I wouldn't say PTO is strict, but if you're actually going on vacation/away, you need to take a day off. No one cares if you've got personal appts, have to take the kids to the doc, you take a half day because you're burnt out, etc.
I would your quality of life would be better in rare or oncology compared to many years in device. It's more laid back, but has it's own unique challenges. Where I'm at in rare, territories are multi states, and therefore lots of travel. I actually like being in rare disease. It's different, and you don't feel like a drug rep. And docs see you differently. It is more patient centered than other divisions because each story is unique and lifechanging. Especially if it's a genetic disease. It's hard staying motivated, as you aren't getting a script/contract all the time. At least where I'm at, it takes years to build up and get some people actually looking. So I like that part. I've just been there quite a while, and everyone is leaving for significantly more pay, and newbies are coming in making more. My biggest reason for hanging on is the excellent management in my company. They get it, support you, and push back with upper management. That is also more valuable than higher pay. For a certain amount of time.