[tomkatf]

...the answer is yes. (I'm assuming you're using Photoshop) You will set up the actual size of the final image when you create a new file using the image size/canvas commands. I've been using the Wacom Graphire(4 x 5") tablet for years and actually have the mapping area set up to about 1 x 1.5". This allows me to move the cursor/tool from corner to corner on my monitor without moving my wrist at all, which gives me a stable and more accurate base to work from. YMMV and HTH!

Best,
Tom