Not all VOIP is exteranl.
I work in a school.
We put in a phone point in every classroom and every office. You have to be able to send calls to the teacher, the teachers need to call in assistance (in rough schools), emergency numbers, the office to check on children, the parents to see where the kids are, etc.
We have 4 outgoing ISDN lines. Everything else is internal, there is no SIP to the outside world so there's no IP traffic outside the local network (though when my leased line comes through, it's the first upgrade planned).
We also have gigabit-to-the-desktop.
Hint: Guess what was the first option we had to turn on once we had a normal amount of traffic on the network and 30+ phones? QoS. Because, although the outside lines were fine, after a certain number of handsets, and with day-to-day server replication etc. we were experiencing phone calls dropping because the network couldn't keep up. Even VLANning the phones off didn't help much because they still shared the same priority as someone downloading their roaming profile.
You HAVE to put QoS on after a while. And it cures the problem instantly. Haven't had a problem since and the effect was immediate (VLANning it off helped in that we QoS'd the entire voice VLAN rather than the individual phones, protocols, etc.). If I have to put QoS on in a small school with only 50 internal phones and all analogue outside lines, it's not something that you "only want to care about" in an extreme scenario. And I guarantee you that when we get our SIP outgoing, we're going to need to QoS them against the kids downloading huge videos even if that's only on our end.
QoS exists in every managed switch (and has done for, what, 10-15 years?), and is a commodity feature, because it's necessary. Not if you have two phones on an idle gigabit network, but any serious scenario of IP phone deployment requires it. Hell, we can do several gigabytes of voice data a day just on internal calls.