45 hours a week is a lot of emergency medicine man, that's more than some residents work. That's 5-6 shifts a week (if doing 8s), which means that either your only day off or one of your two days off will be you flipping from nights to days. Trust me, those are not days off, waking up at 1pm with a headache and forcing yourself to get out of bed then spending the rest of the day nauseous and tired. You are not going to be able to productively pursue outside business ventures, hobbies, or really anything.
It's really hard to come up with a solid number for EM pay because it varies so much based on the market, the year and who you ask, every resident plays up their job offer to make it sound better and every attending in academia inflates private pay from their end stage grass-is-greener complex. I'm not trying to perpetuate doom and gloom, but I suspect EM physicians will continue to take pay cuts as legislation against balance billing is passed and new residencies pump out grads that CMGs use to saturate even once non-competitive markets and drive down pay. But unfortunately that's the reality of every medical specialty, not just EM. Anesthesia, hospitalists and family medicine docs have it way worse than us in terms of job degradation. Maybe sub-specialty surgeons will still have high pay and more autonomy, but at the cost of working 60+ hours a week for an entire career after a decade of residency and fellowship.
