What family physicians need to know about vaccines this back-to-school season

Back-to-school visits are filling primary care schedules, and the vaccine conversation inside them has only grown longer.

Sarah C. Nosal, M.D., FAAFP, president of the American Academy of Family Physicians (AAFP), recommends that family physicians work from the AAFP's own immunization schedules, developed with other medical organizations and the Vaccine Integrity Project, rather than trying to reconcile competing guidance in the exam room.

Where the schedule question lands

Federal childhood vaccine recommendations were narrowed in January and stayed by a federal court in March, and the case is on appeal.

The AAFP published its own 2026 child, adolescent and adult schedules in March. Nosal said the vaccines with strong evidence behind them remain recommended, and that the ones moved into shared clinical decision-making describe something family physicians already do.

Shared decision-making, by her account, means evaluating a patient's own risk factors and their ability to make an informed choice, the same conversation she says happens with any treatment recommendation.

The economics of keeping vaccines in the office

Nosal acknowledged vaccines are expensive and said reimbursement rates are the most common concern she hears.

Even so, she said the majority of vaccines children receive are administered in a primary care office, and that childhood and flu vaccines are the ones most likely to be stocked there. Vaccines covered under other parts of insurance, including Medicare Part D, are more likely to sit with larger networks that have the capital for in-house pharmacies.

She was direct about the counseling time.

Documentation and CPT codes let a practice capture the work, she said, but she added that those codes are not yet reimbursable by CMS and that most private payers are not paying them either. The AAFP continues to advocate for payment.

What a practice gives up by sending patients elsewhere

Nosal said pharmacies often will not vaccinate infants or children, so referring a family out can eliminate the opportunity entirely. She also pointed to registry gaps.

Not all states require that adult vaccinations be reported to an immunization registry, which she said leaves patients at risk of a missed dose, a duplicate dose or a record no one can reconcile.

On exemption paperwork, Nosal said she treats the form as the start of a conversation rather than a decision already made.

Most parents who ask about a reduced or staggered schedule, she said, choose the standard one once they have talked through the risks and benefits. Things are confusing right now, she said, and the family physician's office remains where patients go to sort it out.

Related content: AAFP President Sarah C. Nosal, M.D., on vaccine schedules, stocking costs and the back-to-school visit