Low pay for a lot of difficult work. You will never get a raise and if you do it'll be less than 4% every other year. The workload is untenable, you will have to manage 10 or more studies with systems from the 90s and early 2000s that are not efficient. Most people (non PMs, sr management) have worked there forever and are fine with managing studies with word doc and excel, again it's a flawed system. Ideas are never excepted by senior management and they are out of touch with what is happening to the actual PMs. The manager doesn't even know how to run a study and can't help employees during critical times like study start up. High PM turnover across the US. Just run. Best day of my life was when I turned in my notice.