I've worked for an emergency physicians group for 3 years now. Our's is a democratic group that offers no RVU cap, which means you can make lots of money if you chart properly on a very difficult patient (ie intubation, chest tube insert, fracture mgmt, subluxation reduction, difficult laceration or one in a bad place, etc etc). For these visits, you'll get paid more because they are procedures. If you want to know the details, let me just say it's a LOT more. In fact, that's how somebody as money-hungry as some people on SDN would be satisfied in the future if they realized the only way to make money in this business is to do procedures (i.e. procedural sedation like anesth, or surgery like a surgeon of some kind).
Also, I'm not trying to mislead him by saying it's shift work. Our physicians work 8-12 hour shifts. We use programs to schedule all of them, so that they roughly work 180 hours per month or thereabouts. Yes, they are random but it's not terribly difficult to manage. They can work extra shifts if they wish and if they become partners in the group (they make almost triple their salary) and they can work less if they want to after that. You'll have to work nights and weekends. You'll get over it. All of us are going to do our ER rotations in our 4th year. Watch, you'll get over it.
I will not comment on the difficulty of an ER physician but I'll tell you, it's difficult for me to imagine a mid-leveler taking over the responsibilites of an ER doc. Definitely PAs anyway. Some critical care skills aren't even part of their curriculum. I can't say much about NPs. Besides, PCP's already function as referral machines. Or they should, anyway. Patients need to be educated on what the ER is used for and the ER doc shouldn't have to arrange for the management of patient's chronic illnesses but sometimes that's the case in situations where there's no PCP.
Interpersonal skills aren't a nice thing to have as a physician. It's almost required. This point is argued on this forum once in a while and attracts all the misinformed people who automatically assume pathology or surgery is the way to go for the social invalids. I have many years of hospital experience, I can tell you in this difficult atmosphere that being a jerk anywhere in the hierarchy will not get you far and it has gotten a handful of individuals fired. We can go into that too if you want.