There was seriously no pun intended with that “hard pill to swallow” comment.
You’re right about the medical system being the culprit. I don’t know how to switch between basic and advanced medical so I just removed the ace_medical.pbo file from the addons folder and all seems acceptable now ... only seeing about a 5% fps hit with ACE3 now.
I think it defaults to basic medical, like with the Showcases/Night mission. Maybe you have to drop an advanced medical flag into missions to enable that? I dunno, but I don’t think it matters since the whole ACE3 medical system is probably the culprit. A real wildcard since some missions already bog down framerate without ACE3.
It’s really too bad since even the basic medical system is pretty cool. Hopefully they can sort out the performance issues in future releases but I won’t be using ace_medical.pbo until then.