Maintenance of certification and maintenance of professionalism.

The most treasured and valued gift given by the public to the medical profession is that of self-regulation. However, the ability of professionals in many fields to self-regulate has come into question. Self-regulation of the medical profession by physicians is no exception and is currently under siege. Many different societal, professional, and regulatory forces have combined into what some have termed a perfect storm to question the wisdom of permitting physicians to continue their privileged status of selfregulation. These forces have raised concerns about the ability of the profession to effectively, efficiently, and transparently perform this critical function. Such forces include increased governmental oversight, especially of government-funded programs (which now comprise approximately half of all medical expenditures), and concerns by large businesses about unexplained variation inmedical costs for their workers, by insurers concerned with controlling their ‘‘medical loss ratio,’’ and by the public and patients accustomed to the rules of the marketplace and consumerism, which they are increasingly applying to medical decision making. One of the mainstays of physicians’ self-regulation was the development of specialty certifying boards in the 1930s. Certification by such specialty boards quickly became a measure by which a physician could demonstrate reaching a ‘‘professiondefined’’ level of quality and expertise. Board certification by one of the 24 boards recognized by the American Board of Medical Specialties (ABMS) is currently seen as a hallmark of a highquality, well-trained, and knowledgeable physician. It is a status now achieved by approximately 85% of all physicians in practice in the United States. Over the past several decades, the certifying boards have moved from a once-in-a-career certifying event to a more continuous lifelong program termed Maintenance of Certification (MOC), a change that has been coupled to the provision of