The public has long entrusted the medical profession to regulate its own practices, but our efforts to do so have been uneven. In place of rigorous, enforceable standards, we have sometimes reverted to pseudoaccountability: weak regulations that only give the appearance that we have been responsible in setting and enforcing high standards. We have failed to deal effectively with substandard practitioners, lagged in preventing medical errors, inadequately documented patient care in the medical record, slipped up in protecting patients in clinical research projects, and accepted financial arrangements with industry that may affect our judgment. In response, government has intervened, and threatens to intervene further with regulations that sometimes are excessively intrusive and cumbersome. To preserve our remaining autonomy, we must show that we are serious about protecting the public. Professional membership organizations must stop promulgating weak guidelines and offering evaluative methods to assess and regulate their own coveted members. Instead, they must turn over assessment of their members to arm's-length, disinterested groups. Regulatory programs must have provisions with impeccable standards, surveillance processes, and methods to deal with infractions. In planning new self-regulatory approaches, we should invite open discussion and genuine involvement by independent members of the public or the government to help ensure that our decisions about standard setting are not self-serving. Our profession has already lost much authority. We can ill afford to lose more.