They are condescending arrogant overly sensitive ****s who greatly over-estimate their own value in my opinion. And I have always believed it is about their ego and bottom line rather than anything about a client (I despise the word patient and would never hire one who used that condescending term). I don't so much think of it as a service because I don't think those people really do anything besides sit there. I think of it like paying rent.
I have seen (for more than the initial interview of them) 3 of those people over the years and never bothered with them at all when I left - I just left and have not regretted it one bit. The 4th that I still hire will more than likely tell me she is retiring soon, I will say fine and that will be that. I will leave and that will be the end of it.