All surgeons are held to the same standards, Being board certified does not hold you to a higher standard. Board certification is a added distinction that one attains after completing their residency. It is offered by the ABMS ( American Board of Medical Specialties ). You can become board certified in any specialty of medicine. American Board of Surgery ( ABS ) is the specific board entity for surgeons. Basically, it involves taking a test to confirm your knowledge in the field. It's origins were initially meant to certify experts in the fields of medicine. It has become a tool for hospitals to compete by saying that they have more board certified doctors and are therefore better. Bottom line is if you wish to practice in the US, you will have to be board certified. This may change because there are a few law suits questioning the boards dominance in this matter. Hope this helps.