The document outlines the changes over time to the requirements for physicians to maintain their certification through the American Board of Internal Medicine (ABIM). It discusses the introduction of requirements in 2000 called Continuous Professional Development (CPD) and later renamed to Maintenance of Certification (MOC) in 2006. Key requirements included passing a recertification exam, completing 100 self evaluation points across medical knowledge, practice improvement, and elective categories, and participating in quality improvement and patient experience activities every five years. Fees could be paid annually or prepaid for 10 years. By 2015, some requirements like practice improvement were suspended while others like earning 100 points every 5 years continued.