John Howard wrote:
...yes I know medium format requires a separate collection of lenses and is more expensive. But... assume it does not matter.
But you really can't put those considerations aside. They are very important factors.
The least expensive 40 to 60MP medium format camera body costs roughly double what a full frame camera with roughly the same resolution.
Add that there's considerably less lens selection for medium format. Especially, telephotos are very limited (a 500mm or 600mm FF equivalent lens for a medium format camera would be massive and horrifically expensive). Medium format also have slower frame rates and other limitations.
Let's see... a Nikon D850 or a Canon 5DS camera offer a choice of approx. 60 lenses each. A Sony A7RIII doesn't have as large selection.... Sony offers around 20 full frame capable lenses.
Buy a Fuji GFX or a Hasselblad X1D II you'll have 8 or 9 native lenses to choose among. A Pentax 645Z or Leaf Mamiya 645DF each give you access to around 15 current lenses. There also may be adapters to allow other system lenses or vintage lenses that can be used on these cameras. But there is not a lot of third party support for medium format. Nowhere near what there is for the full frame DSLRs, which also generally have option of adapting or directly using vintage lenses.
In the last few years medium format have largely switched from CCD to CMOS sensors, following the approx. 10-year lead of smaller format DSLRs. As a result, the smaller formats have less advantage now in terms of high ISO. While frame rates and autofocus performance are other areas where medium format has improved considerably too, these performance factors still lag DSLRs in smaller formats.
When it comes to many image qualities, size matters. If you will be making 30" and 40" wide prints, it would be better to opt for the medium format camera. But if your largest prints will be done with a 24" wide or smaller printer, you will see little difference (and, similarly, if your largest prints will be done with a 13" wide printer, APS-C can serve fine). All this assumes minimal image cropping.
Keep in mind that "medium format" digital really isn't all that much larger than "full frame" digital. The typical "medium format" camera in the 50 to 60MP range has a 33x44mm sensor. Sure, that's bigger than the 24x36mm sensor of a "full frame" camera... But it's a far cry from the 60x80mm images some medium format film cameras produced. The increase in sensor area from digital APS-C format to full frame is 2.33X, while the increase from full frame format to medium format is approx. 1.66X. (Some medium format sensors are a little larger, while others are a little smaller... "medium format" isn't as standardized as "full frame".)
I can only speak for myself.... Coming from a film background where I used 35mm, medium format and large format.... Today APS-C is my "digital 35mm" and full frame is my "digital medium format"... and the fact that they can share a lot of lenses and accessories is HUGE. Back in the days of film I had to buy, maintain and carry three completely different systems. About the only things those film systems shared were light meters, tripods and some studio lighting gear.