When delivering comprehensive medical care, primary care physicians often provide services traditionally provided by subspecialists, including diagnostic procedures. One of these is the skin biopsy, a relatively safe and easy procedure. Whether nondermatologists should perform skin biopsies is a paradigm for a number of similar issues facing primary care physicians, and there is no simple resolution. At the core of this issue is a dilemma: how can one acquire broad expertise and provide optimal comprehensive medical care in the face of rapidly expanding knowledge and specialized techniques that pressure even specialists to subspecialize? This issue also reflects a major social concern: where do the interests of the individual patient, the individual physician, and society diverge when it comes to provision of care by certified specialists?
Skin disorders that require medical attention are common. Reportedly, 30% of all Americans are affected by dermatologic problems at one time or another.1 The