Many challenges face practicing surgeons in today's medical environment. Decreasing revenues create a need for increasing patient volume. Increasing costs of malpractice insurance not only provide financial burdens, but also cause many practitioners to relocate or change the focus of their practice. Technological advancements with the rapid emergence of new procedures and medical devices tax the practicing physician's ability to keep apace of changes. These changes, in combination with increased focus on patient safety and physician competence, place even greater demands on practicing in the surgical subspecialties. In this environment, finding time to improve skills and gain competence in new procedures is a daunting task. This article addresses the topic of surgical competence, provides insight into how to learn to do and prove competence to perform new surgical procedures, as well as reviews the opportunities available for self-evaluation currently available for the practicing surgeon.