The debate on the issue of certificates of added qualifications (CAQs) will continue since the arguments are strong in each direction. Unlike orthopedic surgery, the vast majority of medical specialties link certification with accreditation (CAQs with fellowship training). Differentiation in specialties and subspecialties is inevitable because of the advances in science and technology and the influence of social and economic factors. Accreditation and certification both have an important role in the definition of new and established subspecialties and the goal to genuinely improve patient care. Constant and repetitive reassessment of these issues is critical.