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I don't think it's that much work. It's just that when you hit a wall, you have to fix it yourself. But many of the fixes are easy -- OTP usually does things in a very simple way, and sometimes something more complex is needed to scale beyond.

I think this is the case regardless of what languages or systems you use, but more well used systems may have more experts and more documentation to lean on.

For things that are a good fit for Erlang, it seems worth it to train up a couple people with deep internal knowledge of the VM you're using. As you said in another part of the thread, Erlang doesn't have a lot of abstraction -- most scaling problems aren't too many layers deep.