I can see what you mean. However, docs that do manual tend to break up surgeries into more than one day for large procedures. Some set limits on grafts extracted.
Then you have some docs that use techs and nurses to extract do large cases in one day 3000+ grafts and such clinics are even able to handle more than 1 patient a day due to this. Maximizing patients by running something like a mill. So doctor would be fatigued regardless and be creating thousands of recipient sites a day. The worst part is, the doc is working on multiple patients and the surgery day is not dedicated to you.
With most fue docs i spoke with, they limit extractions per day, and, only focus on you as the patient of the day. Heart surgeons doing nonstop 8-10 surgeries and are standing probably are more fatigued. If a doctor can handle fue extractions, it is likely they do not feel fatigued.
Another question to ask is, are you paying the rate you pay for surgery to a doc? Each doctor charges different. So, if techs/nurses extract, what justifies the price as it is not a surgeon scoring the donor area?
Ive seen some amazing results with noticeable yield when docs extract and do most surgical aspects themselves.