You can't have it both ways
Can't speak for everywhere, but we have less admin staff than ever. We do a lot of our own. Yes, we have to market - we didn't choose to, we'd rather not, we're not trained to, but we can't not.
Your friend the psychiatrist - yes, he provides a service in that he's there, he can listen, he can offer his expertise - but he cannot make people be happy, any more than I can make them clever, without their input.
Suppose he has a patient who rarely shows up to sessions, won't speak, asks for different appointments from those available, because his part time job makes them awkward, or he slept through his alarm.
Suppose that patient's fees are paid by the taxpayer (including your friend), though the patient will have to pay back the debt if he's ever happy enough to earn the money to do so.
Suppose that patient complains that he doesn't think the facilities at your friend's practice are fun enough, the coffee isn't nice, the chairs are a bit crap.
Suppose the patient, after 3 years of therapy which he may or may not pay for later, for which he rarely turned up and seldom contributed, then gets to affect your friend's professional standing by filling out an online survey about how 'satisfied' he feels with the whole process.
Then you have yourself a more workable analogy.