Its not as painful as some might have you think.
I pretty much compose and focus everything on ground glass and I have yet have a problem or capture something out of focus. Recently I did upgrade to an IQ back, which gives me the advantage of checking focus non-tethered, however, I use the better screen to really look out for lens flare.
Like was mentioned before, having a powerful loupe is key.
Just for full disclosure, I spent 8 years working exclusively with a 4x5 camera and the last 5 years with a MF technical camera, so I am pretty use to using ground glass.