For most folks autovacuum "Just Works", transparently and in the background. For people with large volumes of UPSERTs or similar workloads with lots of activity against existing rows, it may be necessary to tune autovacuum - usually to be more aggressive than the defaults. Aside from figuring out that this is a thing that can be done and then doing it (or paying someone to figure this out for you), there really isn't much operational burden involved.

I have seen cases where it made sense to run regularly scheduled vacuums outside of just leaving it all to autovacuum, but in my experience this is rare - when I see someone worrying about vacuums it's usually the case that they should just change an autovacuum knob and then forget about it.