and accurately self-assess is in dispute, with research showing no consensus and more clinical experience does not necessarily lead to better outcomes of care. Fewer than 30% of physicians examine their own performance data and try to improve. The MOC program structure tries to address these concerns with a sound theoretical rationale via the six ACGME competencies framework and a respectable body of scientific evidence, and to address its relationship to patient outcomes, physician performance, validity of the assessment or educational methods utilized and learning or improvement potential. The validity of the studies that the American Board of Internal Medicine cites to support these arguments has been questioned, because the authors of these studies are individuals who are employed by, or have previously been employed by, the American Board of Medical Specialties or its related bodies (see Hawkins, Richard E.). In addition, there appears to be a tightly-knit, self-credentialed "patient safety/medical quality" industry developing in the United States, from which the authors of many of the studies supporting maintenance of certification have emerged. The American Board of Internal Medicine is an organization that attempts to assess physicians through proprietary testing and completion of required modules. The American Board of Internal Medicine has issued more than 425,000 initial certificates in internal medicine and its subspecialties in the United States and its territories since its founding. From 2001 to 2013, American Board of Internal Medicine certified 91,024 physicians in general internal medicine. From 2001 to 2013, the American Board of Internal Medicine certified more than 10,000 cardiologists and more than 6,400 medical oncologists. More than 140,000 physicians – including more than 8,000 physicians holding certifications that hold certifications which are valid indefinitely — are currently enrolled in the American Board of Internal Medicine's Maintenance of Certification program. Maintenance of Certification (MOC) The American Board of Internal Medicine asserts that research shows that physician knowledge deteriorates and practice habits and patterns fail to change, over time, in response to medical advances. Every 10 years, some internists and subspecialists certified in or after 1990 renew their certifications through the American Board of Internal Medicine's Maintenance of Certification program. The American Board of Internal Medicine's Maintenance of Certification program changed in January 2014. The program now requires physicians to: Possess a valid medical license Earn Maintenance of Certification points (points count toward all certificates you are maintaining) Some Maintenance of Certification activity every two years