Change is coming rapidly in America’s health care system. Bi-partisan reforms moving forward in the U.S. Congress represent a dramatic shift to a value-based payment system for health care services according to quality measures such as Maintenance of Certification. Private third-party payers, consumers, and other health care professions are moving rapidly along these lines. Optometry is already behind the medical profession in terms of having a system to clearly demonstrate continued competency to payers and consumers, but the creation of an American Board of Optometry would provide a unified national platform to establish and demonstrate competency and value and position our profession solidly for the future. The vote on this issue by the AOA House of Delegates at its June, 2009 meeting is crucial to protect optometry’s future.