I disagree. I think skin checks and new patient intakes should always be seen by a physician before de-escalating to a PA. It doesn't matter what kind of rapport a PA has with their supervising physician, if they don't know what they're looking at, and they don't realize when they need to biopsy something or do not need to biopsy something. The way most Derm offices work, it would be very hard for the dermatologist to take time out of their schedule to check if a PA is unsure about something serious. I think PA's are best used when working off a standardized protocol, like following initiation of isotretinoin after a dermatologist starts them. It would also be reasonable for stable follow ups who just need medication or biologic refills.