Pros
The contract rate is competitive, and the direct deposit is reliable. This is the beginning and end of the professionalism you will experience
Cons
At first, the environment seems merely chaotic. You'll soon realize the chaos is a carefully engineered defense mechanism. A huge portion of the development work is stunningly repetitive and could be easily automated with a few simple scripts. The long-tenured team knows this. Their job security is therefore dependent on ensuring the process remains manual, complex, and tribal. I started 2 months after a verbal offer because there were some "unforseen" requirements. Once there, I spent the first 6 weeks attending meetings and got 0 assignments despite asking for work.
This is the key to understanding everything that happens here. They cannot afford to pause, organize, and codify their methods, because doing so would expose how automatable their work is, rendering their specialized knowledge obsolete.
How do they prevent this? By creating a culture of constant, manufactured crisis. Everything is needed yesterday and everyobody is under water. This frantic pace serves a critical purpose: it ensures no one, especially a competent newcomer, ever has the time to breathe, analyze the workflow, and suggest improvements. There's "no time" for onboarding, "no time" to guide you on how to interpret their documentation, and "no time" to answer clarifying questions.
Your attempts to bring order are not just unhelpful; they are a direct threat to this system and are pushed back. Your requests for help are largely ingored. All the while, you'll be forced to work within their archaic framework: copy-pasting entire code blocks for new sites instead of using a single reusable component; critical values hardcoded directly into the code; real patient data and personal experimental code in a test system,an overly complicated way of managing variables, the concept of automated testing is non-existent; QA is one person frantically clicking through the site before a go-live.
The feedback loop is non-existent because a real performance review would require discussing process, which is the one topic they must avoid. There is no formal onboarding documentation so I had to rely on the staff for that and they were just too busy. So you work in a silent void until you are unceremoniously fired mid-task via your agent. The chaos is so complete that several weeks after the termination, I still had their equipment and live VPN access—a testament to a team so focused on protecting their inefficient system that they ignore basic operational security.