Its customers need big enterprise and there isn't a lot of other competition in that space. Not stuff with an ecosystem of systems integrators buzzing around.
If you don't need all that get Hubspot or Zoho or SugarCRM or something.
We even spun off a startup that is essentially a platform on top of Salesforce for that entire industry.
It's competitive but their sales are just as aggressive and it was harder to justify not switching the more we wanted those kinds of features.
I haven't used an implementation of SFDC that I've liked yet.