It's an ordeal, honestly. I don't think the design minds at Paizo actually considered how people would play this without automation.
Let's consider just Initiative. Initiative without a VTT is honestly stupid. Each creature has its own Initiative score, which fluctuates based on delayed actions, getting knocked out during a combat, etc. Let's say I have 5 players and 6 goblins - that's ELEVEN initiative scores to track. Then I have to remember which Goblin is Goblin #1 in the order, has that goblin taken its reaction, does it have any conditions to track, etc.?
What am I doing to try to get around this? Well, I have dry erase condition cards to remind people if they're Clumsy, Enfeebled, etc., and by how much. I have dry erase clothespins that I can write "GOBLIN x#" upon, and slide it around a track at the top of my GM screen like a shuffleboard in a meat raffle.
So I'm left wondering, do I need all this stuff just to run a blasted game? Is there any way that Paizo could have made the game without all this minutiae? Why isn't there a better option out there for a fantasy RPG that is streamlined and balanced?
Honestly, I don't know how I'm going to teach a group of 6 teenagers relatively new to TTPRGS how to play this 650 page rulebook. But I'll be damned if I try to DM 5e again - I'd rather quit gaming.