CJEU, 8th chamber, June 25, 2026, No C-343/25

1 This request for a preliminary ruling concerns the interpretation of Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications (OJ 2005 L 255, p. 22), as amended by Directive 2013/55/EU of the European Parliament and of the Council of 20 November 2013 (OJ 2013 L 354, p. 132) (‘Directive 2005/36’), and of Article 49 TFEU.

2 The request has been made in proceedings between the Caisse primaire d’assurance maladie (CPAM) de la Gironde (Local Sickness Insurance Fund of the Department of Gironde, France; ‘the CPAM de la Gironde’) and LX, concerning the granting of LX’s application for authorisation to practise as a specialist doctor, on a self-employed basis, in the non-standard-fee sector – enabling her to charge fees higher than the regulated standard fees – which had initially been refused by the CPAM de la Gironde.

 Legal context

 European Union law

3 Under recital 38 of Directive 2005/36:

‘The provisions of this Directive do not affect the powers of the Member States as regards the organisation of their national social security system and determining the activities which must be pursued under that system.’

4 Article 1 of that directive, which is entitled ‘Purpose’, provides:

‘This Directive establishes rules according to which a Member State which makes access to or pursuit of a regulated profession in its territory contingent upon possession of specific professional qualifications (referred to hereinafter as the host Member State) shall recognise professional qualifications obtained in one or more other Member States (referred to hereinafter as the home Member State) and which allow the holder of the said qualifications to pursue the same profession there, for access to and pursuit of that profession.

This Directive also establishes rules concerning partial access to a regulated profession and recognition of professional traineeships pursued in another Member State.’

5 Article 2 of that directive, which is entitled ‘Scope’, provides, in the first subparagraph of paragraph 1 thereof:

‘This Directive shall apply to all nationals of a Member State wishing to pursue a regulated profession in a Member State, including those belonging to the liberal professions, other than that in which they obtained their professional qualifications, on either a self-employed or employed basis.’

6 Article 3 of that directive, which is entitled ‘Definitions’, provides, in paragraph 1 thereof:

‘1. For the purposes of this Directive, the following definitions apply:

(a) “regulated profession”: a professional activity or group of professional activities, access to which, the pursuit of which, or one of the modes of pursuit of which is subject, directly or indirectly, by virtue of legislative, regulatory or administrative provisions to the possession of specific professional qualifications; in particular, the use of a professional title limited by legislative, regulatory or administrative provisions to holders of a given professional qualification shall constitute a mode of pursuit. …;

(b) “professional qualifications”: qualifications attested by evidence of formal qualifications, an attestation of competence referred to in Article 11, point (a)(i) and/or professional experience;

(c) “evidence of formal qualifications”: diplomas, certificates and other evidence issued by an authority in a Member State designated pursuant to legislative, regulatory or administrative provisions of that Member State and certifying successful completion of professional training obtained mainly in the Community. Where the first sentence of this definition does not apply, evidence of formal qualifications referred to in paragraph 3 shall be treated as evidence of formal qualifications;

…

(e) “regulated education and training”: any training which is specifically geared to the pursuit of a given profession and which comprises a course or courses complemented, where appropriate, by professional training, or probationary or professional practice.

…

(f) “professional experience”: the actual and lawful full-time or equivalent part-time pursuit of the profession concerned in a Member State;

…’

7 Article 4 of Directive 2005/36, entitled ‘Effects of recognition’, provides, in paragraph 1 thereof:

‘The recognition of professional qualifications by the host Member State shall allow beneficiaries to gain access in that Member State to the same profession as that for which they are qualified in the home Member State and to pursue it in the host Member State under the same conditions as its nationals.’

 French law

 The 2016 Agreement

8 Since the adoption of the convention nationale du 29 mai 1980 (national agreement of 29 May 1980), approved by the arrêté du 5 juin 1980, portant approbation de la convention conclue entre, d’une part, la Caisse nationale de l’assurance maladie des travailleurs salariés et conjointement la Caisse centrale de secours mutuels agricoles et la Caisse nationale d’assurance maladie et maternité des travailleurs non salariés des professions non agricoles et, d’autre part, la Fédération des médecins de France (Decree of 5 June 1980 approving the agreement between the National Sickness Insurance Fund for Employees and, jointly, the Central Agricultural Mutual Benefit Fund and the National Sickness and Maternity Insurance Fund for self-employed workers in non-agricultural occupations, on the one hand, and the French Federation of Doctors, on the other hand) (JORF No 131 of 6 June 1980, p. 4938), doctors who have signed up to that agreement may practise in two different sectors, namely Sector 1, in which they undertake to charge the applicable regulated standard fees, except for cases where higher fees are charged due to special circumstances, and Sector 2, in which they may charge fees higher than the regulated standard fees, with patients being reimbursed only on the basis of the agreement with the health insurance fund. There is also a more marginal Sector 3 which is not covered by reimbursement agreements, where fees are unregulated but patients are not reimbursed by the social security system.

9 The national agreement applicable to the dispute in the main proceedings is that concluded on 25 August 2016 and approved by the arrêté ministériel du 20 octobre 2016, portant approbation de la convention nationale organisant les rapports entre les médecins libéraux et l’assurance maladie (Ministerial Decree of 20 October 2016 approving the national agreement governing relationships between self-employed doctors and the sickness insurance scheme) (JORF No 248 of 23 October 2016, Text No 10) (‘the 2016 Agreement’). That agreement lays down, inter alia, the conditions for being authorised to work as a self-employed doctor in Sector 2.

10 Under Article 38.1.1 of the 2016 Agreement, doctors who are setting up to work on a self-employed basis for the first time in the specialism they wish to practise and who hold, inter alia, the public hospital qualification of ‘ancien assistant des hôpitaux’ (former non-permanent hospital practitioner), ‘ancien chef de clinique des universités’ (former head of a university hospital), ‘médecin des armées’ (military doctor) or ‘praticien hospitalier nommé à titre permanent’ (hospital medical practitioner under a permanent contract) may apply for authorisation to charge non-standard fees in Sector 2.

11 According to Article 38.1.2 of that agreement, doctors with qualifications obtained abroad in hospitals located in a territory covered by the European Union’s professional qualifications recognition system established by Directive 2005/36 may also gain entry to the non-standard-fee sector, subject, inter alia, to the condition that those qualifications are recognised as being equivalent, in particular, to the public hospital qualification of ‘ancien assistant des hôpitaux’. That equivalence is to be recognised by the fund responsible for the area where the doctor’s main practice is located, after consulting with the Conseil national de l’ordre des médecins (National Council of the Medical Association, France).

 The Public Health Code

12 Article R. 6152-504 of the code de la santé publique (Public Health Code), in its wording in force since 12 October 2015, resulting from décret no 2015-1260 du 9 octobre 2015 (Decree No 2015-1260 of 9 October 2015) (JORF No 236 of 11 October 2015, Text No 12), provides that generalist and specialist ‘assistants des hôpitaux’ work full-time or part-time performing diagnostic, treatment and prevention duties or carrying out pharmaceutical or biological procedures within the institution, under the authority of the head of the department or, if there is no such figure, the head of the service, operational unit or any other internal unit to which they report.

13 Article R. 6152-510 of that code, in its wording in force since 1 April 2015, resulting from décret no 2015-320 du 20 mars 2015 (Decree No 2015-320 of 20 March 2015) (JORF No 69 of 22 March 2015, Text No 15), provides that ‘assistants des hôpitaux’ are recruited under written contracts concluded with the director of the public health institution.

14 Under Article R. 6152-537 of that code, in its wording in force from 28 August 2014 to 1 September 2020, resulting from décret no 2014-963 du 22 août 2014 (Decree No 2014-963 of 22 August 2014) (JORF No 197 of 27 August 2014, Text No 22), applicable to the dispute in the main proceedings, to be entitled to use the title of ‘ancien assistant spécialiste des hôpitaux’ or ‘ancien assistant généraliste des hôpitaux’, an individual must provide proof of two years of effective service in either one of those roles.

 The dispute in the main proceedings and the questions referred for a preliminary ruling

15 LX, a doctor of medicine practising as a specialist on a self-employed basis in France, applied to the CPAM de la Gironde for authorisation to practise in the non-standard-fee sector, known as ‘Sector 2’, as described in paragraph 8 above.

16 By decision of 10 October 2017, adopted after consulting the National Council of the Medical Association, the CPAM de la Gironde rejected that application on the ground that, because she had worked as a non-permanent practitioner in an Italian hospital as a self-employed practitioner, LX had not worked full time in a public hospital role for a period of two years.

17 By judgment of 3 September 2019, the tribunal de grande instance de Bordeaux (Regional Court, Bordeaux, France) found that LX had performed functions equivalent to those of an ‘assistant des hopitaux’, which enabled her to gain entry to the non-standard-fee sector.

18 By decision of 31 March 2022, the cour d’appel de Bordeaux (Court of Appeal, Bordeaux, France) confirmed that judgment.

19 For LX’s application to be granted, that court noted that a national of a Member State who claims the title of ‘assistant des hôpitaux’ must establish that he or she is in possession of the relevant professional experience, namely the effective and lawful exercise of the profession concerned in that Member State, regardless of the nature of the employment relationship. In that regard, that court specified that LX, in her capacity as full-time non-permanent hospital practitioner, had carried out consultations and performed surgical interventions in an Italian public hospital for a period of more than two years, under the authority of a director, subject to the same constraints as non-permanent hospital practitioners in the public service already in post. She had been recruited as a self-employed professional under an ‘autonomous contract for self-employed practitioners’ because there were no openings under the selection procedure due to budgetary restrictions. The cour d’appel de Bordeaux (Court of Appeal, Bordeaux) concluded that LX had performed her duties under the same conditions as a non-permanent hospital practitioner pursuing his or her professional activity within a hospital under an employment contract, notwithstanding the terms of her contract.

20 On 3 June 2022, the CPAM de la Gironde brought an appeal on a point of law against that court’s judgment before the Cour de cassation (Court of Cassation, France), which is the referring court.

21 In support of its appeal, the CPAM de la Gironde challenges the finding of the cour d’appel de Bordeaux (Court of Appeal, Bordeaux) that LX performed functions equivalent to those of an ‘assistant des hôpitaux’, granting her entry to the non-standard-fee sector.

22 First, the CPAM de la Gironde disputes the applicability of Directive 2005/36 to the dispute in the main proceedings. It argues that it follows from recital 38 of that directive that the rules relating to access by self-employed doctors to the non-standard-fee sector, which concern the pricing of services and their reimbursement by the health insurance system, fall outside the scope of that directive.

23 Secondly, the CPAM de la Gironde argues that, in any event, that directive does not treat in all cases individuals working on a self-employed basis and individuals working under employment contracts as equivalent. It concludes therefrom that a practitioner who has been pursuing medical activities on a self-employed basis cannot claim that his or her qualifications are equivalent to those which must be obtained by a doctor pursuing his or her activities within a hospital under an employment contract.

24 The Cour de cassation (Court of Cassation) seeks to ascertain, in the first place, whether the title of ‘assistant des hôpitaux’ corresponds to evidence of formal qualifications or professional experience within the meaning of Directive 2005/36 in so far as (i) the procedure for the automatic recognition of professional qualifications provided for by that directive applies to evidence of formal qualifications as a doctor of medicine, the list of which is set out in Annex V to that directive and does not include the title of ‘assistant des hôpitaux’ and (ii) the provisions of Chapter II of that directive, concerning recognition of professional experience, relate to the activities listed in Annex IV thereto, which does not concern doctors.

25 That court, in the second place, raises the question whether recital 38 of Directive 2005/36 is such as to preclude the application of that directive in the context of a dispute in the area of social security, which calls into question the application of a national agreement on the conditions of access to a fee sector for doctors working on a self-employed basis.

26 In the third and last place, in the event that Directive 2005/36 is found not to apply to the dispute in the main proceedings, that court also has doubts as to the inferences to be drawn from the application of Article 49 TFEU.

27 In this respect, the referring court notes that it is apparent from the case-law of the Conseil d’État (Council of State, France) that (i) the setting by the public authorities of the fees charged by healthcare professionals working under the health insurance fund has neither the purpose nor the effect of hindering, in itself, the freedom of establishment, as guaranteed by Article 49 TFEU, and (ii) the obligation to comply with the applicable fees is justified by the objective of maintaining a body of medical professionals in private practice that is accessible to all and ensures a fair balance between the quality of care and its cost, with a view to protecting public health.

28 In those circumstances, the Cour de cassation (Court of Cassation) decided to stay the proceedings and to refer the following questions to the Court of Justice for a preliminary ruling:

‘(1) Should [Directive 2005/36] be interpreted as meaning that its scope covers national legislation laying down conditions for access to the sector permitting application of non-standard fees under the social security system for a doctor who obtained his or her qualification in a hospital in another Member State of the European Union?

(2) If such legislation does not fall within the scope of [Directive 2005/36], does Article 49 [TFEU] preclude that legislation from making it possible to refuse to grant a doctor who has obtained a qualification in a hospital in another Member State … access to the non-standard-[fee] sector under the social security system (Sector 2), on the grounds that that doctor pursued his or her professional activity in that hospital on a self-employed basis?’

 Consideration of the questions referred

 The first question

29 By its first question, the referring court asks, in essence, whether Directive 2005/36 must be interpreted as meaning that its scope covers legislation of a Member State which makes access by self-employed doctors to the non-standard-fee sector – when those doctors obtained a qualification after working as non-permanent practitioners in a hospital located in another Member State – conditional upon that qualification being recognised as equivalent to that of ‘assistant des hôpitaux’, within the meaning of that national legislation.

30 Directive 2005/36 applies, according to Article 2(1) thereof, to all nationals of a Member State, wishing to pursue a regulated profession in a Member State, including those belonging to the liberal professions, other than that in which they obtained their professional qualifications on either a self-employed or employed basis.

31 It should be borne in mind that the definition of ‘regulated profession’ within the meaning of that directive is a matter of EU law (judgment of 6 October 2015, Brouillard, C‑298/14, EU:C:2015:652, paragraph 36 and the case-law cited).

32 Under point (a) of Article 3(1) of that directive, ‘regulated profession’ means a professional activity or group of professional activities, access to which, the pursuit of which, or one of the modes of pursuit of which is subject, directly or indirectly, by virtue of legislative, regulatory or administrative provisions, to the possession of specific professional qualifications.

33 Pursuant to the case-law of the Court, the concept of ‘specific professional qualifications’ in that provision does not cover all qualifications attested by evidence of formal qualifications, but only those relating to training which is specifically designed to prepare candidates to pursue a given profession (see, to that effect, judgments of 6 October 2015, Brouillard, C‑298/14, EU:C:2015:652, paragraph 38, and of 26 June 2019, Commission v Greece, C‑729/17, EU:C:2019:534, paragraph 87).

34 In the present case, the qualification of ‘ancien assistant des hôpitaux’, as referred to in Article 38.1.1 of the 2016 Agreement, enables a self-employed doctor, whose evidence of formal qualifications is, moreover, automatically recognised on the basis of the relevant provisions of Chapter III of Directive 2005/36, relating to the recognition on the basis of coordination of minimum training conditions, to pursue his or her specialism, on a self-employed basis, in the non-standard-fee sector, within which he or she can charge fees higher than the regulated standard fees.

35 In this respect, it should be noted that, as stated in paragraph 10 above, the pursuit of such a specialism in the non-standard-fee sector is open also to holders of other public hospital qualifications corresponding to other types of professional experience, such as, inter alia, that of ‘ancien chef de clinique des universités’, ‘médecin des armées’ or ‘praticien hospitalier nommé à titre permanent’. Moreover, it is not apparent that, during the two-year period of hospital experience required in order to gain access to that sector, the practitioner receives specific training, preparing him or her for further work in that hospital, nor is it apparent that he or she is called upon to carry out specifically defined duties with respect to that sector. It follows that the determining factor for gaining access to the title of ‘ancien assistant des hôpitaux’ does not lie in the specialism pursued as such, but in the fact that the self-employed doctor worked in a hospital on the basis of a contract of employment.

36 Therefore, the period of hospital practice allowing a doctor to obtain the title of ‘ancien assistant des hôpitaux’ does not specifically aim to prepare the holder of that title to pursue a given profession, within the meaning of the case-law referred to in paragraph 33 above, but to allow a doctor to gain access to a specific fee scheme (see, by analogy, judgment of 6 October 2015, Brouillard, C‑298/14, EU:C:2015:652, paragraph 39).

37 Accordingly, since the title of ‘ancien assistant des hôpitaux’ does not confer ‘specific professional qualifications’, within the meaning of point (a) of Article 3(1) of Directive 2005/36, the practice by a doctor of his or her specialism under a specific health insurance scheme cannot be treated in the same way as the pursuit of a ‘regulated profession’ within the meaning of that directive (see, by analogy, judgment of 6 October 2015, Brouillard, C‑298/14, EU:C:2015:652, paragraphs 40 and 42).

38 Consequently, that directive is not applicable to the situation at issue in the main proceedings (see, by analogy, judgment of 6 October 2015, Brouillard, C‑298/14, EU:C:2015:652, paragraph 42).

39 In the light of all the foregoing considerations, the answer to the first question is that Directive 2005/36 must be interpreted as meaning that its scope does not cover legislation of a Member State which makes access by self-employed doctors to the non-standard-fee sector – when those doctors obtained a qualification after working as non-permanent practitioners in a hospital located in another Member State – conditional upon that qualification being recognised as equivalent to that of ‘assistant des hôpitaux’, within the meaning of that national legislation.

 The second question

40 By its second question, the referring court asks, in essence, whether Article 49 TFEU must be interpreted as precluding legislation of a Member State under which access to the non-standard-fee sector is refused to a self-employed doctor who has acquired a qualification after working as a non-permanent practitioner in a hospital located in another Member State, on the ground that that activity was pursued on a self-employed basis.

41 It should also be borne in mind that the authorities of a Member State to which an application has been made by an EU national for authorisation to practise a profession, access to which depends, under national legislation, on the possession of a diploma or professional qualification or on periods of practical experience, are required to take into consideration all the diplomas, certificates and other evidence of formal qualifications of the person concerned and his or her relevant experience, by comparing the specialised knowledge and abilities so certified, and that experience, with the knowledge and qualifications required by the national legislation (judgment of 8 July 2021, Lietuvos Respublikos sveikatos apsaugos ministerija, C‑166/20, EU:C:2021:554, paragraph 34 and the case-law cited).

42 Since that case-law is merely the expression in judicial decisions of a principle inherent in the fundamental freedoms of the FEU Treaty, the legal effect of that principle cannot be reduced as a result of the adoption of directives on mutual recognition of diplomas (judgment of 8 July 2021, Lietuvos Respublikos sveikatos apsaugos ministerija, C‑166/20, EU:C:2021:554, paragraph 35 and the case-law cited).

43 The object of such directives is, as is apparent from Article 53(1) TFEU, to facilitate the mutual recognition of diplomas, certificates and other evidence of formal qualifications by laying down rules and common criteria which result, as far as possible, in automatic recognition of those diplomas, certificates and other evidence of formal qualifications. It is not the purpose of those directives to make recognition of such diplomas, certificates and other evidence of formal qualifications more difficult in situations falling outside their scope, nor may they have such an effect (judgment of 8 July 2021, Lietuvos Respublikos sveikatos apsaugos ministerija, C‑166/20, EU:C:2021:554, paragraph 36 and the case-law cited).

44 Those considerations apply in particular to Directive 2005/36, which was adopted on the basis, in particular, of Article 47(1) EC (now Article 53(1) TFEU) (judgment of 8 July 2021, Lietuvos Respublikos sveikatos apsaugos ministerija, C‑166/20, EU:C:2021:554, paragraph 37).

45 In the present case, in a situation such as that in the main proceedings, which, as is apparent from the answer to the first question as set out in paragraph 39 above, does not fall within the scope of Directive 2005/36, the host Member State concerned must comply with its obligations regarding recognition of professional qualifications, as recalled in paragraph 41 above, which apply to situations falling within the scope, inter alia, of Article 49 TFEU (see, to that effect, judgment of 8 July 2021, Lietuvos Respublikos sveikatos apsaugos ministerija, C‑166/20, EU:C:2021:554, paragraph 38 and the case-law cited).

46 However, even if applied without any discrimination on the basis of nationality, national requirements concerning qualifications may have the effect of hindering nationals of the other EU Member States in the exercise of their right of establishment guaranteed by Article 49 TFEU (see, to that effect, judgment of 7 May 1991, Vlassopoulou, C‑340/89, EU:C:1991:193, paragraph 15).

47 In that regard, as the European Commission submits in its written observations, to make recognition of the equivalence between the hospital practice carried out in the home Member State and the practice leading to the title of ‘ancien assistant des hôpitaux’ – which gives access to the non-standard-fee sector – subject to the condition that the practitioner was bound by an employment contract to the hospital within which he or she worked, is liable to hinder access to that sector by practitioners who have not concluded such contracts. Thus, national legislation providing for such a condition is liable to affect more specifically practitioners who have pursued their activity in another Member State.

48 It is settled case-law that restrictions on freedom of establishment which are applicable without discrimination on grounds of nationality may be justified by overriding reasons relating to the general interest, provided that the restrictions are appropriate for securing attainment of the objective pursued and do not go beyond what is necessary for attaining that objective (judgment of 21 September 2017, Malta Dental Technologists Association and Reynaud, C‑125/16, EU:C:2017:707, paragraph 56 and the case-law cited).

49 In the present case, it should be noted that the French Government puts forward overriding reasons relating to the protection of public health which it claims are capable of justifying the restriction at issue in the main proceedings.

50 In that regard, it must be borne in mind that the protection of public health constitutes an overriding reason in the general interest capable of justifying a restriction of the freedom of establishment (see, to that effect, judgment of 21 September 2017, Malta Dental Technologists Association and Reynaud, C‑125/16, EU:C:2017:707, paragraph 58).

51 However, even if it is assumed that the restriction at issue in the main proceedings is justified by such an overriding reason in the general interest, the requirement of systematically having to be bound by an employment contract in order to be treated in the same way as an ‘ancien assistant des hôpitaux’ does not appear to be either necessary or proportionate to the objective pursued.

52 It cannot, in fact, be automatically ruled out that a practitioner who has not been bound by an employment contract to the hospital in another Member State in which he or she acquired his or her experience has similar or equivalent professional experience and, in essence, offers guarantees of the same nature as those offered by an ‘ancien assistant des hôpitaux’ in France, in respect of overriding requirements, such as those relating to the protection of public health, capable of justifying the contested restriction of the freedom of establishment (see, by analogy, judgment of 17 December 2020, Onofrei, C‑218/19, EU:C:2020:1034, paragraph 35).

53 In that regard, it is important to emphasise that, in the course of the comparative examination referred to in paragraph 41 above, only objective differences may be taken into consideration. Where equivalence is established, the Member State must recognise that the foreign diploma, or the practical experience acquired abroad, satisfies the conditions required for the pursuit of the profession concerned (see, to that effect, judgment of 6 October 2015, Brouillard, C‑298/14, EU:C:2015:652, paragraphs 54 and 57).

54 In the present case, the French Government stated, in its written observations, that the nature of the contract binding the doctor to the hospital in which he or she worked on a self-employed basis does not, in itself, constitute a direct criterion for assessment, but nevertheless remains relevant when comparing the actual conditions under which the person concerned pursued his or her professional activity.

55 As is apparent from paragraph 19 above, the cour d’appel de Bordeaux (Court of Appeal, Bordeaux) held that LX had worked under conditions equivalent to those of a non-permanent hospital practitioner bound by an employment contract.

56 Therefore, the answer to the second question is that Article 49 TFEU must be interpreted as precluding legislation of a Member State under which access to the non-standard-fee sector is refused to a self-employed doctor who has acquired a qualification after working as a non-permanent practitioner in a hospital located in another Member State, on the ground that that activity was pursued on a self-employed basis, where that doctor pursued that activity in conditions equivalent to those which apply to ‘assistants des hôpitaux’ pursuing their activity in the first Member State under an employment contract.

 Costs

57 Since these proceedings are, for the parties to the main proceedings, a step in the action pending before the referring court, the decision on costs is a matter for that court. Costs incurred in submitting observations to the Court, other than the costs of those parties, are not recoverable.

On those grounds, the Court (Eighth Chamber) hereby rules:

1. Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications, as amended by Directive 2013/55/EU of the European Parliament and of the Council of 20 November 2013,

must be interpreted as meaning that its scope does not cover legislation of a Member State which makes access by self-employed doctors to the non-standard-fee sector – when those doctors obtained a qualification after working as non-permanent practitioners in a hospital located in another Member State – conditional upon that qualification being recognised as equivalent to that of ‘assistant des hôpitaux’, within the meaning of that national legislation.

2. Article 49 TFEU

must be interpreted as precluding legislation of a Member State under which access to the non-standard-fee sector is refused to a self-employed doctor who has acquired a qualification after working as a non-permanent practitioner in a hospital located in another Member State, on the ground that that activity was pursued on a self-employed basis, where that doctor pursued that activity in conditions equivalent to those which apply to ‘assistants des hôpitaux’ pursuing their activity in the first Member State under an employment contract.