Truly, for my energy-weapon totin', headshottin' badass wasteland chick, V.A.T.S. is the alpha and the omega. It's the entire reason she's able to own the battlefield, and it lets me keep the initiative instead of constantly just backpedaling and holding down the trigger.
The "Project Nevada" mod I've got installed ostensibly makes the game more like a first-person shooter, but while it does feel a bit smoother, it still has that janky action-figure feel that makes shooting in Fallout so generally unfun. V.A.T.S. singlehandedly makes Fallout: New Vegas fun.
On top of that, V.A.T.S. makes for great stories. These days, I avoid the "Bloody Mess" perk, because I like the randomness of the aftermath of a V.A.T.S. attack. I fight with energy weapons, so critical strikes often vaporize my enemies. I have to admit, I've always been a bit disappointed by this, since I get a sick kick out of the many goofy ways enemies blow apart in Fallout games. All the same, V.A.T.S. opens up all sorts of humorous and tactical options, given that you can actually effectively target an enemy's various parts. (I do wish, however, that the camera weren't so finnicky and selective—there are far too many times where I'll just be unable to get the damned camera to focus on an enemy's head, to the point where I'll have to pop out and back into V.A.T.S. to make it work.)
So now I'll pause for a second and imagine the future: Can you imagine if the next Fallout, let's just call it Fallout 4, had combat that was actually good on its own? Enemies who use the environment intelligently and are animated smoothly, whose A.I. has gradations and whom you can hide from, re-ambush, and confuse? Imagine an aiming and shooting feel that felt closer to, say, Borderlands 2. Okay, now imagine that on top of all that, you also had V.A.T.S. Suddenly, the system would feel less like a band-aid and more like a garnish. Considering how enjoyable V.A.T.S. already is, I'd welcome that with open arms.