1) I have a similar complaint as the person with the vertical monitor, which is lack of customizable workspace. At minimum the dialogue box on the right hand side should be moveable/customizable like the pallets in Photoshop. I use two monitors and usually keep the the main image in the left and all the pallets in the right hand monitor. It's possible to drag the window partially into the right monitor to give a bit more screen real estate, but it jumps back again every time ACR is opened.
2) It's badly missing a navigator panel like in Photoshop. If for example you are spotting, looking for CA, etc whilst at 100-300%, you need to spacebar drag and drop your way around the image, which isn't very good (bad enough with an 8MP image, but even worse with a 24MP scan). Also, with a navigator panel it would be possible to see exactly where you are.
3) Use the same shortcut keys that Photoshop uses. For example, although Page Up and Page Down navigates up and down the image OK, CTRL, ALT Page Up and Page Down doesn't let you navigate across the image like it does in Photoshop (left/right is better for spotting skies, etc). Also, CTRL + 0 to fit image to screen doesn't work if you use the numeric keypad, you need to use the 0 along the top of the keyboard instead (same goes with CTRL Alt + 0 for 100% view).
4) Better renaming in the Save options. The same goes for the stand-alone DNG convertor, which is also rubbish in this regard (in fact, I think it's exactly the same from memory). Use the same options that are in Bridges batch rename tool, which give much better flexibility and control. As an example, say you have a load of RAW files you want to convert to DNG. You find the folder, select the files in Bridge, click them (which opens them in ACR), select all, save as DNG, but there's no useful options for renaming. This means that you then have to batch rename them afterwards using Bridge's batch rename tool, when it could have been done in one hit. As it is, it doesn't even allow you to use the date the image was taken or add any custom text. All it does is give you options for parts of the serial number and today's date, which lets face it, are poor choices for photo file names.
5) Add preserve details slider to noise reduction area to mask edges/areas of detail? I must admit, I don't do noise reduction in ACR I do it in Photoshop, but to me it's logical to have a slider to preserve edges/details like in the reduce noise filter.
6) One last thing, which is only very minor, is in the workflow options. It gives the option to change the image size and resolution, why not show the print size so that you don't have to work it out in your head.