The concept of an implicit contract between the public and a profession is used as a foundation for the responsibility for professions to develop continued competency assessment and enforcement mechanisms that ensure that the public can expect safe and competent care. The literature in medicine, other health professions, and from other countries is reviewed. There is concern that the fact of continued practice alone does not ensure continued competency in a changing profession and that mandatory continuing education attendance is insufficient. Public-interest groups that have looked at the issue report greater concern among the public than in the professions that effective continued competency mechanism be established and that action be taken where practitioners who are not competent are identified. There has been substantial develop of a variety of approaches in medicine, especially through the specialty boards which account for the majority of medical practitioners, in other health fields, and in several countries.