Well, I suppose one can ask where ANY format fits into one's own view of the craft, for that matter. If you do not use the range of medium formats, then you can answer that question more definitively than many of the rest of us can. In my own situation the conclusion is different. I have found that with a small darkroom and low ceiling height, a 6x4.5 negative strikes a good balance of quality and convenience/printability. I use Mamiya AFD-II and Pro TL cameras, and along with their respective lenses they meet my needs very well. I also use Pentax 6x7 (and own but rarely use Mamiya RZ + lenses), and that gives me a good sized negative for scanning colour images. I love using colour negative film, for some reason, with the Pentax. The smaller 6x4.5 is for me more strictly intended for darkroom printing and so I shoot only B/W with it nowadays. If I had the space and the money for LF enlargers and all that goes with using LF gear in the field, I would still think that the beauty of the 645 is the ability to take portraits and more spontaneous photographs while getting a neg that prints to 12"x16" with barely any grain visible. For 35mm to achieve that, it has to be really slow film and good, fast lenses that may cost quite a bit more. The practical side of using slower film is living with slow shutter speeds. So MF lives nicely in the bracket where better than 35 mm quality is desired coupled with better than LF handling. Every way in which film can be made or developed better for the sake of 35 mm applies equally to the larger formats. But the handling and ergonomics issues with LF are what they are, unfortunately. While you may have very exacting standards to which you work, mine may be looser, and so I haven't missed LF that much. Incidentally I own two 4x5s but I just haven't figured out how to practically put them to good use yet, and I need to also spend a bit of effort on their physical condition, accessories etc. Maybe I will get to that sooner than I think, and then maybe I may find myself where you are now, who knows.