The hospital doctor for adults with complicated problems, and the gateway to a dozen specialties. Four to five years of residency.
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Pay, the path, pros and cons and the facts on one printable page. Good for a wall or a guidance counsellor.
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What you earn and what it costs to get there.
Typical net
$350,000
Part-time or new
$250,000
Busy hospital with call
$450,000
CIHI (Canadian Institute for Health Information) reports average gross payments of about $445,000 a year for internal medicine and its subspecialties (2023 to 2024), with a median near $390,000. Hospital work has low overhead, so most general internists net $300,000 to $400,000. It varies by province and by how you bill.
$65,000 to $95,000
Salary across the 4 to 5 years of internal medicine residency, rising each year
Paid employees with benefits and a union contract. Quebec pays the least, Alberta and Ontario the most.
$400,000 and up
Small-city hospitals pay premiums because one internist covers everything
In a community hospital you may be the heart, lung, kidney and ICU (intensive care unit) doctor all at once. That breadth is valued and paid.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a three year undergraduate degree, three years at a cheaper medical school, and the exam fees. The high end is a four year degree, four years at an expensive medical school, the MCAT (medical school admission test) with applications and interviews, the MCCQE (the national Canadian licensing exam), and the Royal College certification exam. Residency is paid, so the training years after medical school are salaried rather than another tuition bill. Most graduates still leave medical school owing $80,000 to $150,000 because living costs sit on top of the tuition counted here.
Typical debt at the end of medical school is $80,000 to $150,000. Residency pay lets you start paying it down.
Pension only if salaried
Some hospital and academic contracts include one. Ontario residents are in HOOPP (the Healthcare of Ontario Pension Plan) during training.
Union contract during residency
Provincial residents' associations negotiate pay, call limits and leave.
Malpractice coverage
Through the CMPA (Canadian Medical Protective Association), mostly reimbursed by the province.
Professional corporation
Most provinces let doctors incorporate, which lowers taxes on money left in the business.
The exact path from high school to qualified.
Every internal medicine subspecialty, from cardiology to cancer, starts with these same steps.
High school
Grades 11 and 12
Top marks in biology, chemistry, math and English. You need a very high average for a science undergrad.
Bachelor's degree
3 to 4 years
Any major works. Keep a GPA (grade point average) above 3.8, volunteer, do research. Write the MCAT (medical school admission test).
Medical school, the MD (doctor of medicine)
3 to 4 years
Acceptance rates are 5% to 15%. Classes, then clinical rotations. Internal medicine is the biggest block.
Core internal medicine residency
3 years
Matched through CaRMS (the residency matching service). Wards, the ICU (intensive care unit), emergency consults and clinics. In year 3 you choose: stay general, or apply to a subspecialty.
General internal medicine years, then certification
1 to 2 years
One to two more years of broad training. Pass the Royal College exam to become FRCPC (Fellow of the Royal College of Physicians of Canada), then register with your provincial College of Physicians and Surgeons.
Biology and chemistry
Required for nearly every pre-med path.
Calculus and functions
Physics
Tested on the MCAT (medical school admission test).
English
Internists write long, careful notes and talk to families about hard decisions.
You need a licence from your provincial College of Physicians and Surgeons to practise, and Royal College certification in internal medicine to call yourself an internist. The Royal College credential is national, so moving provinces is mostly paperwork. Quebec requires working French.
Things you don't need, but that help.
After 3 core years you can apply for 2 to 3 more years in any of these.
Cardiology, gastroenterology, respirology
Heart, gut, lungs. Procedure-heavy, highest pay.
Nephrology, endocrinology, rheumatology
Kidneys, hormones, joints. Clinic-based, steadier hours.
Hematology, medical oncology, infectious diseases
Blood, cancer, infections. Often salaried in academic centres.
Critical care, geriatrics, palliative care
The ICU (intensive care unit), older adults, end of life.
Research experience
Helps at some schools.
Hospital volunteering
Shows you know what a ward actually looks like.
French
Opens Ottawa, New Brunswick and Quebec programs.
Liking puzzles more than procedures
Internal medicine is thinking-heavy. If you want to fix things with your hands, look at surgery.
Not everyone subspecializes. General internists run hospital wards, see referrals for patients with five problems at once, and are the backbone of every community hospital in Canada. It is one of the most in-demand jobs in medicine and a good choice if you like breadth over depth.
Day to day, pros and cons, where you'd work.
On the ward: morning rounds with residents on 15 to 25 admitted patients, each with a mix of heart failure, diabetes, infection, kidney trouble. Adjust medications, order tests, talk to families, decide who can go home. Afternoon consults from the emergency department: a new admission with something nobody has figured out yet. On clinic weeks, 10 to 20 outpatients a day. Overnight call means new admissions all night.
The good
The hard parts
Things people don't tell you.
Sir William Osler, born in Bond Head, Ontario in 1849 and trained at McGill, is called the father of modern medicine. He invented the idea of teaching medicine at the bedside instead of in lecture halls.
When a doctor gets sick with something complicated, they often ask an internist. The specialty exists to sort out patients whose problems do not fit one organ.
Cardiologists, kidney doctors, cancer doctors, lung doctors, intensive care doctors and more all did the same 3 years of internal medicine first. CIHI (Canadian Institute for Health Information) counts 13 subspecialties of internal medicine. Choosing it keeps more careers open than any other residency.
Last checked September 2026. Pay figures are typical full-time annual amounts in Canadian dollars, based on Government of Canada Job Bank wage data and published salary grids. They vary by province, employer and experience. Tuition is for domestic students.