"There are illnesses that can only be cured by naming them." One of the central challenges raised by the financialization of private practice companies in France lies in safeguarding the professional independence of practitioners.

Since France in 1990 authorized the opening of private practice companies to external capital, regulated professions, particularly in the health care sector, have undergone a significant transformation. While this evolution has facilitated investment capacity, cost-sharing, and network development, it has also introduced investor-driven logics that sit uneasily with a system traditionally grounded in professional autonomy, ethical responsibility, and patient primacy.

French law seeks to reconcile these competing dynamics through the concept of effective control. Article 5 of Law No. 90-1258, incorporated in 2023, requires that more than half of the share capital and voting rights of a private practice company be held by professionals practicing within the company, whether directly or through a holding structure. However, formal compliance with these thresholds does not, in itself, guarantee that practitioners retain genuine decision-making power.

This tension has been addressed by the jurisprudence of the French Administrative Supreme Court, which has progressively shifted from a formal to a functional analysis of governance. In a series of landmark decisions issued in 2023 in the veterinary sector, the Court upheld the removal of companies whose capital structure formally complied with statutory requirements, but whose governance arrangements effectively transferred control to financial investors. Indicators such as veto rights over strategic decisions, asymmetric economic rights, contractual dependency, and the marginalization of professionals in operational management were treated as evidence of a loss of effective control.

Subsequent decisions in the medical imaging sector in 2024 and 2025 illustrate a more nuanced approach. Where practicing professionals demonstrably retain operational authority and no contrary evidence is established, the mere presence of investors benefiting from enhanced financial rights does not automatically undermine effective control. Control must therefore be assessed in concreto, based on actual governance mechanisms rather than capital ownership alone.

Recent institutional reports, including those issued by the French Senate and by IGAS and IGF, suggest that legislative clarification may be forthcoming. These reports advocate for a harmonized, cross-professional definition of effective control, grounded in indicators such as management autonomy, economic substance, and decision-making independence.

Pending further regulatory developments, best practices are emerging. They include practitioner-led management, proportionate and protective (rather than controlling) veto rights, balanced economic arrangements preserving the professionals' financial substance, and internal governance charters clearly separating professional judgment from financial interests. Together, these principles reflect a regulatory balance: financial participation is not prohibited, but it must not displace professional independence as the cornerstone of regulated practice.