Maintenance of Certification (MOC) programs are a source of irritation and controversy in medical communities today. The American Board of Medical Specialties (ABMS), representing 24 specialty member boards, notes that prior to the 1970s, board certification of a physician provided them with lifetime credentials. These written and sometimes oral exams were designed to test for basic competence in that particular specialty. (This was analogous to medical licensure based on an individual passing the three parts of the examinations given by the National Board of Medical Examiners [NBME]. In 1992, this exam was superseded by the U.S. Medical Licensing Examination [USMLE], sponsored by the Federation of State Medical Boards [FSMB] and the [NBME]). As recognition that the science and practice of medicine underwent substantial and sometimes rapid changes over time, efforts were begun to assure that diplomates of the various specialty boards were, in fact, still competent to practice their specialties. Initially, the individual state boards of medicine required 50 to 150 hours of continuing medical education (CME) for each cycle of license renewal. Attendees at CME courses were given a Certificate of Attendance by the program sponsors, which could be used to verify individual participation. I ran a CME program for 25 years and noted that many registrants would duly sign in each morning, and then shortly leave to play golf!