Don’t get me wrong based on the title; I am not advocating for proficiency testing (PT). After Medical Boards, Resident In-Service and Board exams, I never thought I would be thinking about any more testing at all. There are better ways to test for ongoing real proficiency. Exercises that test “real-world” skills, such as focused review of signed out cases or concurrent reviews - with feedback – not only lead to better outcomes (patient safety) but also improve practice (constructive feedback). But testing is an unfortunate part of modern life. It’s a metric, and regulators like metrics. For years we dealt with the specter of impending gynecologic cytology PT. Based on the complexity of the federally mandated glass slide testing format, the organizations capable of producing such a monumental effort appeared to reach a détente with CMS, and no testing took place for many years after the federal regulation went into effect. However, when one organization came up with a program, the seeming détente was at an end, and CAP and ASCP were essentially forced to enter the fray.