American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Maintenance of Certification

Maintenance of Certification (MOC) refers to the continuous process of professional development that surgeons must participate in to maintain board certification. Board certification is a professional credential communicating to patients that a physician is up to date with the most recent standards of practice and patient care. MOC involves ongoing measurement of six core competencies, which include practice-based learning and improvement, patient care and procedural skills, systems-based practice, medical knowledge, interpersonal and communication skills, and professionalism. Even though MOC promotes high-quality patient care, a vocal minority of physicians have expressed displeasure with MOC calling on state legislatures to take action prohibiting the use of MOC for licensure, hospital privileging, reimbursement, and employment. In response to these concerns, several states have enacted legislation prohibiting MOC in some way.

The American College of Surgeons (ACS) is opposed to legislation prohibiting MOC because it interferes with the right of the profession to set its own standards, interferes with the ability of hospital medical staff to set quality standards for their institutions, and denies patients the right to know whether the specialists caring for them are up to date in their fields. The ACS sees board certification and recertification as an important component of surgeons meeting higher standards of quality surgical care, and supports educational activities to assist surgeons in their recertification efforts.

The following items are useful documents for ACS Chapters and Fellows who advocate with their state legislators to defend MOC. Questions about MOC legislation, along with requests for further information or assistance with advocacy initiatives, may be sent to


Maintenance of Certification Toolkit