That you somehow have to adapt the results into the same format the ORM uses. And has to adapt the parameters into taking data from the ORM. Or has to split your entire functionality from the ORM so you can actually access the database directly without one part of your code interfering with the others.
The ORMs I've tried tend to produce some pretty specific table structures that are a pain in the ass to work with outside of the ORM, imo
One of the sticking points I've found in the past is if I create a new table outside of the ORM, it doesn't know how to use it. Then if I try to add it to the ORM's model it doesn't use the existing table, it creates a conflict. Annoying stuff like that