Medusa is fast and strongly benefits from player piloting, but it just doesn't hit hard enough to justify player piloting. You'll impact the fight much more with one of faster cruisers or capitals.
It's also rare. so you'll very likely find a Falcon(P) to pilot long before a Medusa. Since Medusa is 9 speed you have strong drawbacks from including one into early mostly frigate fleet, unlike Falcon(P).
I'll note Medusa seem a lot more common to me now, given they've been added to the Independents roster, in addition to Tri-tach's. I think I've run across my first Medusa for sale fairly early on in a number of runs. Just doing a check with 3 quickly started game and Stellar Networks, there's typically 4-7 Medusa for sale somewhere at the beginning of the game. Falcon (P) seems to number between 8 and 12. I'd say it's only about half as common as the Falcon (P). So something like 1/3 chance you'll find a Medusa before a Falcon (P).
It is an example of an elite ship for it's size where it hits more like a cruiser than a frigate. I didn't pick an elite destroyer because there aren't any really, Harbinger used to kinda be one but it got nerfed and medusa is not quite there. A elite destroyer would probably need to hit like a battlecruiser to be a destroyer version of a Hyperion.
It would also need to be costed like a battlecruiser, given a Hyperion is costed like a Falcon or Venture.
Although, Medusa literally hits about as hard as a Hyperion, so cruiser tier by that metric, given it havs identical maximum flux stat lines, and similar 2 medium energy plus one medium universal vs 2 small universal and 3 forward small energies. System Expertise NPC officers can make it move pretty well.
I do think the Extended Shields s-mod helps them a fair bit, along with the extra 5 OP. 360 shield Medusa are possible now, but perhaps not optimal due to phase skimmer dropping shields. In AI hands, they seem to stand up to 0.96 late game Ordos better than most frigates (although perhaps not Hyperions). I've been trying to make use of some aggressive SO Glimmers but they just drop really fast. Scarabs which used to do OK end game seem to also pop rather quickly for me. All those Brilliants switching to Plasma Burn (and losing the fighter wings), and the introduction of Novas, means Ordo hunting is harder for frigates, while making it easier for missile ships (since there are fewer PD fighters, no smart flares, and Novas are glass cannons).
