Dr. Scasta raises a number of important issues in his letter, but I will comment only on those that are pertinent to the ABPN MOC program. Contrary to Dr. Scasta's allegation, the ABPN has never tried to "nuzzle up" to licensing boards. The Federation of State Medical Boards (FSMB) on its own has recently developed proposed standards for Maintenance of Licensure (MOL) for state medical boards, and luckily enough, it does appear that MOC will fulfill those MOL standards. Whether or not the proposed MOL standards will be adopted is up to those state boards, and the ABPN has no input into that process.

Dr. Scasta rightly notes that the ABPN's ultimate goal is to promote "lifelong learning," but it has not chosen to do so primarily through extrinsic "carrots" and "sticks." As a matter of fact, the ABPN has repeatedly stated that it doubts there will ever be enough "carrots" or big enough "sticks" to force diplomates to pursue "lifelong learning." The reality of our world, however, is that there will always be "carrots" and "sticks," and the ABPN cannot control other organizations that choose to try to achieve their goals by emphasizing those extrinsic motivators. While the ABPN MOC Program must adhere to the standards of the American Board of Medical Specialties, the ABPN has repeatedly advocated for flexible MOC requirements within those standards that are relevant to the clinical practices of specific diplomates, that are not overly burdensome, and that reinforce the intrinsic motivation of diplomates to participate in MOC. The ABPN believes that quality physicians have always participated in "lifelong learning" and been willing to demonstrate that their knowledge and skills are up to date. In our current era of documentation and attention to medical errors and patient safety, those goals seem especially relevant.

The ABPN does recognize that maintaining and demonstrating one's competency is not easy, and it is committed to working with professional organizations like APA to support diplomates in their efforts to do so. Those efforts are far too important to be described as "twiddling away" time. The ABPN hopes that most diplomates will conclude that the intrinsic professional satisfaction inherent in pursuing "lifelong learning" is enough rationale for participating in MOC.