All physicians want to give their patients the best quality care and to believe that they themselves have kept abreast of new information and technology. All patients want to believe that their physicians are wise, learned, and up to date on the condition for which they are consulting. The debate continues as to how we might best attain these shared goals of process (clinician performance) and outcomes (patient results) measures. Physicians historically kept their knowledge current through the ongoing practice of medicine, interaction with their peers, and continuing medical education. External stakeholders, including the public, third-party payers, the government, and independent specialty medical boards, have demanded more measurable outcomes. One current means of assuring quality and, by extension, competence is through specialty board certification and Maintenance of Certification (MOC). The professional incentive for physicians to comply with MOC is increasingly becoming a requirement for hospital credentialing and privileges and for insurance approval for in-network benefits.