After reading Dr. David Scasta's letter in the February 4 Psychiatric News, I feel compelled to comment as the subject is near to my heart.

First, it is interesting that an APA publication's choice of person to respond was none other than the CEO of ABPN. Perhaps this is a "fox in the henhouse." I would have much preferred to see comments from someone from APA currently working with ABPN on our behalf.

I, unlike Dr. Scasta, will not be grandfathered and, in fact, am in the first group required to meet all maintenance of certification (MOC) requirements. My opinions regarding the requirements reflect a history of being an educator and serving in personnel management before becoming a physician.

Regulations do not a good physician make. Those of us who are motivated toward lifelong learning will continue to be. Those who are not, simply will not, and will find a way around the system.

Next, we all understand how dangerous it is to make medical assumptions based on studies with an n of 5. To make changes in an office practice based on five patient reviews is ludicrous. The performance in practice (PIP) module would suggest we do this.

I have participated on many a committee to ponder how best to evaluate and reward performance and have seen peer reviews come and go. It is exceedingly difficult to find peers who know enough about an individual's performance to properly assess competence and also are willing to do so. The end result is physicians give physicians good reviews regardless of merit.

I am one of few who have carefully read the MOC requirements and tried to incorporate them into my practice. Most colleagues I speak to regarding this subject have no concept that there are things they must be doing now to remain eligible for recertification six years from now. So my last comment is this: what does ABPN plan to do when it audits physician after physician to find they have not done a single PIP when they are due for recertification?

JANE THEOBALD, M.D.
Omaha, Neb.