The conversation traces the 90-year history and evolving mission of the American Board of Orthopaedic Surgery. Leaders describe the board’s origins, its role in establishing standards, and the evidence linking certification with improved quality and safety. They contrast U.S., Canadian, and Hong Kong certification models while emphasizing professionalism, accountability, and the privilege of self-regulation. Looking ahead, they highlight technology, AI, reduced burden, and strengthened partnerships as core to advancing patient-centered assessment and maintaining trust in the profession.