The adult body, all of it, and the complicated patients nobody else can sort out. Eleven years of training.
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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
$256,560
Part-time or academic
$73,570
Hospital group or high volume
$475,430
The national median is $256,560 a year, and the bottom tenth are near $73,570. The wage survey counts internists who are somebody's employee. Plenty work as partners in their own group and are never counted, and they usually earn more. The low end is mostly part-time and university salaries.
$65,000 to $80,000
Salary across the 3 years of internal medicine residency
Roughly what a new teacher earns, for 60 to 80 hour weeks, while the loans from medical school keep growing. It is paid hospital work, not school, so nobody is charging you tuition.
$475,430 or more
What the highest paid tenth of internists earn
Subspecialists who finish an extra fellowship, for example cardiology or gastroenterology, are counted under their own occupation codes and usually earn more again. Straight clinic internists sit lower in this range than hospital based ones.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is four years at an in state public university at about $11,000 a year, then a public in state medical school at around $40,000 a year, plus the admission test, applications and the three licensing exam steps. The high end is the higher undergraduate rate followed by a private medical school at around $65,000 a year and a fuller interview season. The three year residency after medical school is a paid job, so it adds time but not tuition. Graduates who borrow typically leave with about $200,000 of debt, and Public Service Loan Forgiveness clears whatever is left after ten years of payments at a nonprofit hospital, which most teaching hospitals are.
Medical graduates who borrow typically leave with around $200,000 of debt. Public Service Loan Forgiveness (PSLF) clears whatever is left after 10 years of payments if you work for a nonprofit hospital, and most teaching hospitals are nonprofit.
Malpractice insurance paid
Almost always covered by the hospital or the group. It is expensive coverage you never have to buy.
Loan repayment for underserved areas
Federal and state programs pay down medical school debt if you work in a rural or shortage area.
Signing bonuses
Common outside big cities, because small towns are short of internists.
Shift work if you want it
Hospitalists usually work blocks of days on and days off, with nothing waiting when you are off.
The exact path from high school to qualified.
Eleven years after high school before you practice on your own.
High school
Grades 11 and 12
Biology, chemistry, physics and math, with grades good enough for a competitive college.
Bachelor's degree
4 years
Any major, but you must finish the pre-medical science courses and sit the Medical College Admission Test (MCAT).
Medical school
4 years
Two years of science, then two years of hospital rotations. You graduate as a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).
Internal medicine residency
3 years
Wards, clinics and intensive care, paid and supervised, with more independence each year. Matched to a program by a national computer match.
License and board certification
During and after residency
State medical license, then certification by the American Board of Internal Medicine.
Biology
Hearts, lungs, kidneys and hormones are the whole job.
Chemistry
Drugs and lab values make sense only if chemistry does.
Math and statistics
You read studies for a living and decide whether the numbers mean anything.
English
Half of internal medicine is getting a story out of a patient and writing it down clearly.
Every state licenses physicians through its own medical board, and you hold a separate license in each state where you work. The exams are national: the USMLE (United States Medical Licensing Examination) runs in three steps, the last of which tests whether you can practice without supervision. Board certification comes from the American Board of Internal Medicine and is not legally required to practice, but almost every hospital and insurer asks for it.
Public medical schools
Much cheaper if you are a resident of that state, and many of them favor in-state applicants.
Private medical schools
No state preference, far higher tuition.
Osteopathic schools
Award a Doctor of Osteopathic Medicine (DO) degree and train in the same residency programs.
Residency match
Internal medicine offers more first-year residency positions than any other specialty, which makes it the most reachable door into medicine.
Things you don't need, but that help.
Cardiology
Three more years. Hearts, catheters and some of the highest pay in medicine.
Gastroenterology
Three more years. Scopes, procedures, strong demand.
Pulmonary and critical care
Lungs plus running intensive care units. Intense and respected.
Geriatrics or infectious disease
One to two years. Badly needed, and paid less than the procedure specialties. Choose them with your eyes open.
Research during medical school
Matters for competitive fellowships more than for residency.
Spanish or another second language
Changes what you can actually do in a clinic in most of the country.
Tolerance for uncertainty
Internists get the patients whose problem nobody has named yet.
Rural or underserved experience
Opens loan repayment programs and some school admissions preferences.
Two very different lives come out of the same training. A hospitalist looks after admitted patients in blocks, often seven days on and seven days off, and goes home with nothing pending. A clinic internist keeps a panel of patients for years, knows their families, and carries an inbox of lab results and messages that never empties. Pay is usually higher on the hospital side. Continuity is the reason people choose the clinic side.
Day to day, pros and cons, where you'd work.
On the wards: pre-round at 7am reading overnight notes and labs, then see each patient, then present and decide the plan with the team. Afternoons are procedures, family conversations and discharges. In clinic: 16 to 22 patients, mostly blood pressure, diabetes, heart failure, thyroid, cholesterol and the patient who feels wrong and does not know why. Then an hour or two of charting after the last one leaves.
The good
The hard parts
Things people don't tell you.
An intern is a first-year doctor in any specialty. An internist is a fully trained specialist in adult medicine. The words look alike and mean completely different things, which is why many internists just say they do internal medicine.
Cardiology, oncology, endocrinology, rheumatology, nephrology and infectious disease all began as branches of internal medicine, and you still reach every one of them by finishing an internal medicine residency first.
Step 3 of the USMLE (United States Medical Licensing Examination) is specifically designed to test whether you can practice without supervision. The first two steps test what you know. The last one tests whether anyone should let you loose.
The American College of Physicians publishes Annals of Internal Medicine, one of the most cited medical journals in the world. Internists are expected to read the evidence, not just be told the answer.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.