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Yes
It probably depends most on the people. If the people you are around now challenge and invigorate you to do better work each day then I'd stay. If not and you need a smaller shop to produce that feeling of wonderment then I'd go for that.
If you believe in the agency, it is the right agency for you.
I would go smaller is the pay is better and you get to work on clients you like more. If health isn't your thing that is difficult.
I really do like where I'm at currently, surrounded by highly talented people. plus the small perks are nice...late night cabs/meals, ton of resources and all the other stuff that comes along with being at a global shop. I mostly work on health, but have been given projects on regular consumer brands as well. It's just I'm a little worn down on the whole pharma/health category now. And last year I made senior ad, but to be fair it was over due. But this would give me 4 promotions in 5 years. The question isn't am I ready, but is this a good career move. Especially if I ever want to go back to a big shop or get to the west coast.