Direct Access To Physical Therapy: You Have It, Or You Don’t

According to the American Physical Therapy Association (APTA), 46 states currently have what they call “some form of direct access”. I am not sure what, exactly, “some form” means. If you look at the states that have “unfettered direct access” – which is also a misnomer unto itself – you are looking at about 16 at last count.

Texas is considered a “direct access” state. I can tell you right now – it simply is not, in any way, shape, or form. But the APTA continues to put Texas (and many other states) in this nebulous category of “some form of direct access”. Sure, you can do an evaluation of a patient without a referral – but what good is that if you can’t then treat the patient without someone else’s consent or approval?

Telling the media, legislators, lobbyists, and worst of all, patients – that patients have “direct access” to physical therapy – is simply not telling the truth. When we go back to legislators and tell them we only have “some form of direct access, but we need to expand it”, should we really expect them to do so? “Well, you already have it according to your own professional association”, I can hear them saying. One would have to wonder if this in fact impairs our position in the health care world instead of enhancing it.

You either have direct access to a physical therapist – or you don’t. There’s no in-between. You can either access a physical therapist, by patient choice, without limitations and referral requirements and other silliness – or you can’t. You can either make full use of their skills and training within their scope of practice – or you can’t.

It’s that simple.

Physical therapists have varying degrees of referral requirement in most states. In Texas, treatment can only be initiated with a referral from a physician, dentist, chiropractor, podiatrist, physician’s assistant, and advanced nurse practitioner. All of these providers have little to no understanding of what physical therapists do, what is within their scope of practice, or what degree of training they possess – yet they are all given the responsibility of deciding when and if physical therapy treatment is indicated.

Imagine a non-physician telling a surgeon when it is appropriate to operate. When you put it in those terms, we would all agree how ludicrous that sounds. And I suspect I know what response you’d receive from the surgeon if that dialogue actually took place, and it might even involve a few expletives. But you’ll rarely see that kind of response from a PT – even though perhaps you should.

Physical therapists in this country have been treating this issue (no pun intended) with kid gloves. They have historically dealt with this issue as though they are dogs anxiously awaiting the next scraps to be thrown from the health care table, and that they should be happy with whatever they get. And that is obviously the tack that the APTA has chosen to take, given their usage of the phrase “some form of direct access” and their utter excitement and joy in its pronouncement.

At this point in our professional development, we need to stand tall. We are the leaders in conservative care for musculoskeletal disorders. Accessing a physical therapist as a first line of care saves the health care system money. The research confirms this. Period. There is NO research to indicate – anywhere in the world – that there are any patient safety issues with direct access to a physical therapist. Period. Consider that direct access to physical therapy is a standard in most countries outside of our borders – and it works just fine.

It is time for physical therapists to simply say NO to accepting anything less than true direct access. We should not just accept the scraps as they fall from the table. In accepting anything less, we do a disservice to our profession by viewing ourselves as deserving of and accepting of a subservient role in the health care arena. Worse yet, we do a disservice to our patients who look to us as advocates for cost-effective and quality conservative care.

Direct access is something a patient either has – or doesn’t. There is no in-between. Physical therapists should not play in-between either.

Photo credits: Brian Hillegas