I am currently ED Manager for a 35,000 bed non-trauma ED in a moderate sized city. My director is a micro-manager, and the current leadership team is going through firing / transitions. I am pretty well respected and don't worry about myself, but the environment is fairly obnoxious. I love my staff and the ED docs, but the administration is driving me a bit crazy. I have been in the position three years and have 5 years supervisory experience. I have an opportunity for a director position in a small rural hospital. The admin team there seems very dynamic and outgoing, and it is attractive. Here are the facts: Current commute: 5 minutes each way. If I take the rural: 1 hour each way. Current beds in ED: 28. Rural hospital: 8. Present manager salary: $84,000. Rural hospital Director salary: $100,000. Here is my major question: would this be seen by future employers as a move up or down? If I go from 35,000 visits a year to 18,000, will that impact my stock in the future? Should I just wait it out? Would love your thoughts!