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What is Direct Access to Physical Therapy?

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Updated October 07, 2012

Question: What is Direct Access to Physical Therapy?
In the past my doctor prescribed physical therapy for me. Now she says that I can have direct access to physical therapy. What is direct access?
Answer:

Direct access refers to the ability of patients to be evaluated and treated by a physical therapist without being referred by a doctor or other healthcare practitioner. If you feel you have a problem that may benefit from the skilled services of a physical therapist, you may be able to refer yourself to physical therapy for treatment. Sometimes direct access is called self-referral.

In the United States, provisions for physical therapy services are governed by each individual state through a "state-practice" act. The practice act is legislation that outlines how physical therapy services will be delivered. Historically, each state's practice act provided that physical therapy services would be provided only if ordered by a licensed physician or other licensed healthcare practitioner. Each state lists different professionals who may refer patients to physical therapy, including podiatrists, dentists and nurse practitioners.

The American Physical Therapy Association (APTA) has lobbied successfully in many states to help change the law to allow patients direct access to physical therapy. By having direct access in each state, physical therapists are recognized as the licensed professionals of choice to initially manage musculoskeletal and movement disorders in patients. You can check to see if your state allows direct access on the APTA's website.

Why Is Direct Access Important?

Healthcare is expensive. It seems that with every passing year, more money is being spent on healthcare, with no objective data that patients are achieving better outcomes. A system that allows the patient to directly seek the services of a physical therapist can help save healthcare dollars by eliminating unnecessary tests or other specialist referrals. Many conditions can be successfully evaluated and treated with no expensive diagnostic testing.

Is Direct Access Safe?

Some opponents of direct access to physical therapy services argue that patients may be put at risk if they visit a physical therapist directly. Physical therapists lack the ability to order certain diagnostic tests or prescribe medication to help manage pain.

To date, there is no objective data indicating that self-referral to physical therapy puts patients at increased risk. Also, there is nothing indicating that self-referred patients consume more healthcare dollars during or after their physical therapy care episode.

Physical therapists are also trained to recognize "red flags" that may signal the need for more invasive medical intervention. In those cases, referral to your physician or healthcare provider is made immediately.

Many states also have safety nets built into the legislation that governs the practice of physical therapy. For instance, some states allow direct access only to therapists who have been practicing for three or more years. Others allow a certain time frame or specific number of physical therapy visits during an episode of care. If the patient requires skilled physical therapy after the time frame or visit threshold is reached, referral to the patient's doctor is mandatory.

If you are suffering from a musculoskeletal condition that causes functional movement limitations, use your best judgment when deciding which healthcare practitioner to see. A visit to your local physical therapist is a safe place to start on the road to recovery. Remember that not all states allow for direct access to physical therapy. You can check the APTA direct access map to see if your state allows direct access. If you are unsure if physical therapy is right for you, a discussion with your doctor may be necessary to help you decide.

Sources:

APTA Direct Access in Practice http://www.apta.org/directaccess/

Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research

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