Smiths11

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How easy is it to do a career in EM as an attending without doing nights? I love EM but I hate working nights. Do most groups offer such positions for lower pay? And how about the same question but as it pertains to holidays and weekends? I'd be happy with a pay cut if it means a better lifestyle.
 
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Smiths11

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Thanks, but what if you want to work in the actual ED and not an urgent care center? Personally, I don't see why scheduling isn't done in a free market way. High demand for a shift -> lower pay, and vice versa.
 

dotcb

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I know exactly zero EM grads who have begun their careers with a "no nights" arrangement. On the contrary, most new grads are asked to do as many nights as they're willing to.

In my group - per diem faculty do 50% nights, full time assistant professor 3 nights/mo, associate prof 2 nights/mo, full prof 1 night/mo, > 60 yo no nights.

If you loathe nights and want to work in the ED, I strongly would consider other options.
 
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Janders

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I know a couple people working few nights, due to getting into groups with marked (compensated) nocturnist coverage. They do, say 2 out of 15 a month. The nocturnists get a 20% pay bump, and eat up perhaps half the nights, leaving the other half to the rest of the docs. Its actually hard to find a nocturnist willing to do it LONG term for 20% bump...

Otherwise, it is split evenly.

Hell, I'll hire you to work days only... but the pay cut is going to be SUBSTANTIAL. I don't love nights. Some things are fun-- I like the nurses, I like the relaxed attitude, I like that I can eat at my desk, I like that I can usually get a few minutes of paperwork / admin / email done. But they wreck your circadian rhythm and family life. Plus plays heck with trying to do committees and admin work. Frankly, if someone wanted to come work for us and do zero nights, we wouldn't even listen to the offer. If we did listen, the pay cut they'd need to take to convince us to pick up their extra nights... would be very significant.
 

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Should we start the bidding? Day/Eve only for 50% pay cut.
 

emergentmd

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You can do this by going Locums or finding a FSED that will put you in the contract. If you go locums, just pick up day shifts. If you do FSED, then your pay would likely be less.

If you want a to work in a SDG or CMG full time, then you are probably hosed. If you find a desperate CMG, I am sure you can swing it but IMO overnight wingman is just a bad. Difficult to swing for sure.

But with EM, anything is possible.

I am actually going to go part time at my main gig (6 dys a month) and we have nocturnists. So I will probably have to work past Midnight once a month. If I wanted to, I could just stick to Locums days.
 
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Cinematographer

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If I recall correctly, this brother has made several-to-many threads in the same spirit. I, myself, suspect that the handwriting is on the wall.
Looking at the poster's history makes it seem like he/she is not actually committed to the specialty. Not to mention the red flags the poster has written about, but that's another story.
 
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Smiths11

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Looking at the poster's history makes it seem like he/she is not actually committed to the specialty. Not to mention the red flags the poster has written about, but that's another story.
Save the judgment for other matters. You're not a PD reviewing my application so this post is meaningless. Have something helpful to say or don't say anything at all.
 

Makati2008

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Save the judgment for other matters. You're not a PD reviewing my application so this post is meaningless. Have something helpful to say or don't say anything at all.
He is right. You seem to be quite flighty when it comes to a specialty as well as your red flags/insecurities are worrisome. I would recommend you NOT going into EM.


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Smiths11

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He is right. You seem to be quite flighty when it comes to a specialty as well as your red flags/insecurities are worrisome. I would recommend you NOT going into EM.


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Didn't ask for your recommendation. Please stick to the original topic.
 

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Yes, you can work all day shifts with no holidays or weekends and you can make $500k while living in Los Angeles and only work in nice areas where there are no narcotic addicts. And all the consultants will love you and treat you with irreverent respect and patients will gush with excitement at their perceived competence of you. The physician's lounge will be lined with velvet and flat screen TVs that you can watch while grabbing a quick bite of lobster during your 30 minute lunch break. The bathrooms have the softest 4-ply toilet paper you'll ever feel and the heated seats keep you so perfectly comfortable while you leisurely drop a deuce mid-shift.
 

Makati2008

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Didn't ask for your recommendation. Please stick to the original topic.
You are proving my point. Good luck in the match.

PS- if you are serious I would be nicer to your future colleagues. Also most of us on this board already have what you supposedly want.

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Smiths11

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You can do this by going Locums or finding a FSED that will put you in the contract. If you go locums, just pick up day shifts. If you do FSED, then your pay would likely be less.

If you want a to work in a SDG or CMG full time, then you are probably hosed. If you find a desperate CMG, I am sure you can swing it but IMO overnight wingman is just a bad. Difficult to swing for sure.

But with EM, anything is possible.

I am actually going to go part time at my main gig (6 dys a month) and we have nocturnists. So I will probably have to work past Midnight once a month. If I wanted to, I could just stick to Locums days.
Thanks for your reply! If you don't mind me asking, how far out of residency are you? And you would say your type of setup is fairly easy to find or are you one of the lucky few? Actually, I plan on doing part time eventually as well. I'm hearing different opinions from different folks so am having trouble getting a clear picture.
 

Makati2008

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Why? Because I don't appreciate unsolicited advice from strangers (trolls) who ignore the original post all together?



Right back at you
Best of luck once again. May you mature in your decision making as well as communication skills prior to residency.


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Got Em

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Yes, you can work all day shifts with no holidays or weekends and you can make $500k while living in Los Angeles and only work in nice areas where there are no narcotic addicts. And all the consultants will love you and treat you with irreverent respect and patients will gush with excitement at their perceived competence of you. The physician's lounge will be lined with velvet and flat screen TVs that you can watch while grabbing a quick bite of lobster during your 30 minute lunch break. The bathrooms have the softest 4-ply toilet paper you'll ever feel and the heated seats keep you so perfectly comfortable while you leisurely drop a deuce mid-shift.
Thanks for your reply! If you don't mind me asking, how far out of residency are you? And you would say your type of setup is fairly easy to find or are you one of the lucky few? Actually, I plan on doing part time eventually as well. I'm hearing different opinions from different folks so am having trouble getting a clear picture.
This is all you need to know right here. Good luck brother.
 
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Smiths11

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Best of luck once again. May you mature in your decision making as well as communication skills prior to residency.


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And same to you, fellow med student
 

GeneralVeers

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I don't mind nights if I'm on them consistently. What I do hate is switching back and forth.

Night shifts have a lot of advantages:
1. Nurses are usually better
2. No administration is around to bother you
3. You are really "in charge".
4. Usually get to pick your own schedule
 

smq123

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And same to you, fellow med student
Based on his posts, Makati seems to be a resident....

Also, I just want to make sure that I understand your initial post correctly - you want to work in the emergency department, but you want the lifestyle of an outpatient PCP (i.e. no nights, weekends, or holidays). Does that sum it up?
 

racerwad

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Save the judgment for other matters. You're not a PD reviewing my application so this post is meaningless. Have something helpful to say or don't say anything at all.
I would argue that the advice of the folks who are doing what you hope to do is actually quite helpful. Posts #2 and #4 speak directly to your question. EmergentMD's posts also reinforce the idea that while it certainly can be done, it is rare and requires investment into the group. From their post history, EmergentMD has done this for a while now and has put equity into his practice at the front end which is paying dividends now in terms of compensation and flexibility.

One of the things our specialty offers is time (or availability). There are very few among us who want to work nights, weekends, or holidays; however, we all accept that this is part of the deal. Burning this many calories to avoid them this early in your "career" is probably not a good sign.
 
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Smiths11

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I would argue that the advice of the folks who are doing what you hope to do is actually quite helpful. Posts #2 and #4 speak directly to your question. EmergentMD's posts also reinforce the idea that while it certainly can be done, it is rare and requires investment into the group. From their post history, EmergentMD has done this for a while now and has put equity into his practice at the front end which is paying dividends now in terms of compensation and flexibility.

One of the things our specialty offers is time (or availability). There are very few among us who want to work nights, weekends, or holidays; however, we all accept that this is part of the deal. Burning this many calories to avoid them this early in your "career" is probably not a good sign.
Yes, emergentmd was very helpful, and he wasn't the one I was replying to with that comment.

And I completely agree nobody likes nights and weekends, hence I'm trying to understand why there financial trade offs aren't more common
 
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Smiths11

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I don't mind nights if I'm on them consistently. What I do hate is switching back and forth.

Night shifts have a lot of advantages:
1. Nurses are usually better
2. No administration is around to bother you
3. You are really "in charge".
4. Usually get to pick your own schedule
Actually I like the nightshift itself as well. My worry is what it does to your family life and health.
 

RustedFox

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I'll jump in the fray.

I changed groups and primary job sites in January. I have 2-3 nights/month as opposed to 6-7 nights/month. This month, I have one nightshift.

My life is infinitely better. Crazy, infinitely better.

Veers is deadnuts right about the swtiching... THAT is the killer. I'm happy on a two-week stretch of nights, but its the weekly/1.5 weekly switches that are murder.

Nights are great for the reasons that Veers stated; but I want to opt-out, too.

That being said, to the OP:

Dude, good luck matching in EM. I was an "outside shot", too.

But when you're fresh out; suck it up. Nobody is not going to work nights without some sort of crazy-ass catch when you're fresh out.

After a few years, the game changes.

The game is always changing.
 
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racerwad

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Yes, emergentmd was very helpful, and he wasn't the one I was replying to with that comment.

And I completely agree nobody likes nights and weekends, hence I'm trying to understand why there financial trade offs aren't more common
The "tradeoffs" don't exist because there is simply too much work and too few people willing to do it. Depending upon how you look at it, nights are at least a third, if not half the FTEs that any department has to fill. It is an issue we all deal with so we all have to work nights at some point. It is just part of the job, especially at the beginning, as almost everyone has pointed out. It isn't as though you are the first person to recognize the issue and propose some sort of solution.
 
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WilcoWorld

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There are jobs out there where one can work no nights. The problem is, you can not count on any job staying that way. Here's the likely story of your no nights career:

You sign with a group that promises you'll work about 3 nights/year. They have 3 full time nocturnists.
You get there and it's great, you work one night in the first 6 months.
You buy a nice, but not ostentatious, house.
In the next 6 months you work your other 2 nights and life is good.
Your spouse joins a book club and makes some friends. The kids love it there.
One of your nocturnists announces a desire to cut back because his kids are getting to that age.
No biggie, you're a sizable group and all just going to work a few extra nights while you try to hire a new nocturnist. Maybe 6 per year, that's totally manageable.
Plus you're kids are in a great school.
The second nocturnist gets sick. Now you're all going to have to work about 3 nights per month, but just until she's done with chemo.
Then the 3rd noctiurnist decides he wants to join the regular scheduling pool, nights are getting busier.
Now 1/3 of your weekdays are nights and 1/2 of your weekend shifts are nights.

So, you find a job 2 states over that tells you they pay so much for nights that only the people who want to have to work 'em.
The family doesn't want to move, but they're willing to do it for your sanity.
You get there and the first six months are great...
 

Birdstrike

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How easy is it to do a career in EM as an attending without doing nights? I love EM but I hate working nights. Do most groups offer such positions for lower pay? And how about the same question but as it pertains to holidays and weekends? I'd be happy with a pay cut if it means a better lifestyle.
If you choose EM you'll work nights, more than you want. Period. No ifs ands or buts about it. Just don't believe anything anyone tells you otherwise. Just. Don't. Do. It.
 

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I know I probably shouldn't disagree with the wise Bird, but...

I would like to highlight what was mentioned/alluded to earlier in the thread: Days only isn't all that hard to get as a locums doc. Of course, locums has it's own downsides and requires a bit of legwork to create a stable and reliable income, but 250-300K working only ten shifts a month (days only) would not be that difficult in the current environment.

I suspect such opportunities will be possible for at least the next five years.

Of course, this type of thing requires an EM residency full of nights and an "EM attitude" that I am not sure I have seen expressed in this thread.

HH
 

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Of course, this type of thing requires an EM residency full of nights and an "EM attitude" that I am not sure I have seen expressed in this thread.

HH
Of all the points made, this is the most telling of why the OP won't make it in EM. They are a unicorn wanting a unicorn job, but standing in the way is that pesky residency that requires "a lot of sacrifice." Maybe the next thread from the OP should be, "which residencies don't require night shifts and gives scheduled breaks for milk and cookies.
 

Birdstrike

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I know I probably shouldn't disagree with the wise Bird, but...

I would like to highlight what was mentioned/alluded to earlier in the thread: Days only isn't all that hard to get as a locums doc. Of course, locums has it's own downsides and requires a bit of legwork to create a stable and reliable income, but 250-300K working only ten shifts a month (days only) would not be that difficult in the current environment.

I suspect such opportunities will be possible for at least the next five years.

Of course, this type of thing requires an EM residency full of nights and an "EM attitude" that I am not sure I have seen expressed in this thread.

HH
Questions for you:

1-Are you an EM doctor? (I'll answer that one for you, "Yes.")
2-How many night shifts did/do you want to work?
3-Have you had to work any night shifts in your career, and if so, how many?
4-Was the number in question 3, greater than question 2?

Hammock, please answer for the benefit of the medical students reading. Thanks.
 
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Apollyon

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Questions for you:

1-Are you an EM doctor? (I'll answer that one for you, "Yes.")
2-How many night shifts did/do you want to work?
3-Have you had to work any night shifts in your career, and if so, how many?
4-Was the number in question 4, greater than question 3?

For the medical students, please answer.
I think you have your math wrong (ie, #4, should be 3, than 2?).

Also, for note, you addressed this to an attending colleague, but put it to the med students at the end.
 

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I would like to highlight what was mentioned/alluded to earlier in the thread: Days only isn't all that hard to get as a locums doc. Of course, locums has it's own downsides and requires a bit of legwork to create a stable and reliable income, but 250-300K working only ten shifts a month (days only) would not be that difficult in the current environment.
It's more than easy. 10-12s is 120 hours. At $250/hr that's 30k/month. For 12 months that's $360.

And I wouldn't even answer the text for only $250/hr. Base rate in my town is now over $275. Locums gets more.
 
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It's more than easy. 10-12s is 120 hours. At $250/hr that's 30k/month. For 12 months that's $360.

And I wouldn't even answer the text for only $250/hr. Base rate in my town is now over $275. Locums gets more.
Where are you, again? Texas, right?
 

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I'm a EM resident. Bro/sis


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I will never understand why people willfully misrepresent themselves and then act so smugly self-satisfied in correcting others.

Misrepresenting your status is against tos.
 
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Makati2008

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I will never understand why people willfully misrepresent themselves and then act so smugly self-satisfied in correcting others.

Misrepresenting your status is against tos.
It was stated to show that I have experience in applying to EM programs and successfully matched. Nothing more or less.

FYI- I use the app 99% of the time and had forgotten what it had listed.


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doctalaughs

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I don't mind nights if I'm on them consistently. What I do hate is switching back and forth.

Night shifts have a lot of advantages:
1. Nurses are usually better
2. No administration is around to bother you
3. You are really "in charge".
4. Usually get to pick your own schedule
Out of curiosity if switching is the main issue how come groups dont have people do all their nights at once (ie do 3-4 weeks twice a year of all nights then be done for 6 months)?


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The White Coat Investor

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I dropped my 3 night shifts a month from my usual schedule this summer. I figure that was a six figure decision. There are groups where you can do this. Don't expect it right out of residency and expect it to come at a steep price. You may not be able to buy your way out of nights, weekends, AND holidays. Even in my group (which many on here refer to as a unicorn) you can only buy out of nights but still have to do your share of weekends and holidays.
 
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I am required to work 2-3 nights a month with my new job. That's really not bad. The residency 5-6 per month was way harder. I actually like them. I did ask about dropping nights and it's just not possible with my group to guarantee but if you work less overall then your percentage stays the same and you can easily get 1 night a month. Overall, while nights get in the way of circadian rhythm and my overall happiness I do find that I can actually see my family a bunch. Mornings might not overlap but afternoons and evenings do. The 3-11pm shift is the killer. I will go a week without seeing anyone at home awake.
 
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Smiths11

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Of all the points made, this is the most telling of why the OP won't make it in EM. They are a unicorn wanting a unicorn job, but standing in the way is that pesky residency that requires "a lot of sacrifice." Maybe the next thread from the OP should be, "which residencies don't require night shifts and gives scheduled breaks for milk and cookies.
Thanks for the encouragement! I didn't know it was so wrong to inquire about lifestyle of a potential future career, my bad! I should have known, anyone who says they have a passion for EM but don't like staying up at nights is a god damn liar. In fact, any doctor who even considers valuing their kids and health above or equal to his career should be publicly shamed and have their license revoked! How dare anyone inquire about, or weigh the pros and cons of their future career?

I apologize for trolling you all like the way I did. If only there was a forum where med students can communicate with and get advice from real doctors, I would have surely created a thread on there instead. Didn't mean to upset you like this!
 
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Smiths11

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On a more serious note, I appreciate all the helpful replies. It's interesting because I still see a diversity of experiences on this matter. I guess I'll have to experience it myself. Thanks again!
 

racerwad

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On a more serious note, I appreciate all the helpful replies. It's interesting because I still see a diversity of experiences on this matter. I guess I'll have to experience it myself. Thanks again!
No one is arguing with you that nights, weekends, and holidays are lame work hours. Few people seek them out but almost everyone accepts that it is part of the gig, at least during training and for some amount of time thereafter. It is somewhat offensive that you're looking for some sort of work around that the rest of us are too dumb to have noticed. Nights, weekends, and holidays are like drunks, salty consultants, and PG scores - they are universal warts on what is otherwise a great specialty. Did you really think that "most groups" would have some sort of mechanism for dealing with these scheduling issues, but somehow very few of us have heard of or work at such groups? None of use would put up with those things if we didn't have to. There really is no way of getting around it without putting in some amount of time on the front end. Your ****ty attitude basically doubles down on your dumb question, which clearly irritated members here. Add to that your post history, and there you go, snarky replies. Also, I don't know where you are seeing it, but there was very little diversity in the replies. Some people pointed out the positives/silver-linings to nights, but everyone agreed there isn't a simply way out. You asked about a dollar figure and @The White Coat Investor gave you exactly that.

...If only there was a forum where med students can communicate with and get advice from real doctors, I would have surely created a thread on there instead. Didn't mean to upset you like this!
It isn't our fault that you don't like the advice you're getting from "real doctors." The reality of nights, weekends, and holidays in EM apparently isn't what you like. That isn't our fault.
 
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Smiths11

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No one is arguing with you that nights, weekends, and holidays are lame work hours. Few people seek them out but almost everyone accepts that it is part of the gig, at least during training and for some amount of time thereafter. It is somewhat offensive that you're looking for some sort of work around that the rest of us are too dumb to have noticed. Nights, weekends, and holidays are like drunks, salty consultants, and PG scores - they are universal warts on what is otherwise a great specialty. Did you really think that "most groups" would have some sort of mechanism for dealing with these scheduling issues, but somehow very few of us have heard of or work at such groups? None of use would put up with those things if we didn't have to. There really is no way of getting around it without putting in some amount of time on the front end. Your ****ty attitude basically doubles down on your dumb question, which clearly irritated members here. Add to that your post history, and there you go, snarky replies. Also, I don't know where you are seeing it, but there was very little diversity in the replies. Some people pointed out the positives/silver-linings to nights, but everyone agreed there isn't a simply way out. You asked about a dollar figure and @The White Coat Investor gave you exactly that.

It isn't our fault that you don't like the advice you're getting from "real doctors." The reality of nights, weekends, and holidays in EM apparently isn't what you like. That isn't our fault.
First, the bolded above is totally wrong. I think I said I really appreciate the advice and comments from those who actually replied to the question without being condescending jerks, regardless of their answer.

What I don't appreciate is the "advice" and comments several of the posters are making about say, how I couldn't possibly survive EM.

Snarky comments lead to snarky replies. Just go back and read all the posts and you'll see there is a major difference in attitude between my replies to those actually helpful posts and to those who were patronizing.

And in diversity, I saw some say they do 5-6 nights, some do 3, some do only day, and some as in White Coat Investor, mentioned a major pay differential in his group if you want to give up nights. It was these comments I found very helpful.