definitive authorization through the AEP/PACT/PCC framework, but other PADHUE may come to France for supplementary or specialized training through pathways such as stagiaire associé, fellowship or FFI/DFMS/DFMSA.
• When does a PADHUE take the EVC? In the PACT pathway, the practitioner takes the EVC after obtaining the AEP and while practicing under the PACT framework, before moving into associate-practitioner status and the PCC. The EVC must be taken before the AEP expires.
• What happens after passing the EVC? Subject to the applicable conditions and hospital recruitment, the practitioner can enter associate practitioner status and undertake the PCC.
• Is the EVC taken after the PCC? No. In the PACT pathway, the EVC comes before the PCC: AEP → PACT → EVC → Associate Practitioner → PCC → CNAE.
• Can a PADHUE come to France without immediately taking the EVC? Yes. A practitioner seeking additional or specialized training may potentially use a different pathway, such as stagiaire associé, fellowship, FFI, DFMS, or DFMSA.
• What is FFI status? FFI (Faisant Fonction d’Interne) is a training status relevant to certain specialized medical training arrangements, including DFMS and DFMSA. It should be considered a training pathway, rather than a mandatory stage of the EVC/PCC authorization route.
• What is the difference between AEP and ATE? The AEP is the provisional authorization associated with the PACT pathway. The ATE is a temporary authorization mechanism that may apply in specific transitional or training situations. They are not interchangeable.
• Can a PADHUE work in France before definitive authorization? Yes, depending on the applicable status and authorization. Possible frameworks include PACT, associate practitioner, stagiaire associé, fellowship and FFI, as well as certain ATE situations. Each has its own scope of practice and supervision requirements.
• Is the PADHUE Stock procedure still open? No. New applications under the former procedure can no longer be filed.

How J2M Can Assist PADHUE Practitioners and Hospitals

PADHUE cases are often difficult because professional authorization, hospital recruitment and immigration status interact but are not the same legal process. The first step is therefore not necessarily to file an application; it is to identify the correct pathway.

J2M Law Firm assists PADHUE practitioners and healthcare institutions with issues including:

• identifying the appropriate PADHUE pathway;
• assessing eligibility;
• reviewing professional and administrative documentation;
• AEP and PACT matters;
• EVC-related planning;
• PCC and hospital-placement issues;
• ATE-related procedures;
• training pathways including FFI/DFMS/DFMSA;
• interaction between professional authorization and French immigration status; and
• anticipating procedural problems before they delay recruitment or clinical practice.

For hospitals and Directions des Affaires Médicales (DAM), early legal review can also help identify whether a prospective foreign-trained practitioner can actually begin working under the intended status and what steps must be completed before arrival or recruitment.

For practitioners, the key question is:

Which PADHUE pathway corresponds to my current situation and my professional objective in France?

Once that question has been answered, the next administrative and professional steps become much clearer.

Related J2M resources:

• Practicing medicine in France as a foreigner
• Find your pathway to practicing medicine in France
• Youtube Medicine in France

This article provides general information based on the regulatory framework identified above. PADHUE eligibility and procedures depend on the practitioner’s individual circumstances and on the regulations applicable at the time of the application. Specific cases should be reviewed against the current legal and administrative framework.

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