If you're running with tv out then I'm not sure since I have never messed with that but if you are using either a PC monitor or a fixed frequency or limited frequency monitor such as an arcade monitor, than AdvancedMAME is definitely worth the trouble.
I currently use AdvancedMAME on a 27" SVGA arcade style monitor and I am able to get most games using nearly the entire screen even vertical games. Of course vertical games will have black bars on the left and right of the monitor, that can't be helped if you want to keep the original aspect ratio.
This cabinet has Windows installed on it but I boot straight to DOS. I have tried MAME32 on it and it just doesn't compare to AdvanceMAME. Although MAME32 is getting much better, it still doesn't play games right IMO that use non 60Hz refresh rates. Try playing Moon Patrol or R-type and you will see they don't look right in MAME32. In AdvancedMAME you can generate modes with the correct refresh rate which will give you smooth scrolling and the correct game aspect ratio...this is of course assuming your monitor can support the desired frequencies.
In the past I have used AdvancedMAME on a real 15Khz monitor and it is much better than DOS MAME or even the windows version of MAME if you want the games to look their best and run the best.
If you want something that is simple to set up, than no, AdvancedMAME isn't the solution....but it is worth the setup time IMHO.
I'm currently building (albeit slowly) a cocktail cabinet that will house a 19" standard res arcade monitor and although I hope to get it to run windows for networking purposes and maybe some win-based emulators and a jukebox, it will primarily run AdvancedMAME and AdvancedMENU.
I don't want to sound like a commercial, but the AdvancedProjects are the best thing to happen to the MAME emulation community IMO. They aren't simple to use but they are worth it!
If you are having troubles with AdvancedMAME, you may wish to try not using the auto modes. I couldn't get them to work properly so I create my own modes. You will definitely want to read the docs to understand how to do this and it takes a little experimentation to figure out what does what...