In France, Foreign Doctors Underpaid Despite Their Essential Role in Public Hospitals

Thousands of non-EU trained physicians, including many Tunisian doctors, play a critical role in keeping French hospitals running — yet face precarious working conditions and glaring wage disparities.

Foreign-trained doctors known as Padhue (praticiens à diplôme hors Union européenne) are vital to the French healthcare system. These professionals, many of whom come from North Africa, Sub-Saharan Africa, and the Middle East, routinely perform night shifts, consultations, and emergency duties — all while earning salaries significantly lower than those of their French counterparts.

A Dependent Yet Unequal Hospital System

According to testimonies gathered in recent months, Padhue earn between €1,400 and €2,000 per month, while French doctors at the same level can earn up to €5,000. One such case is that of Dr. Abdelhalim Bensaidi, an Algerian diabetologist, who went on a hunger strike last spring to protest what he described as the systemic injustice faced by foreign doctors.

Despite holding titles such as “associate intern” or “acting intern,” many of these doctors shoulder responsibilities equal to those of fully licensed hospital practitioners — sometimes even managing entire departments on their own.

A parliamentary report published in November confirmed the scale of the issue, highlighting concerning practices in certain hospitals that heavily rely on Padhue to fill staffing shortages — without providing them with equivalent legal status or fair compensation.

In theory, these doctors must pass a qualification exam known as the épreuves de vérification des connaissances (EVC) to have their skills officially recognized. In practice, the EVC operates like a highly selective competition, with a limited number of slots available depending on the medical specialty. It is common for candidates scoring above 13/20 to be rejected simply due to quota restrictions.

This bureaucratic complexity keeps many of these professionals in precarious limbo for years. In the meantime, they continue to serve — essential yet marginalized — in a hospital system plagued by chronic staffing shortages.

Toward a Simplified Path to Legalization

At the end of May 2025, following increasing mobilization and mounting media pressure, the French Ministry of Health issued two decrees aimed at easing access to legal recognition for foreign doctors. The announced measures include:

• An internal pathway to validate the experience of doctors already working in hospitals;

• Revisions to the skills validation process to accelerate authorizations to practice;

• Special provisions for France’s overseas territories;

• A more flexible framework for granting temporary practice authorizations.

While these measures have been welcomed as a first step, advocacy groups representing Padhue doctors stress that they remain insufficient without a comprehensive overhaul of the integration system and concrete wage revaluation.

Analysis

The precarious status of non-EU trained physicians highlights a grey area in the French healthcare system — one where clinical excellence does not guarantee recognition or fair pay.

This reality creates a dual vulnerability: on one hand, French public hospitals rely heavily on underpaid foreign medical staff; on the other, these doctors face increasing professional burnout and a deepening sense of injustice, pushing some to leave for other European countries or the private sector.

From a macroeconomic perspective, France cannot sustainably rely on a highly qualified foreign workforce without offering clear, stable, and equitable career prospects. While the May decrees provide a technical lever, they do not address the structural asymmetry between the country’s dependence on these doctors and their lack of institutional recognition.

Three key areas merit urgent attention:

• Immediate salary revaluation for Padhue to reflect their actual workload;

• Elimination of the implicit numerus clausus in the EVC, to evaluate candidates based on competence rather than quotas;

• Gradual but automatic integration into the public hospital system after 12 to 24 months of validated, supervised practice.

Ultimately, the issue goes beyond administrative regularization. It is about restoring legitimacy and social justice in a core pillar of public service.

Without decisive action, the French hospital system risks further strain under the weight of its contradictions.