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. Counsellors: send it to a student from your own email in one click.
The median pay is about $311,000 a year. Across everyone in the job it runs from about $126,000 at the lower end to about $607,000 at the upper end. The source is listed under Sources at the end of this page.
10 to 13 years after high school, on the usual route.
$74,000 to $164,000 all in for tuition, fees, exams and kit. Living costs are not counted.
Yes. It is a regulated job, so you need a licence or registration before you can work.
Good demand nationally, from government outlook data. Demand varies by region, so check your area.
Or read the whole thing here
What you earn and what it costs to get there.
Median
$311,000
Lower end
$126,000
Upper end
$607,000
Job Bank does not give internists a figure of their own. It pools them with all medical specialists: a median of about $311,000 a year (low $126,000, high $607,000) for 2023 to 2024. Most doctors in Canada bill the provincial health plan, and published billing figures are gross payments before office and practice costs, not take-home pay. Hospital work has low practice costs. It varies by province and by how you bill.
About $429,000
Median gross clinical payment, internal medicine doctors, 2024 to 2025
CIHI (Canadian Institute for Health Information) counts 14,004 doctors in this group. The middle 60% were paid $219,000 to $726,000. This is billing before office, staff and other practice costs, not take-home pay. Read from CIHI's data tables, downloaded in a browser with Claude in Chrome on 6 November 2026, because cihi.ca refuses our checker.
$73,000 to $99,000
A year in Ontario from July 1, 2025, in postgraduate years 1 to 5 (PGY1 to PGY5), over the 4 to 5 years of internal medicine residency
Set by the 2023 to 2026 agreement between PARO (Professional Association of Residents of Ontario) and Ontario's teaching hospitals, which stays in force until a new one is signed. Other provinces have their own agreements and pay scales.
$344,000 in Manitoba
Job Bank's median for all medical specialists in Manitoba, 2023 to 2024, the highest of the provinces
Quebec is close at $343,000. Ontario's median is $296,000, Alberta's $272,000 and Nova Scotia's $207,000. These cover every kind of medical specialist, not internists alone.
Roughly, all in
$74,000 to $164,000
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. Many graduates still leave medical school with a large debt, because living costs sit on top of the tuition counted here.
Roughly $74,000 to $164,000 in total before living costs, which many students borrow on top. 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 your GPA (grade point average) as high as you can, volunteer, do research. Write the MCAT (medical school admission test).
Medical school, the MD (doctor of medicine)
3 to 4 years
Very competitive: most applicants are turned down. 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.
In Quebec you apply to medical school straight from CEGEP (public college), with no bachelor's degree first.
Finish Secondary V
Age 16 or 17
With Secondary V math (Technical and Scientific, or Science option), chemistry and physics. These are the entry courses for the CEGEP (public college) science program.
Science DEC (Diploma of College Studies)
2 years
A 2 year CEGEP (public college) program (200.B1), offered in English at Dawson and the other English colleges. Take the biology and chemistry courses medical schools ask for.
Medical school, straight from CEGEP
4 to 5 years
No bachelor's degree needed. McGill and Montréal start with a 1 year preparatory year, Laval and Sherbrooke do not. You need a top R-score (the CEGEP ranking score), the Casper test and interviews.
Internal medicine residency
5 years
Matched through CaRMS (the residency matching service). 3 core years, then choose a subspecialty or stay general. At Montréal, staying general means 2 more years of general internal medicine, taught in French.
Royal College exam and CMQ (Collège des médecins du Québec) permit
End of residency
Pass the Royal College exams. The CMQ, the Quebec college of physicians, then issues your permit and specialist certificate once you show French. A Quebec high school diploma counts.
Get a hospital position
Before you start
Every specialist working in a Quebec hospital must hold a spot in its PEM (plan d'effectifs médicaux, the medical staffing plan). The health ministry approves how many each hospital gets.
Montréal and Laval set a minimum R-score (the CEGEP ranking score) of 33 for CEGEP applicants in 2026. McGill's Med-P year is only for recent CEGEP graduates.
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.
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. The federal job outlook expects a strong risk of labour shortage for medical specialists as a group from 2026 to 2035. It is 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, moved medical students from lecture halls onto hospital wards and helped build the residency training every doctor still does. His 1892 internal medicine textbook was the most influential for 40 years.
In the 2026 residency match, 16.9% of Canadian medical graduates ranked internal medicine as their first choice. Only family medicine was more popular, at 26.4%.
Cardiologists, kidney doctors, cancer doctors, lung doctors, intensive care doctors and more all did the same 3 years of internal medicine first.
Every list is built from the same numbers shown above, so you can see where this career sits next to the others.
Doctors first, then the rest of the field. See every career in health.
Last checked November 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. How every figure on this site is sourced and checked.
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