A practical reference for foreign-trained doctors, dentists, midwives, and pharmacists — and for the hospitals and Directions des Affaires Médicales (DAM) recruiting them.
If you hold a medical, dental, midwifery, or pharmacy degree obtained outside the European Union, you are what French regulation calls a PADHUE (Praticien à Diplôme Hors Union Européenne). France offers several distinct statuses and pathways to practice or train here, and which one applies to you depends on your administrative situation, your training background, and your professional experience. Each route is governed by its own regulatory texts, its own eligibility rules, and its own paperwork — which is exactly where most candidates and hospitals lose time.
This guide answers the questions PADHUE candidates and DAM teams ask most often — what PACT, EVC, PCC, AEP, and ATE actually mean, who qualifies for each, and how long each stage takes — status by status, in the order a candidate is likely to move through them. It closes with a summary table, an FAQ, and the practical next steps. It reflects the regulatory framework as currently applied; recruitment decisions and case-by-case eligibility remain the responsibility of the hiring institution, and specific situations should always be checked against the current texts or with counsel.
Related on this site: practiving medicine in France as a Padhue · Padhue a legal road map ·
Path 1 — How can a PADHUE start practicing medicine in France now?
What is PACT status (Temporary Associate Contractual Practitioner)?
The PACT status is the entry point for PADHUE — including recognized refugees — who:
- are in good standing civically and have no disqualifying conviction;
- meet the physical fitness requirements for practice;
- hold a valid residence status; and
- have been granted a Provisional Authorization to Practice (AEP).
Getting the AEP. The AEP is issued by the regional health agency (ARS) after a specialized PADHUE commission reviews the file. To qualify, a candidate must generally show three years of full-time professional experience, including at least one year within the last three, commit to sitting the Knowledge Verification Examinations (EVC — see below), and be able to work under the supervision of a health establishment. The AEP is valid for 13 months and can be renewed once; it authorizes supervised practice within one named institution. Sitting the EVC before the AEP expires is mandatory — missing that deadline can lead to withdrawal of the authorization.
What a PACT can do. While the AEP is in force, the practitioner may carry out diagnostic, treatment, and emergency-care acts, take part in on-call and standby duty alongside residents, and contribute to the continuity of care within the institution.
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 setting the territorial jurisdiction of the review commissions.
What happens after passing the EVC? Associate Practitioner status
Once a candidate has passed the EVC, a second, temporary status opens up: associate practitioner, built around the mandatory Skills Consolidation Pathway (PCC).
Eligibility. Two conditions: having passed the EVC (whether through the internal track, external track, or “List B”), and being recruited by a public hospital or a nonprofit private hospital (ESPIC).
Duration. The contract runs for the length of the consolidation pathway — two years for doctors and pharmacists, one year for midwives and dentists.
Scope of practice. The associate practitioner carries out care, diagnosis, and prevention duties under the responsibility of a fully licensed practitioner, capped at 10 half-days a week (48 hours maximum over any rolling four-month period).
What is the PCC (Skills Consolidation Pathway) and is it mandatory?
The PCC is a supervised, practical training pathway required by French regulation. It lets the candidate demonstrate — in real clinical conditions — the clinical, interpersonal, and organizational competencies needed before being allowed to practice autonomously. EVC laureates must enroll in initial training at the university (UFR) matching their profession and specialty, tied to wherever they have been assigned.
Quick recap
| Step | Status held | Purpose |
|---|---|---|
| Passing the EVC | — | Demonstrates core theoretical and practical knowledge |
| Completing the PCC | Associate practitioner | Two years’ supervised practice for doctors/pharmacists; one year for midwives/dentists |
| Review by the National Practice Authorization Commission (CNAE) | — | Grants the authorization to practice and register with the professional order — or prescribes an additional PCC |
Two things worth planning around early: track the national examination calendar published by the CNG, and start the search for a placement institution well before the EVC results come out — the PCC only begins once a hospital has agreed to host the candidate.
Legal basis: Articles L.4111-2 and L.4221-12 of the Public Health Code; Articles R.6152-901 to R.6152-933; Order of 9 July 2021 on the organization of the EVC; Directive 2005/36/EC of the European Parliament and Council on the recognition of professional qualifications.
What is the “PADHUE Stock” backlog procedure?
This was a now-closed, exceptional route for PADHUE who had practiced in France for at least two years between 1 January 2015 and 30 June 2021, including at least one day of practice between 1 October 2018 and 30 June 2019. New applications under this procedure can no longer be filed. A number of candidates from that cohort, however, remain on a waiting list for a hospital placement, simply because not enough institutions have agreed to host them under the CNAE framework — and no deadline has been set for them to complete their PCC.
For those still in the pipeline, the CNAE can grant full authorization, refuse the application, or order a PCC. Where a PCC is ordered, it typically combines theoretical and practical components, must take place in a department approved to host residents, and only starts once the ARS has assigned the candidate to a host institution (which is also what allows them to enroll at the university). At the end of the PCC, the candidate must file a fresh application with the CNAE to obtain definitive authorization to practice.
Legal basis: Article 83 of Law No. 2006-1640 of 21 December 2006 (as amended by Law No. 2022-1616 of 23 December 2022); Decree No. 2020-1017 of 7 August 2020.
Path 2 — What training statuses exist for PADHUE before full authorization?
Three statuses exist for PADHUE who are not (yet) seeking full authorization to practice, but want structured clinical training in a French institution.
What is the associate trainee status (Stagiaire associé)?
Open to PADHUE seeking supplementary training under an international cooperation agreement. Placements run six months, renewable once at the same institution, for a maximum of two years in France overall, capped at 10 half-days a week (48 hours over any rolling four months). The trainee takes part in prevention, diagnosis, and care activities, delegated by and under the responsibility of a named, fully licensed practitioner.
The cooperation agreement must be drafted at least two months before the placement begins and cleared by the prefect of the host department. It has to spell out the trainee’s regular administrative status, the training’s learning objectives, the institution’s selection criteria, the name of the supervising practitioner, the host structure, and the dates, duration, and practical content of the placement. It is signed by the trainee, the director of the host institution, the supervising practitioner, the partner organization behind the cooperation arrangement, and, where relevant, whoever is funding the trainee’s stipend.
Legal basis: Article L.6134-1 and Article R.6134-2 1° of the Public Health Code; Order of 16 May 2011 on associate trainees (as amended by the Order of 9 February 2024); interministerial circular DIMM/BIP/DGOS/RH4 No. 2012-111 of 7 March 2012.
What is the fellowship status for PADHUE?
Also for PADHUE pursuing further training in France, under a cooperation agreement and subject to a Temporary Authorization to Practice (ATE) issued by the CNG. Same rhythm as the trainee status: six months, renewable once at the same institution, two years total nationwide, up to 10 half-days a week within the 48-hour weekly cap (averaged over four months). Scope of activity mirrors the trainee status — prevention, diagnosis, and care, delegated and supervised.
The ATE application file, built around the cooperation agreement, needs the hosting hospital’s promise of placement, proof of identity, proof of the degree, a certification from the competent authorities in the country of origin that the degree in question authorizes lawful practice of the specialty there, the training project itself, a CV, a criminal record extract (or equivalent), a French Bulletin n°3 if the candidate has already resided in France, and proof of French-language proficiency.
Legal basis: Article L.6134-1 and Article R.6134-2 3° CSP; Article L.4111-1-2 2° CSP; Articles R.4111-33 and R.4111-35 CSP; Decree No. 2017-1601 of 22 November 2017; Order of 19 March 2018.
What is FFI status (Faisant Fonction d’Interne) and who qualifies?
For PADHUE training under a DFMS (Specialized Medical Training Diploma, for those still specializing) or a DFMSA (Advanced Specialized Medical Training Diploma, for those already specialized). Each year, a ministerial order sets the number of places available by discipline, specialty, inter-region, and subdivision.
Selected candidates are appointed FFI by the director of the host institution, for the duration of the placement, renewable every six months.
Application window: files are submitted in December of the year before the placement starts, and generally include a proof of identity and nationality, a transcript of specialized training from the home institution, a cover letter, a sworn statement that the candidate does not already hold a diploma or interuniversity specialization certificate, and, where relevant, an interuniversity cooperation agreement signed by both the training UFR and the host institution.
Two recruitment routes. Under the national route, candidates apply through the University of Strasbourg, which centralizes applications before forwarding eligible files to participating French universities, each of which runs its own selection panel; successful candidates enroll in September for a November start. Under the cooperation-agreement route, UFRs and hospitals can offer a reserved PADHUE placement under an interuniversity agreement, listed separately.
Duration. DFMS: two to six semesters (one to three years). DFMSA: one to two semesters (six months to a year).
Legal basis: Articles R.6153-41 to R.6153-44 CSP; Order of 3 August 2010 on the DFMS and DFMSA; interministerial circular DGOS/RH1/RH4/DDI/BIP No. 2012-330 of 31 August 2012; circular No. 2013-0003 of 7 February 2013.
Path 3 — What if your degree was obtained inside the EU?
What is the “i bis” procedure for non-EU nationals with an EU degree?
This route lets certain health professionals — doctors, pharmacists, dentists, midwives — with a degree obtained inside the EU, but who are themselves nationals of a non-EU country, practice in France temporarily or permanently, under conditions. It is a quota-based procedure: without a ministerial order opening a set number of places for a given year, the CNG cannot process any file received under this route, however complete. Where a quota is open, it grants authorization to practice renewable roughly every three to four years.
Legal basis: Article L.4111-2 I bis and Article L.4221-9 CSP; Order of 13 May 2024 fixing the maximum number of authorizations to be issued under those articles.
What is the procedure for EU nationals with an EU degree?
Step 1. Check whether the degree in question appears on the official list of recognized diplomas and qualifications eligible for automatic recognition (published via Légifrance).
Step 2 — if the degree is on the list: the professional’s regional Ordre council handles automatic recognition, checks French-language proficiency, issues a certificate of conformity or acquired rights, and rules on registration to the professional roll.
Step 2 — if the degree is not on the list: the candidate must instead file an authorization-to-practice application with the CNAE at the CNG.
How do you register for the EVC (Knowledge Verification Examinations)?
Registration for the EVC follows its own calendar and process, published each year by the CNG. Since the EVC result is the gateway into the associate-practitioner/PCC pathway described above, tracking the registration window closely — and preparing well ahead of it — is one of the highest-leverage things a candidate (or a sponsoring institution) can do.
What is the ATE (Temporary Authorization to Practice)?
The ATE exists to cover the gap while a candidate’s file moves through one of the procedures above. It’s relevant for PADHUE who are: waiting for their AEP to be issued; on the EVC 2024 supplementary list awaiting a placement; or waiting to appear before the CNAE and, if the outcome is favorable, to be registered with the professional order.
Procedure. The recruiting institution requests the ATE from the ARS through the online démarches simplifiées platform, allowing the practitioner to keep working at the institution while the underlying procedure is finalized.
Legal basis: Instruction DGOS/RH2/2025/107 of 30 July 2025 on the temporary, derogatory measures authorizing certain foreign medical and pharmacy practitioners holding non-EU degrees to practice.
Frequently asked questions
What does PADHUE mean? PADHUE stands for Praticien à Diplôme Hors Union Européenne — a doctor, dentist, midwife, or pharmacist who obtained their degree outside the European Union and wants to practice in France.
What is the difference between PACT and associate practitioner status? PACT covers a PADHUE holding a Provisional Authorization to Practice (AEP) before sitting the EVC. Associate practitioner status begins after passing the EVC, once the candidate enters the PCC (Skills Consolidation Pathway). They sit at different points on the same overall route.
How long does the PADHUE authorization process take? There is no single timeline — it depends on the EVC exam calendar, how quickly a hospital placement is secured, and the length of the PCC (one to two years depending on the profession). Candidates and institutions who start planning before EVC results come out generally move faster than those who start afterward.
Can a PADHUE work in France before getting full authorization to practice? Yes, through several intermediate statuses — PACT (with an AEP), associate practitioner (during the PCC), associate trainee, fellowship, or FFI — each with its own scope of practice and supervision requirements, and through the ATE as a bridge status between stages.
Is the “PADHUE Stock” procedure still open? No. New applications under that backlog procedure can no longer be filed, though candidates from the original cohort may still be waiting for a hospital placement to complete their PCC.
Why this rarely goes smoothly on paper alone
Every status above looks linear on a regulatory chart — degree, examination, placement, authorization. In practice, each transition (AEP to PACT, EVC to PCC, PCC to CNAE hearing) is a point where a missing document, a missed deadline, or an institution unfamiliar with the framework can stall or derail an otherwise-qualified candidate. For hospitals, that risk shows up as a recruited doctor who never actually starts; for practitioners, it shows up as months or years of delay.
J2M advises health establishments and PADHUE practitioners at each of these stages — from structuring the AEP and ATE applications to anticipating what happens if an authorization is refused after the candidate has already arrived. If you are navigating one of these pathways, we’re glad to review where your file currently stands.