Not necessarily. As I discussed with some other fine gentlemen in a different thread, by tinkering with the settings of Project Nevada and adding a mod like Equipment Looted When First Arrived in New Vegas, you can greatly increase you survival difficulty in the early-to-mid stages of New Vegas.
Equipment Looted realistically takes away your probably high-end gear, while giving you a way to get it back later in the game.
Project Nevada allows to set loot and ammo rarity, making the early parts of Vegas quite desparete. Also, by simply making your health tied solely to you Endurance, rather then level (same for enemies), you will make the game much more gear dependent (and realistic, I'd say). Lowering the amount of skill points given per level is also very helpful, as it forces you to carefully consider your choices and makes you unable to simply max-out your character, instead forcing you to specialize.
Trust me on this - this makes for a great experience. Even after fighting off the Enclave in "Escape" in Capital Wasteland, I was in danger when fighting the Powder Gangers, and that feeling never really went away.