OBX lighthouse on a bigger day...sweep down the beach can be brutal. Denied 4 times.
They say OB SF is the worst of the worst, but I've never been there.
I've never had a problem at any reef breaks, Hawaii, Indo, Puerto Rico, etc.
But anytime the water is really really cold, like NE water 40 and below, the paddle outs are always worse, even if the conditions aren't as bad. I'd rather take a beating in warm water than 35 degree water with a 5 mil w/ hood, boots, and gloves, any day of the week.