The April issue of Pediatric News, the newspaper for pediatricians, has a front-page story on the official position of the American Academy of Pediatrics to oppose nurse practitioners (NPs) in independent practice. It doesn’t matter that in some areas of the country, the ONLY primary care provider may be an NP or a physician’s assistant (PA).

The National Association of Pediatric Nurse Practitioners (NAPNAP) has issued a statement that points out their dismay regarding this position by their physician colleagues, noting that there is abundant evidence documenting that pediatric NPs have clinical outcomes that are comparable to those of pediatricians and asserting that NAPNAP will continue to focus on reforming health care to ensure access to care for the nation’s children.

The issue is who will control and be paid for care coordination through medical homes. Physician groups have been insistent that only practices led by a physician should qualify as “medical homes.” This means that an NP or PA in a rural area who has physician backup through telemedicine must pretend that the physician “leads” the practice—and the physician will get the fee for the care coordination even if that coordination is done solely by the NP or PA. Sounds like a good way to reduce access to care coordination, drive up costs, and put frontline practitioners out of practice. Whose interests are being served?

Diana J. Mason, AJN editor-in-chief