I’ve lost patience here. I stayed through a two year EHR upgrade and took on after hours support the entire time. My raises have been abysmal and from my talk with leadership today sounds like its not going to get better. Is that a sign I should start looking?

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Yeah, that sounds exhausting and honestly pretty demoralizing. You put in two solid years of extra grind after-hours support during a massive EHR rollout is no joke and then get told the raises aren’t going to reflect that effort? That’s a gut punch.
It’s completely valid to feel fed up right now. Yes, this is absolutely a sign to start looking. When leadership straight-up tells you meaningful improvement isn’t coming, they’re basically confirming they’re comfortable taking your extra effort without fairly compensating you. That’s not a place that values you the way you deserve, especially after you’ve proven how much you’ll step up. It doesn’t mean you have to rage-quit tomorrow, but quietly opening up applications, updating your resume, and seeing what’s out there makes total sense. Sometimes just knowing you have options lifts a huge weight.

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You stayed through a major project and took on extra work. If that didn't move the needle on your comp, nothing is going to. Listen to your gut and to what leadership just told you. Time to move on.

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You first have to look to see what you can make elsewhere. That should be the real determining factor. No point leaving because you didn’t get a raise to just make the same money elsewhere. At least not in my opinion. Open to some differing views.

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I met someone, who routinely "looked" around for a similar position in other companies and then brought the salary offer(s) to HR and asked to be compensated at the other, higher rate. Otherwise, she was prepared - and willing - to leave. She has been working at the same company for over 20 years. She just stands up for herself to be compensated at 'the going rate.'
(I don't have that courage.)

dont burn the bridge make sure you can go back later when they can compensate with sign bonuses and other incentives.

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