As an advanced practice nurse (APN) treating the uninsured, I appreciated the August Guest Editorial ("Power Failure," by Maureen Shawn Kennedy and Karen Roush), which states that "as long as APNs provide care to populations largely neglected by MDs [horizontal ellipsis] the [American Medical Association] AMA is quiet." This is not entirely true. In Indiana, managed care companies administer Medicaid programs for children and require that all patients be assigned primary care physicians, despite the critical shortage of physicians who accept Medicaid. Patients in rural areas are assigned to physicians who may be 60 miles away; as a result, many families do not have access to health care. Attempts to legislate mandates to designate APNs as primary care providers are met with opposition by state medical associations. It seems that even when physicians do not want the job, they don't want APNs to do it either.

Marcia Plant Jackson, MPH, RN

Indianapolis, IN

I was astonished by "Protecting Patients or Turf?" (AJN Reports, August). Any nurse holding a doctorate and working in a clinical setting has earned a title worthy of address. Public health and safety may be minute concerns to the AMA and to physicians threatened by the competition that the "nurse doctors" may pose for the dwindling insurance reimbursements.

Mazen A. Ideis, CPhT, NREMT-B

Florence, KY