The development of orthopedic certification in the United States.

The development of medical education standards and state licensure requirements occurred simultaneously in the 1900s. The result was that annual state licensure became the physician's certification. Eventually, the explosion of scientific knowledge due to hospital-based clinical practices and stimulation from national societies led to specialization within medicine. Primary specialty boards were organized in the 1930s to issue credentials and define qualifications for specialists. Just as licensure became the certification of a physician, primary boards became the certification of a physician specialist. Certification has become progressively more important in relationship to individual patients, national societies, hospitals, and third-party carriers. Recertification is the recognition by a primary board of a diplomate's continuing qualifications. The majority of primary boards have plans to institute recertification in order to evaluate pertinent cognitive knowledge of a diplomate and to respond to inadequate ongoing peer review. The expansion of scientific and technical knowledge, which led to specialization in the 1930s, inevitably has led to subspecialization. Orthopedic surgeons are using a wide range of fellowships, especially those just completing their residency education. The first certificate of added qualifications for orthopedics was in surgery of the hand.