The qualities of a competent surgeon encompass a solid knowledge base, surgical technical skills, and sound judgement. While written examinations and recertification testing help to maintain fundamental knowledge, measures of surgical competency are more challenging and difficult to define. The importance of quality and safety in patient care is increasingly a priority with high expectations from medical professionals, societies, and the public. This emphasis has resulted in evaluations of competency that impact an otolaryngologist from their training years and spans the entire career. The Joint Commission has also created an expectation for departments to have an ongoing objective process of evaluating health care providers that addresses issues with safety and quality of outliers, low volume providers and new procedures. Lastly, surgeons in the later stages of their careers may now have expectations to demonstrate competency to provide the high standards of patient care and quality expected from our specialty and the public. This panel will discuss controversial topics such as: 1) Surgical volume and credentialing: Is there a minimum number of cases necessary for maintaining privileges? Should we measure individuals or groups of surgeons? Are lower volumes associated with increased complications/use of hospital resources? What are legal implications for residency program directors or hospital administrators? 2) Low-volume surgeries: Who should be doing them? How does a young surgeon gain sufficient experience? How are new techniques introduced? 3) Methods to measure surgical competency: Who should provide oversight? How do we measure competency? Should an impaired surgeon have periodic review of practice? What is fair?