The reason that dermatologists should not send all their slides to dermatopathologists is a scope of practice argument, not an ethical argument.

D r Ackerman proposes that dermatologists should send all their slides to a dermatopathologist. In my opinion, this is really a scope of practice argument where one subspecialty is arguing that only they should get all the referrals. Dr Ackerman has suggested that his opinion is an ethical point. I would disagree. His point of view that dermatologists are greedy because they do not send all their slides to dermatopathologists is as false as saying dermatopathologists who want all slides sent to them are greedy. Are the dermatopathologists really ‘‘altruistic and academic?’’ Dermatopathologists are no more altruistic and academic than the plastic surgeons who do not want facial plastic surgeons, oculoplastic surgeons, or ‘‘dermasurgeons’’ intruding on their ‘‘turf.’’ The weakest part of Dr Ackerman’s opinion is that this issue is different from that of the generalists referring to specialists that exist in all of medicine. We all agree that there is nothing unethical about this type of referral pattern. Just as general pathologists diagnose disease from easy slides and send difficult ones to a dermatopathologist, dermatologists treat easy skin cancers and send difficult ones to a Mohs micrographic surgeon. A general practitioner also treats easy conditions and refers the difficult cases to a specialist. The analogy is the same for the generalist sending to the specialist and the dermatologist sending to the dermatopathologist. The referral is done on behalf of the patient.