What if you have back pain...or you cannot reach your arm behind your back...or your knee hurts when running?
Is the medical doctor still the best person to help? I say NO! Here is why...
That being said, why do we as physical therapists continually feel as though we must rely on a physician’s referral for our patients?
We should be able to evaluate and treat patients in a direct access environment. I don’t need a medical doctor to write a prescription for me to see a dentist and get my teeth cleaned; why should an individual be required to get a prescription for a physical therapist to treat tendinitis?
Here is an example...let’s say somebody reports to a medical doctor with a complaint of elbow pain (visit 1 = $$). The medical doctor orders MRI (visit 2 = $$). Specialist has patient come in to read MRI (visit 3 = $$). Physician now determines diagnosis of lateral epicondylitis and performs steroid injection (visit 4 = $$). When the patient does not get better, THEN they refer to a physical therapist.
Why not skip the middle steps, save time, save money and allow that patient to go directly to a physical therapist that will treat the cause of the pain (rather than inject with steroid and hide the pain temporarily)!?
Studies have shown a 60% savings in health care money for patients who went directly to a physical therapist for back pain versus initial visits with medical doctor and specialists who often order unnecessary imaging (such as MRI). As consumers of health care and citizens of the United States, we have a fiduciary responsibility to decrease and eliminate wasteful spending. Legislation promoting direct access to physical therapists is essential to help reduce state and national debt.
In addition to decreasing the cost of health care, direct access to physical therapists will improve functional outcomes. Evidence suggests that the multifidus (a muscle in the back) begins to atrophy with a single episode of back pain. In most cases, outcomes improve the sooner an individual begins a rehabilitation program after injury. If a patient must spend two weeks jumping through hoops with medical doctors ordering advanced imaging, and going from “specialist” to “specialist” before referral to a physical therapist, outcomes will be negatively affected.
On the other hand, if a patient with acute injury has direct access to the neuromusculoskeletal and functional movement expert, that individual will likely have better outcomes and return to work or desired activity more quickly.
There are certainly instances when a patient presenting to a physical therapist may have symptoms not of mechanical origin. Our education includes differential diagnosis, and our training consists of screening for red flags or medical issues. Our scope of practice does not include medical management, and in those instances we know when to refer out and to whom we should refer.
Physical therapists should be the gate keepers of health care. We are a conservative and low-cost option for patients with neuromusculoskeletal conditions. We are the movement specialists. To require a patient in pain to take the time to see one doctor (physician) before seeing another doctor (physical therapist) is erroneous. In a country with an ever increasing debt, direct access to a physical therapist can save the government, insurance companies, and taxpayers a lot of money. Patient’s in pain want to get better and return to their activities – direct access to a physical therapist allows this to happen more quickly.
As with many issues, direct access to physical therapists is met with opposition. I question the reasoning behind those that oppose direct access. Are they truly acting in an attempt to reduce healthcare cost? Are they truly trying to protect the patient? Or are they acting primarily from economic concern because they fear this will take away “business?” Thus those that oppose direct access to physical therapist use a smoke screen of patient safety to mask their true intentions.
As physical therapists, we need to do a better job of marketing ourselves. We need to inform the healthcare consumer, insurances companies, and legislators about the depth of our knowledge, what we can do to improve quality of life, and how we can save healthcare dollars. Furthermore, we need to support physical therapy research to defend our claims. If we provide a united front, we can make a change. We will see more legislation promoting direct access to physical therapists and subsequently a shift towards physical therapists as gate keepers for healthcare.
-Garrett Mandel, DPT
Follow Dr. Mandel on Twitter @GarrettMandel
Other Good Reads
-A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy
-Redesigning Care Delivery
-Multifidus muscle recovery is not automatic after resolution of acute, first episode low back pain. Spine. 1996
|A Novel Plan Helps Hospital Wean Itself Off Pricey Tests (pdf)|
|File Size:||173 kb|
Currently, most states allow some form of direct access (many with restrictions though). Here in Florida, health care consumers can see a physical therapist for an evaluation and treatment for three weeks; after which, a physician referral is needed. Other states allow a physical therapist unlimited treatment, while my home state of Michigan only allows a physical therapist to perform an evaluation without a referral (get it together, Michigan!).
For those of you reading this article that aren't involved in the physical therapy profession, I hope you now understand the value of seeing a physical therapist! If you're in pain or are having any type of movement dysfunction, save yourself time and money by scheduling an appointment with a physical therapist today!