Declaration of competing interest I have no direct or indirect conflicts of interest with the authors or their institutions. I am a councilor of the American Board of Surgery (ABS), a director of the General Surgery Board of the ABS and on the finance committee of the American Board of Medical Specialties (ABMS). These organizations set standards for board certification and administer certification exams but the opinions expressed in the commentary are my own and do not represent or reflect the views of the ABS, ABMS or the University of Texas Southwestern Medical School.