The Health Care Hall Pass: Permission Or Access?

We hear the phrases bantered about by physical therapists, lobbyists, and legislators alike: unfettered direct access, restricted direct access, and many other state-dependent variations on a similar theme.

There is oftentimes much rejoicing when physical therapists gain some "degree" of access for consumers. Celebrations take place in the streets. The proclamations of "another state with patient access" can be heard resounding through the valleys.

But there is a significant difference between access - and permission.

A patient has true consumer access when they can make choices about their health care providers freely and of their own volition. In terms of physical therapy in the United States, there are now 18 states in which a patient can freely select their physical therapist and be evaluated and treated at the discretion of the physical therapist without a referral from another provider.

Imagine that: a patient making a choice to see a provider who is the master of their own domain of study. But that simple premise only exists in 18 states.

And the other 32 states? What gets construed as "restricted direct access" or the like is really just another form of permission, beautifully disguised as "access". In the grand scheme of things though, there comes a time, somewhere along the line, when the patient has to seek out their permission slip, their health care hall pass.

In most states, physical therapists are just about the only health care provider that a patient requires a referral to see. Most patients can't comprehend why this is. Nor can I, for that matter - especially when the referral can come from someone like a dentist, someone who has absolutely no level of understanding of (nor training in) physical therapy. That's the equivalent to an orthopedic surgeon requiring an optometrist to make a referral to them. Yes, we all know what the response would be now, don't we?

At this point in the history of health care, I am not sure what is worse: the fact that certain lobbying groups think this is still necessary, that legislators continue to ignore data that has been available for two decades, or that physical therapists continue to rejoice over the scraps thrown to them from the health care table. Or that consumers haven’t said “enough is enough” with the hall pass mentality.

There is a vast distinction between permission and access. We have to stop seeking permission. We have to stop celebrating "victories" of "restricted direct access" or "direct access to evaluation" or other loosely-veiled permission slips. As a profession, we cannot continue to seek permission for true ownership of our profession. As advocates for the best interests of our patients (notably a part of the ethical obligation of an APTA member), we cannot accept anything less than consumer access. Patients suffer needlessly when they don't have access - in costs, in time, and in outcome.

Patients don't need permission slips or hall passes. They need access to care. Real consumer access. We can no longer settle for anything less.

Photo credits: cote

Related Articles By Allan Besselink

• The Right To Choose My Health Care Provider
• Three Bipartisan Realities Of Consumer Access To Physical Therapy
• Paternalism And The Demise Of Health Care