Yes. If you have vector or pixel artwork from Illustrator or Photoshop, for example, you need Mr. MCS to convert it to a gerber format. (I haven't a clue how he does that.)
If you want to use an actual PCB layout program and create gerber files complete with solder mask, silk screen, drill file, multiple layers, etc. than you need to lay out the board in that program using their tools -- placing your graphic in the background and tracing is the quickest way to go.
I used to lay out boards in Illustrator as well, which makes it easy to print a transparency, expose a board, etch, etc. But the boardhouses want Gerbers, so I now find it easier to lay the board out in a real PCB layout program, output postscript, make a PDF, print to transparency, etc. Then I can make the board myself and if I like it, it's ten more seconds to output a gerber file and send it off to a boardhouse.