Pediatricians want nondoctors limited on health care actions

CHICAGO -- The nation's largest group of pediatricians wants lawmakers to maintain limits on the kind of health care nondoctors, such as nurse practitioners, can give to children.

The American Academy of Pediatrics is encouraging its doctors to work to block legislation that would allow non-doctors to practice and write prescriptions independently and permit parity in insurance reimbursement.

Some nonphysician caregivers already have succeeded in increasing their autonomy around the country.

The academy's policy, however, says the best care for a child depends on a team with a physician, preferably a pediatrician, in the lead.

"We're a team, and we do well together as a team," said Dr. Carol Berkowitz, lead author of the updated policy statement being published Monday in the February issue of Pediatrics. The statement expands on one issued in 1994.

"It's not aimed at any group, it's trying to set a high standard of care," Berkowitz said.

A nurse practitioners' representative disputed the academy's stand.

The pediatricians' efforts are "aimed at protecting their own turf," said Mary Margaret Gottesman, president of the National Association of Pediatric Nurse Practitioners.

Nurse practitioners also are concerned and committed to quality health care for children, she said.

"That's why we really do want physicians as our collaborating partners," Gottesman said. "But we don't want to have it dictated to us and we don't want to have it written into legislation; it really takes away from our independence as professionals."

Growth in roles

In recent years, there has been growth in the numbers and roles of nondoctor providers -- who include psychologists, physical and occupational therapists -- and alternative medicine practitioners.

For example, New Mexico last year became the first state to allow specially trained psychologists, who don't hold medical degrees, to prescribe drugs for mental illness. The drugs are to be prescribed in consultation with a patient's doctor, said Elaine LeVine, chairwoman of the New Mexico Psychological Association task force, which backed the law.

The American Academy of Physician Assistants favors the pediatricians' policy statement, said Patrick Killeen, the association's liaison to the pediatricians' group.

"It clearly states that a team approach to practicing medicine with the physician as the delegator of responsibility is best, and we support that," Killeen said.