How Russian doctors can get licensed in France: a guide to the exams, paperwork, and timelines

The sole pathway: the PAE procedure

For doctors with a degree from outside the European Union (known as PADHUE), there is only one route to obtain a license to practice in France: the Procédure d’Autorisation d’Exercice (PAE). This lengthy, multi-stage process (averaging 3-4 years) is coordinated by the National Management Center (CNG), which runs the examination, and the Regional Health Agencies (ARS), which handle initial applications.

The EVC: more than an exam, it’s a competition

The centerpiece of the PAE is the knowledge verification exam, the Épreuves de Vérification des Connaissances (EVC). It is crucial to understand that this isn’t a simple pass/fail test; it’s a concours (a competitive examination), where success depends on ranking among the top candidates within a strict quota for each specialty.

The key strategic difference lies in two candidate lists:

Liste A (External Competition): The primary route for most foreign doctors applying from abroad. The number of spots is extremely limited by an annual ministerial decree.

Liste B (Internal Exam): Reserved for refugees, stateless persons, and certain other categories of individuals already residing in France. This is an exam, not a competition; candidates who achieve a passing score are admitted without being subject to the strict quotas.

An analysis of the official 2025 quotas reveals a fundamental filtering mechanism. The total number of spots for external candidates (Liste A) is 400, while for internal candidates (Liste B) it is 4,000. This disparity is especially stark in high-demand specialties: general medicine (80 spots for Liste A vs. 1354 for Liste B), anesthesiology and critical care (18 vs. 309), and emergency medicine (66 vs. 415).

These figures clearly show that the PAE/EVC system functions less as an open channel to attract international specialists and more as a mechanism to legalize and integrate doctors who are already working within the French healthcare system. For a Russian doctor applying from Russia, this means competing for an extremely small number of «leftover» spots in a system designed primarily to address domestic staffing shortages. This makes the Liste A competition incredibly challenging and requires candidates to have a very realistic assessment of their chances.

Specialty	Number of Spots (Liste A — External)	Number of Spots (Liste B — Internal)
Anesthesiology & Critical Care	18	309
Geriatrics	30	410
Cardiology	15	122
Emergency Medicine	66	415
Occupational Medicine	11	112
General Medicine	80	1354
Psychiatry	80	135
Radiology & Medical Imaging	30	112
TOTAL (Medicine)	400	3,415
TOTAL (All Professions)	400	4,000

Source: Decree of June 27, 2025.

The post-EVC consolidation period

Successfully passing the EVC doesn’t grant an immediate right to practice independently. Successful candidates must complete a two-year «skills consolidation period» (parcours de consolidation des compétences, PCC) under the status of a praticien associé (associate practitioner). During this time, the doctor works under the direct supervision of a department head, performing standard duties but without the authority to substitute for other physicians. At the end of this period, the department head submits a report to a national commission. The gross annual salary for this position ranges from €36,083 to €40,775.

Final steps: authorization and registration

Practice Authorization Commission (CAE): After completing the PCC, the doctor’s file is reviewed by the national commission (Commission d’Autorisation d’Exercice, CAE) for their specialty, which then issues the final authorization to practice.
Order of Physicians (Ordre des Médecins): The final, mandatory step is registering with the departmental council of the Order of Physicians. This is a prerequisite for legally practicing medicine in France.

Immigration and income

Doctors who pass the EVC and receive a job offer for a praticien associé position can apply for a multi-year residence permit called «Passeport Talent – profession médicale et de la pharmacie», valid for up to 4 years. One of the conditions is proof of an annual income corresponding to the second salary tier for a praticien associé.

It’s important to note that this subcategory of residence permit does not automatically grant residency rights to family members. They must apply for their own residence permits separately on other grounds. This is a critical factor to consider when planning to relocate with a family.

Salary progression based on experience:

Status / Position	Annual Gross Salary (€)
Intern (1st year)	24,629
Junior Doctor (1st year)	28,495
Associate Practitioner (Tier 1)	36,083
Associate Practitioner (Tier 2)	40,775
Staff Hospital Physician (Tier 1)	55,608
Staff Hospital Physician (Tier 13)	112,417

Income variation by specialty:

Specialty	Average Annual Gross Income (€)
General Medicine	77,417
Psychiatry	70,184
Cardiology	132,610
Radiology	120,676
Ophthalmology	154,783
Anesthesiology & Critical Care	164,798
Oncology	316,365

Preliminary steps

Given the extremely high competition in the external EVC competition, it’s advisable for a doctor from Russia to consider strategies that allow transformation from an «external» candidate to an «internal» one.

Stage d’observation (Observational Internship): Although unpaid and non-clinical, this is an invaluable tool. It allows you to see the French system from the inside, learn protocols, improve your language skills, and, most importantly, network with department heads.
Faisant Fonction d’Interne (FFI): It’s possible to work as an FFI (acting intern) even before passing the EVC if a hospital offers a position. This provides priceless work experience, an official income, and significantly boosts your chances of passing the EVC in the future.

Alternative career paths for medical graduates

Clinical practice isn’t the only option for medical degree holders. French industry offers attractive and well-paying alternatives.

The two primary roles for doctors in the pharma industry are Medical Science Liaison (MSL) and Medical Advisor. These career paths offer a highly competitive but prestigious and financially rewarding alternative to clinical medicine. While starting salaries in a hospital are modest, industry salaries are significantly higher. The average MSL salary in Paris is approximately €85,583 per year. For a candidate who fails to secure a spot in residency or pass the EVC, this is not a defeat but an opportunity to pivot to a more lucrative career.

Role	Average Annual Gross Salary (€)	Notes
Medical Science Liaison (MSL)	€58,624 – €104,583 (in Paris)	A field-based, scientific role requiring deep knowledge in a specific therapeutic area.
Medical Advisor / Manager	€46,000 – €62,200 (mid-level)	An office-based role providing medical expertise to support business operations.
Directeur Médical (Medical Director)	€111,902 – €272,424	A senior leadership position requiring significant industry experience.

Key administrative procedures and long-term integration

Regardless of the chosen path, candidates will face meticulous document preparation. This is not just a formality but the first serious test of your organizational skills.

Apostille: According to the 1961 Hague Convention, all official Russian documents (diplomas, birth certificates, etc.) must be legalized with an apostille to be recognized in France.
Sworn Translator (Traducteur Assermenté): All Russian documents must be translated into French by a sworn translator accredited by a French court. Translations done in Russia are generally not accepted unless certified by the French consulate.

Any mistake, such as a missing apostille or an incorrect translation, can lead to the rejection of your entire application, costing you a full year.

After five years of continuous legal residence in France (e.g., with a «Passeport Talent» permit), you can apply for a permanent resident card and, eventually, for French citizenship through naturalization.

Conclusion and strategic recommendations

The paths to becoming a doctor in France for Russian citizens are complex, strictly regulated, and highly competitive. Alternative careers in the pharmaceutical and MedTech industries represent viable and often more profitable options.

Strategic recommendations for applicants:

Strategic choice of discipline: Approach your choice of an additional subject in PASS or a major in L.AS not as a formality, but as selecting a real alternative career.
Early language preparation: Start intensive French study as early as possible, aiming for a C1 level, not the minimum B2.
Financial planning: Carefully plan your budget, considering the significant cost of living differences between Paris and other cities.

Strategic recommendations for doctors:

Realistic assessment of EVC chances: Carefully analyze the quotas for your specialty in the external competition (Liste A). The competition is extremely high, and the chances of success for a candidate from abroad are statistically low.
System immersion: Actively seek an observational internship (stage d’observation) or an FFI position to gain experience within the French system before taking the EVC.
In-depth EVC preparation: The exam is based on French residency standards. You must study French clinical recommendations and protocols, not just international ones.

General recommendation

The key to success on any of these paths is meticulous long-term planning. Administrative procedures, including apostilling documents in Russia, finding a sworn translator, and meeting application deadlines, should begin at least 18–24 months before your intended start date. The path to a medical career in France is a marathon requiring not only academic and professional knowledge but also exceptional organization and persistence.

Егор Кугно

How Russian doctors can get licensed in France: a guide to the exams, paperwork, and timelines

Further reading on medical careers