The APTA, Seventeen States, And The Harsh Reality Of Direct Access To Physical Therapy

Direct access to physical therapy – at least the way a consumer would view it – is the ability to make a consumer-driven choice to see a physical therapist without any limitation imposed by a gatekeeper or other entity. A consumer would also view physical therapy as the process of both evaluating a condition and implementing a treatment plan for it. I think it is safe to say that the commonly-held perspective by the consumer is that physical therapy in its entirety involves both aspects, and not just one.

The definition of “direct” is simple: “proceeding in a straight line or by the shortest course; without intervening persons, influences, factors, etc”.

But Direct Access to Physical Therapy has become a ridiculous play on words by the American Physical Therapy Association (APTA) – and a game that undermines the future of the profession at its core.

According to the APTA, 46 states now have Direct Access to Physical Therapy. If you are a consumer, that sounds great, doesn’t it? If you are a PT, you are probably pretty proud of your professional autonomy.

However, this is where the ridiculous play on words begins.

The APTA are fond of using the phrase “some degree of direct consumer access to physical therapy treatment”. From that perspective, there are 46 states that have “some degree of access” – Texas being one of those states.

In Texas, you can be evaluated by a physical therapist but cannot initiate treatment unless you have a referral. That’s not access to care, especially when you are unable to receive any treatment, which tends to be a pretty significant component in the consumer’s eyes.

From the consumer’s perspective, Direct Access doesn’t really exist. Patients are not looking to just have a conversation with a physical therapist, perform a few tests, then be told that regardless of how simple the solution might be, they still need to get a script from their gatekeeper in order to implement it.

If you, as a consumer, then go to a legislator and lobby for Direct Access, there is another problem. If you can find one that doesn’t have his pockets full of Big Medicine money, they might actually tell you - “why are you lobbying for this? According to their own professional association, they tell us that 46 states already have it”.

It is time to wake up and smell the coffee.

Reality check #1 – you can either access a physical therapist directly for care – which includes evaluation AND treatment – or you can’t. “Some degree” of access is lunacy. Either you can access a provider directly, without limitation by a gatekeeper – or you can’t. You are either in, or you are not.

Reality check #2 -  There are just 17 states that have direct access to physical therapy: real direct access to care, not just access to components of care.

Reality check #3 - The pursuit of Direct Access by the APTA has been going on since 1978, when the APTA House Of Delegates put forth a resolution to “devise a plan for the development of physical therapy practice independent of practitioner referral”. Over 34 years, we have seen this expand to 17 states – one every couple of years. That certainly isn’t ground-breaking, dramatic progress.

Stating that there are 46 states with direct access thus far certainly sounds a lot more palatable. When the numbers have not changed significantly over the span of three decades, saying that you have “some form” of it has a much better spin to it. The powers-that-be are making good use of our membership dollars, right?

As Benjamin Disraeli once noted -

"There are three kinds of lies: lies, damned lies, and statistics"

At this rate, we will have nationwide direct access to physical therapy by 2078. With Vision 2020 looming, we must remind the APTA and the profession - if you continue to do what you have done, you will continue to get what you have gotten. It is high time to change course.

Photo credits: nate steiner