In summary, CPET is an extremely valuable diagnostic tool that is complicated to perform and interpret by technicians and physicians who have not been adequately trained. Compounding these problems is the marked underfunding relative to the time and cognitive effort required for testing, the professional involvement during performance, and the interpretation of the test results. Also, CPET is not extensively taught in many pulmonary training programs, and requires a large amount of education of technicians, pulmonary physicians, and primary care physicians about indications, proper calibration, performance, and interpretation of the CPET results. Finally, the ATS and ACCP should consider a proficiency testing program to ensure that the sites that are generating and interpreting CPET data have equipment that is well-calibrated, are staffed by physicians, and generate standardized printouts and interpretations. Without these measures, we cannot expect that doctors would know how to correctly order, interpret, or utilize the vast amount of important clinical information contained in this diagnostic test.