Direct Access in Physical Therapy

Direct access physical therapy is the ability of a patient to access a physical therapist without the need for a referral from a physician. Direct access aims to reduce unnecessary steps and time for individuals who would benefit from a physical therapist’s care and treatment_.

Direct access physical therapy can be an effective intervention for the treatment of a variety of diseases, injuries, and functional limitations. The US Military, utilizing direct access, has shown that early and evidenced-based treatment by a physical therapist decreases pain and manages musculoskeletal diseases with positive outcomes. Other studies demonstrate decreased waiting time, a reduction in cost for the patient, reduced orders for imaging and medication prescriptions, and superior satisfaction. Allowing the patient access to a physical therapist first can decrease the amount of time between onset of symptoms and treatment.

Physical therapists now earn a doctorate degree upon completion of their programs. One reason the profession started to make the transition from a master’s degree to a doctorate degree was to provide a further in depth education that prepared therapists to see patients in a direct access manner. Physical therapy students receive training that allows them to make sound clinical judgments, accurate differential diagnoses, and be able to recognize red flags during their evaluation of the patient. Physical therapists are educated on how to evaluate the quality of research improving their ability to stay up to date on current evidence. Physical therapists also have course work in pharmacology, imaging, and nutrition. While they do not order prescriptions or imaging, their knowledge base around these subjects is increasing. Physical therapists recognize their scope of practice and will refer to the correct medical provider if a patient is not appropriate for physical therapy. Building these types of relationships between physical therapists and medical doctors is also beneficial for patients and may help decrease healthcare costs₃.

Currently, all 50 states and Washington D.C. enjoy some level of direct access. However, the ability to access a physical therapist directly does vary state to state with some states having considerable restrictions to direct access and other states having none. Some limitations can be regarding specific treatments such as spinal manipulation while others will require a therapist to refer to the appropriate provider if reasonable progress is not being made within a certain time frame₄. Certain insurances also may require a physician’s order for physical therapy or a follow up visit with a physician after the initial evaluation. Regardless, physical therapists in many cases are allowed to practice with more autonomy improving patient satisfaction and cost.

Each state and their degree of direct access to physical therapy is listed below:

• Limited Direct Access to Physical Therapy
  • Alabama
  • Missouri
  • Mississippi

• Direct Access to Physical Therapy with Some Limitations
  • Arkansas
  • California
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Indiana
  • Illinois
  • Kansas
  • Louisiana
  • Maine
  • Michigan
  • Minnesota
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • Ohio
  • Oklahoma
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • Tennessee
  • Texas
  • Virginia
  • Washington
  • Washington, D.C.
  • Wisconsin

• No Restriction to Direct Access Physical Therapy
  • Alaska
  • Arizona
  • Colorado
  • Hawaii
  • Idaho
  • Iowa
  • Kentucky
  • Maryland
  • Massachusetts
  • Montana
  • Nebraska
  • Nevada
  • North Carolina
  • North Dakota
  • Oregon
  • South Dakota
  • Utah
  • Vermont
  • West Virginia
  • Wyoming

The amount of states that allow direct access will further grow as therapists continue to work with state legislators and demonstrate the importance and efficacy of this model.

With this increase in ease of accessibility, physical therapists need to be prepared to be seen as a primary care clinician. This places a larger responsibility on their shoulders to ensure the appropriate management of their patients. While therapists have been educated and thoroughly trained there is the risk of a therapist or a therapist’s clinic being involved in a lawsuit. Having the appropriate coverage is pivotal in allowing therapists to further their profession to provide their services in a timely manner to patients who would benefit from it the most. Ensure you are covered so you can focus on furthering your career as a healthcare worker.

Written By: Thomas Dyke, PT, DPT, OCS

References:

1. “Direct Access Advocacy.” APTA, https://www.apta.org/advocacy/issues/direct-access-advocacy.
2. Sandra Hon, MS, PT, DPT, Richard Ritter, PT, MA, DPT, Diane D Allen, PT, PhD, Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis, Physical Therapy, Volume 101, Issue 1, January 2021, pzaa201, https://doi.org/10.1093/ptj/pzaa201
3. Deyle, D. Direct Access Physical therapy and Diagnostic Responsibility: The Risk-to-Benefit Ratio. Journal of Orthopaedic & Sports Physical Therapy. 2006; 36 (9): 632-634.
4. Levels of Patient Access to Physical Therapist Services in … – Choosept. https://www.choosept.com/globalassets/choosept/assets/pdf-downloadables/direct-access-by-state-map.pdf.

Photo by Yan Krukov