Subspecialty certification in hand surgery was instituted in 1989 by the collaborative efforts of the American Boards of General Surgery, Plastic Surgery, and Orthopaedic Surgery. Candidates must be certified by their parent board and have demonstrated qualifications in hand surgery beyond those expected of other Board-certified surgeons. Qualifications include 1 year of additional training in an Accreditation Council for Graduate Medical Education accredited hand surgery fellowship, successful passage of a secure examination in hand surgery, and a practice characterized by a majority of cases in hand surgery. The certificates are time limited, and every 10 years one must successfully pass a recertification examination to maintain subspecialty certification. Since its inception, 1431 orthopaedic surgeons have passed the examination and the failure rate has been 3.1%. Six hundred and twenty-three have recertified with a failure rate of 2%. Possession of a certificate of subspecialty qualifications in hand surgery was never intended to bestow special privileges to those who practice hand surgery; rather, it was intended to demonstrate to the public and our profession that certificate holders have met Board Standards and are qualified to treat problems related to the hand and wrist.