In order to provide the best possible care for their patients, most physicians devote considerable effort to staying current on developments in their field. But keeping up with the rapid evolution of knowledge and changes in patient expectations and standards of care can be challenging. Electronic resources available at the point of care can help physicians access the latest information, but, given time pressures, such tools aren’t always used. Yet current clinical knowledge remains the foundation of high-quality care.

How do physicians know if they have succeeded in keeping up with changing foundational knowledge? Strong evidence suggests that none of us are good at knowing what we don’t know.1 Performance scores on quality measures provide some feedback on practice, but these measures aren’t always relevant, particularly for specialists, and they tend to reflect overall team performance rather than the abilities of individual physicians. Comprehensive independent assessments provide critical guidance for — and evidence of — staying current. Maintenance of certification (MOC) plays a key role in supporting this important professional responsibility.

Board certification differs from medical licensure in important ways. Administered by state governments, licensure is quite broad: states allow licensed physicians to practice without restrictions, whether they are administering chemotherapy, replacing heart valves, or delivering babies. It is the profession that has created and applied higher standards for physicians who claim to have specialized knowledge. States don’t regulate claims of special expertise, so we rely on board certification to verify that a physician has received specialized training and achieved and maintained knowledge and skills in a particular field. The medical profession has broadly embraced this credential: 79.1% of all licensed physicians in the United States are board certified by an American Board of Medical Specialties (ABMS) organization.2

Despite critics’ claims to the contrary, we believe the evidence is convincing, albeit incomplete, that certain outcomes are better for patients treated by board-certified physicians. Published data show, for example, that the risk of both death and emergency coronary artery bypass grafting is lower when patients undergoing percutaneous coronary interventions are treated by board-certified interventional cardiologists, and the cost of care for Medicare beneficiaries is 2.5% lower among physicians who were obliged to complete MOC than among those who were not.3 Because the vast majority of physicians are board-certified, certification can easily be taken for granted. But in an Internet-based world where anyone can become, for example, an ordained minister online, reliable credentials based on solid standards have become even more valuable.

Founded in 1970, the American Board of Family Medicine became the first board to exclusively issue time-limited certification. By then, it was widely recognized that a certificate issued at the completion of training meant less as physicians progressed in their careers. Other boards eventually moved to time-limited certification. The American Board of Internal Medicine (ABIM) stopped issuing lifetime certificates in 1990. Boards that never issued lifetime certificates have had a smoother path to time-limited continuous certification since they never had lifetime certificate holders.

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