Direct Access to Physical Therapy

Traditionally, the delivery of health care services has focused on the patient-doctor relationship, established when a person with a health concern seeks the help of a physician. As part of this relationship, the doctor has a well defined role that includes gathering data on the patient, making a differential diagnosis, and developing a treatment plan.

In recent years, though, some individuals and organizations have worked to demolish this system and replace it with a much more fragmented model, where patients must sort through a myriad of health care professionals in the hopes of finding the right practitioner and getting the care they need.

Although these ideas existed previously, the issue of allowing physical therapists access to patients without the benefit of a physician's involvement gained momentum in 1979, when the American Physical Therapy Association's Code of Ethics was revised to allow PTs to practice without referral wherever state law did not expressly prohibit it. Essentially, what their Board of Directors did was turn the issue over to the state level, giving their state chapters the green light to seek direct access.

Concerns from the physician community regarding direct access do not come from financial "turf battle" issues, but rather from a focus on patient safety and expansion in the scope of practice. Physicians have long appreciated the value that physical therapists bring to treatment, but high-quality patient care depends on the ability to develop an accurate differential diagnosis -- something physical therapists cannot bring to their evaluations. No one questions that physical therapists are very good at what they do, developing and implementing treatments to help patients recover after severe injuries and ailments, but their education is lacking in recognizing whether the patient is suffering from a condition that is outside their scope of practice. Physical therapists are trained in therapy, not diagnosis. Physical therapy is very important, but it should be done in collaboration with a physician.

AAOS Direct Access Materials