When Émilie, a nurse who had worked in a hospital for 9 years, decided to set up a private practice, she thought the hardest part would be finding patients. In reality, the hardest part was understanding that she was becoming a business owner — with everything that entails.
Installation: more than just a formality
Choosing the zone
For regulated paramedical professions, installation is regulated by the ARS (Regional Health Agency). Depending on the zone:
- Severely underserved zone: installation aid up to 50,000 euros (ARS incentive contract), tax exemptions if in disadvantaged rural areas, patient base virtually guaranteed immediately
- Underserved zone: moderate aid, good balance between support and quality of life
- Intermediate zone: no aid, no restrictions
- Overserved zone: installation conditional on a colleague's departure (for nurses and midwives)
The zone map is available on your regional ARS website. This is the first document to consult before making any decision.
Installation formalities
- Registration with the Professional Order (physiotherapists, nurses, midwives, speech therapists) — mandatory, annual fee 200 to 400 euros
- ARS registration — ADELI or RPPS number
- CPAM agreement — what allows you to bill the Health Insurance
- URSSAF registration — as a self-employed professional
- Membership in CARPIMKO (retirement fund for self-employed paramedics) — mandatory
- Professional liability insurance — mandatory
Realistic timeline: 2 to 3 months between the decision and the first patient.
The office: buy, rent, or share?
Private practice
A dedicated space of 30 to 60 m² (depending on specialty). Budget:
- Rent: 400 to 1,200 euros/month depending on the city
- Initial setup: 5,000 to 25,000 euros (furniture, medical equipment, accessibility compliance)
- Current expenses: 200 to 400 euros/month (electricity, water, cleaning, internet)
Group practice
The rising formula. You share the space, waiting room, and reception with other healthcare professionals (not necessarily from the same specialty). Advantages:
- Rent divided by 2 to 4
- Cross-referrals between professionals (the physiotherapist refers to the osteopath, the osteopath refers back to the physiotherapist)
- Less professional isolation
- More professional image
Locum work then collaboration
The safest route: start by covering for a colleague during their vacation, then negotiate a collaboration or partnership. You test the patient base, the location, the zone, without major financial commitment.
Real costs for a self-employed paramedic
The classic trap: confusing revenue with income. A physiotherapist who bills 80,000 euros per year doesn't earn 80,000 euros. Here's the reality:
| Expense item | Estimated annual amount |
|---|---|
| URSSAF (health, family allowances) | ~7,500 € |
| CARPIMKO (retirement + benefits) | ~4,800 € |
| Professional Order fee | 300 € |
| Professional Liability Insurance | 500 € |
| Office rent | 6,000-12,000 € |
| Office expenses | 3,000 € |
| Accountant | 1,200 € |
| Materials and supplies | 2,000 € |
| Additional insurance | 1,500 € |
| Continuing education (DPC) | 500 € |
| Total expenses | ~27,000 - 33,000 € |
On revenue of 80,000 euros, that leaves 47,000 to 53,000 euros before income tax. It's decent, but far from the hospital salary × 12 that some imagine.
Building a patient base
In underserved zones, patients come naturally: local doctors refer patients from opening day. In normally served zones, it takes longer.
The levers:
- Introduce yourself to local general practitioners (first source of referrals for physiotherapists, speech therapists, midwives)
- Create a Google Business profile — patients search "physiotherapist near me" before asking their doctor
- Register on Doctolib or Maiia — online appointment booking has become standard
- Specializations — perineal rehabilitation, pediatric respiratory physiotherapy, speech therapy for dyslexia disorders... Specialties in high demand fill schedules faster than general practice
Management software
Essential: billing software compatible with SESAM-Vitale electronic transmission. The main ones:
- Vega (nurses)
- Kinémax, PhysioSuite (physiotherapists)
- Orthoscribe, Logos (speech therapists)
- Doctolib now integrates billing for certain professions
Budget: 50 to 150 euros/month. It's an investment, not optional — manual CPAM billing is an administrative nightmare that will cost you more in time.
Setting up a private practice is an entrepreneurial project. Treat it as such: market research, business plan, financing. Healthcare professionals who succeed with their setup are those who have prepared the business side as seriously as the medical side.