Murray graduated from medical school in 1989 and became certified to practice internal medicine from 1998 to 2008. (Recertification every 10 years is mandated by the certifying organization, the American Board of Internal Medicine.) The typical delay from graduating medical school to certification in internal medicine is three or four years; we don't know why Murray took longer. Though never certified as a cardiologist (or, as of 2009, as an internist), he still can claim to be a cardiologist. Though the distinction may mean little to an unsuspecting patient, it means a great deal to an insurance company. Certification is not the same as licensure, though the terms often are used interchangeably. Licensure is granted at the state level and denotes that a person can practice medicine legally. Certification is fixed by professional societies with an aim to assure a quality product. (To determine whether Dr. Murray—or any internal medicine specialist you know—is certified to practice, just click here and enter the doctor's name.) Like Murray, many licensed doctors are not certified, not all of them scoundrels; however, just about no one practicing medicine is unlicensed—it is roughly the same as driving a car without a license and probably comparably dangerous to those around you.