There are a few younger folks that practice mohs but not officially fellowship trained. Actually, they have done a pretty nice job with their repairs (in California as was mentioned earlier). They don't get referrals like Mohs_01 but they do it for their own patients. Some of them are not bad apples at all and do a very nice job. That said, I think we need to know our limitations and some of us don't seem to know (while others do a fine job of knowing).
What is "not officially fellowship trained" supposed to mean? Sounds like a really weird way to say untrained (or inadequately trained).
I really wouldn't mind these untrained folks who cherry pick the easy cases, if they approached it the right way. That seldom happens.
What normally happens (and this is what I would consider to be the wrong way) is that the doc represents themselves as an expert in Mohs surgery and then does the procedure. Most of the time things are fine, but sometimes unexpected stuff happens, and then things go one of two ways:
-The doc just tries to do it anyway, even though it is beyond what they ought to be doing (worst option)
-Pt refers to a trained Mohs surgeon to bail them out (less bad, but still not as good as if they had just referred in the first place).
So, what is the best way? If the dermatologist just told the pt, "Look this is something that I think I can take care of for you very well, but there is another specialist I could refer you to who has more training and experience in the procedure. What would you prefer to do?", and then let the patient decide, I think that would be fine (and many pts would probably just choose to stay with the doc they already have a relationship with). However, in my experience, this is seldom done.