I run a small office and do everything in rhino+visualarq. Projects are usually 30,000sf and smaller (3000sm). For the most part it works great. It’s easy to present concepts to clients and smoothly develop documents from the design model and construction documents. The projects are relatively small and relatively fast. I’ve previously worked on large scale projects in rhino for concept and then rebuilt everything in revit for construction documents. I don’t find revit fun to use at all and it’s not necessarily a great tool at this scale, so I no longer use it.
For the drawbacks, I 100% agree with everything that @Eugen said! Also, reflected ceiling plans. This absolutely needs to be fixed, and apparently is finally getting addressed in Rhino 8 + Visualarq 3.