Respirologist

What respirologists make

Job Bank's page for respirologists pools every specialist physician and lists a median of about $311,000 a year. CIHI (Canadian Institute for Health Information) does not break respirology out; it reports average gross payments of about $445,000 for internal medicine and its subspecialties (2023 to 2024). Those are billings before overhead. Respirology is hospital-based with low overhead, and bronchoscopy, sleep studies and intensive care shifts add to clinic billing, so most net roughly $330,000 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. Many programs offer an optional third year for research or extra intensive care training.

Intensive care shifts pay

Intensive care is paid by the day or the shift and bills well. Sleep medicine and breathing tests add steady income too. Clinic-only respirologists earn less but sleep more.

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 respirology)

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

Roughly, all in

$79,000 to $175,000

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

Eleven to thirteen years, and these numbers cover only the part you pay for. The low end is a three year undergraduate degree, a three year medical school and the exam fees. The high end is a four year degree plus a four year medical school at Ontario rates near 28,000 dollars a year, plus the MCAT (Medical College Admission Test), applications and interviews. The MCCQE (Medical Council of Canada Qualifying Examination) and the two Royal College exams, internal medicine first and then respirology, add several thousand dollars each. Residency is five paid years, and most graduates leave medical school owing 80,000 to 150,000 dollars.

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 lung 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

   Respirology residency, then certification

   2 years

   Lung clinics, bronchoscopy, breathing tests, sleep medicine and months in intensive care. 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

• Biology and chemistry

  Gas exchange is chemistry. Required for nearly every pre-med path.

• Physics

  Lungs are pressure, volume and flow. Breathing tests and ventilators are applied physics. Also on the MCAT (medical school admission test).

• Calculus and functions

• English

  You will explain a lifelong disease to a smoker who does not want to hear it, over and over.

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 respirology. Both are national credentials, so moving provinces is mostly paperwork. Quebec requires working French. Lung surgery is done by thoracic surgeons; respirologists diagnose, scope and treat with medicine and machines.

Fellowships that change the job

Optional 1 to 2 year add-ons after residency.

• Critical care medicine

  Running the ICU (intensive care unit) full time. Ventilators, the sickest patients in the building, and the highest pay.

• Sleep medicine

  Sleep apnea and other sleep disorders. Reading overnight studies, daytime hours, steady income.

• Interventional pulmonology

  Advanced scopes: biopsying lung tumours, placing stents in airways, draining fluid.

• Lung transplant

  Only at a few centres. Managing the sickest lungs before and after a new pair.

Nice-to-haves before med school

• Research experience

  Respirology programs notice publications.

• Comfort with machines

  Ventilators, breathing test rigs and sleep lab equipment are part of the job.

• French

  Opens Ottawa, New Brunswick and Quebec programs.

• Calm in emergencies

  A blocked airway gives you minutes. Intensive care is not for everyone.

A typical day

Morning clinic: asthma that will not settle, COPD (chronic obstructive pulmonary disease) in a lifelong smoker, a strange shadow on a chest X-ray, a truck driver who falls asleep at red lights. You read breathing tests and CT (computed tomography) scans and adjust inhalers. Midday: two or three bronchoscopies, threading a camera into the lungs to biopsy a spot. Afternoon consults on the wards. Some weeks you are the ICU (intensive care unit) doctor instead, managing ventilators around the clock.

The honest trade-offs

Work life

Typical hours

50 to 60 a week including call

Remote work

Some, reading sleep studies and 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.
• Respiratory TherapistRun ventilators, manage airways and keep people breathing in intensive care. Three years of college, then shift work.
• Thoracic SurgeonThe surgeon for the lungs, esophagus and chest wall, mostly cancer. General surgery first, then two or three more years. About 14 years of training.

Millions of Canadian lungs

More than 3 million Canadians have asthma, and about 2 million adults over 35 live with COPD (chronic obstructive pulmonary disease), according to the Public Health Agency of Canada. Chronic lung disease is one of the top five causes of death in the country.

The ventilator doctor

In many Canadian hospitals, the doctor running the intensive care unit is a respirologist. Ventilators are lung machines, and respirologists spend months of residency learning to run them. That is why they were front and centre in the pandemic.

Sleep apnea is a lung specialty

Sleep medicine in Canada is mostly run by respirologists. A sleep study measures breathing overnight, and the standard treatment, a mask that gently pushes air into the airway, is a breathing machine. Many respirologists spend a day a week reading sleep studies.

A tennis court inside your chest

Unfolded, the tiny air sacs in your lungs would cover roughly the area of a tennis court. That huge surface is how oxygen gets into your blood, and it is what respirologists measure with a breathing test.