I use every medium under the sun but I have been using more photoshop than anything lately. It became a design industry standard quite a while ago. Whether you use a Wacom tablet or good ol' pencil/paper and scanner, linework and perspective are vital to a great rendering. That's something you can't fake and no matter how well you render, something just won't look right.
I actually prefer to do markers, colored pencils, pastels, gouache, etc, but the ability to "undo" and do multiple variations is key to time management on a project. I typically only do it when doing a portrait for a gift or something that won't need adjustments.
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