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kurty is right. It's the quality of the 39 miles that matters. In a rural area, with highway driving and no traffic that's a 40 minute trip. In an urban area it might be a couple of trains, a bus and then a walk which personally would be a nightmare.
Also I wouldn't assume that the "major" hospital is going to offer great pay. The opposite may be true.
I would also guess that the peds clinic will have predictable hours whereas the ER may be random and probably will involve working some holidays and weekends. You should definitely ask about the hours involved in each.
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