Nephrologist

What nephrologists make

Job Bank's page for nephrologists pools every specialist physician and lists a median of about $311,000 a year. CIHI (Canadian Institute for Health Information) does not break nephrology out; it reports average gross payments of about $445,000 for internal medicine and its subspecialties (2023 to 2024). Those are billings before overhead. Nephrology is hospital-based with low overhead, and supervising dialysis units pays steadily, so most nephrologists net roughly $350,000 to $450,000. This is an estimate. It varies by province and by how you bill.

During residency

Paid employees with benefits and a union contract. Quebec pays the least, Alberta and Ontario the most.

Dialysis is steady income

Unlike clinic specialties, a nephrologist's income does not depend on filling a waiting room. The trade is that dialysis patients need you on holidays too.

What it costs to get there

Undergrad degree (3 to 4 years)

$7,000 to $10,000 a year

Medical school, the MD (doctor of medicine), 3 to 4 years

$15,000 to $28,000 a year

MCAT (medical school admission test), applications, interviews

$2,000 to $5,000

Licensing exam (the MCCQE, the national medical exam) and two Royal College exams (internal medicine, then nephrology)

$1,500 for the MCCQE, plus two Royal College exam fees of several thousand dollars each

Roughly, all in

$76,000 to $170,000

Tuition, fees, exams and kit. Not rent, food or travel

The low end is a three year undergraduate degree and a three year medical school at the cheaper end of Canadian tuition, plus the MCAT (medical school admission test), the MCCQE (the national medical licensing exam) and the two Royal College specialty exams, first in internal medicine and then in kidney medicine. The high end is four years of each at higher tuition and the full range of exam and application fees. The five residency years after medical school are paid work, so they add no tuition here. Most graduates leave medical school owing $80,000 to $150,000, and the interest on that borrowing is real money but is not counted in these figures.

Typical debt at the end of medical school is $80,000 to $150,000. Five paid residency years help you pay it down.

Benefits

• 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 path

You become an internal medicine doctor first, then a kidney specialist.

1. 1

   High school

   Grades 11 and 12

   Top marks in biology, chemistry, math and English. You need a very high average for a science undergrad.

2. 2

   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).

3. 3

   Medical school, the MD (doctor of medicine)

   3 to 4 years

   Acceptance rates are 5% to 15%. Classes, then clinical rotations.

4. 4

   Internal medicine residency

   3 years

   Matched through CaRMS (the residency matching service). Hospital wards, the ICU (intensive care unit) and clinics. In year 3 you apply to the subspecialty match.

5. 5

   Nephrology residency, then certification

   2 years

   Dialysis units, transplant clinics, kidney biopsies, and consults for the sickest patients in the hospital. Pass the Royal College exams to become FRCPC (Fellow of the Royal College of Physicians of Canada) and register with your provincial College of Physicians and Surgeons.

High school courses that help

• Chemistry

  Kidneys are chemistry: salt, potassium, acid and water balance. This is the most chemistry-heavy specialty in medicine.

• Biology

  Required for nearly every pre-med path.

• Calculus and functions

  Nephrologists calculate constantly: filtration rates, dialysis doses, fluid balance.

• Physics

  Pressure and flow. Also tested on the MCAT (medical school admission test).

Time and money, at a glance

Years after high school

11 to 13

Med school acceptance rate

Roughly 5% to 15%

Subspecialty match

Moderately competitive

Total tuition

$90,000 to $150,000

Paid while training?

Only during residency, 5 years of it

Heavily regulated

You need a licence from your provincial College of Physicians and Surgeons to practise, and Royal College certification in both internal medicine and nephrology. Both are national credentials, so moving provinces is mostly paperwork. Quebec requires working French. Kidney transplant surgery is done by surgeons; nephrologists prepare patients for it and look after them for life afterward.

Fellowships that change the job

Optional 1 to 2 year add-ons after residency.

• Transplant nephrology

  Matching donors, managing anti-rejection drugs, keeping a new kidney alive for decades.

• Home dialysis

  Teaching patients to dialyze in their own homes. Growing fast because it is cheaper and better for patients.

• Critical care nephrology

  Running dialysis machines in the ICU (intensive care unit) for patients whose kidneys shut down suddenly.

• Glomerular disease

  Rare immune diseases of the kidney filter. Research-heavy and academic.

Nice-to-haves before med school

• Research experience

  Nephrology programs value it.

• Loving chemistry

  If acid-base balance sounds fun, this is your specialty.

• French

  Opens Ottawa, New Brunswick and Quebec programs.

• Emotional stamina

  You will follow some patients for 20 years, and some will die on your watch.

A typical day

Morning rounds through the dialysis unit, checking on 20 to 30 patients hooked to machines that clean their blood for four hours at a time. Then hospital consults: a patient in the ICU (intensive care unit) whose kidneys have stopped, a potassium level that could stop a heart. Afternoon clinic for people with slowly failing kidneys, transplant recipients, and stubborn high blood pressure. A kidney biopsy or two a week. On call, a machine can page you at any hour.

The honest trade-offs

Work life

Typical hours

50 to 60 a week including call

Remote work

Little, some virtual follow-ups

Physical demand

Moderate, long days on your feet

Unionized

Residents yes, attending doctors no

Similar paths

• Internal Medicine DoctorThe hospital doctor for adults with complicated problems, and the gateway to a dozen specialties. Four to five years of residency.
• UrologistThe surgeon for kidneys, bladder, prostate and the male reproductive system. Five years of residency, a mix of clinic and operating room, and a lot of prostate cancer.
• Registered NurseCare for patients in hospitals, clinics and homes. In demand everywhere in Canada.

More than 30,000 Canadians on dialysis

CIHI (Canadian Institute for Health Information) counted more than 50,000 Canadians living with end-stage kidney disease in 2024. About 30,000 of them were on dialysis and about 20,000 were living with a working transplant.

1 in 10 have kidney disease

The Kidney Foundation of Canada says 1 in 10 Canadians has chronic kidney disease, and most do not know it. Kidneys can lose most of their function before you feel anything, which is why nephrologists rely on blood and urine tests, not symptoms.

The most transplanted organ

Kidneys make up the majority of organ transplants in Canada every year. In 2025, about 59% of the 3,174 transplants performed were kidneys, according to CIHI (Canadian Institute for Health Information), and thousands of Canadians were still waiting.

Filtering a bathtub a day

Your two kidneys filter roughly 180 litres of fluid every day and send almost all of it back into the blood, keeping only 1 to 2 litres as urine. Each is about the size of a fist.