A friend experiencing neck pain recently called around to find a physical therapist who would see her. She had been to PT before and knew how much it would help. But because she was seeking out PT directly, without first going to a doctor, clinic after clinic turned her away. One said “we’re not doctors, we can’t diagnose” while another said flatly “we don’t treat without a referral.” Needless to say she was frustrated. She didn’t have the time to coordinate two different appointments, and since her pain was pretty bad, she wanted to get care right away.
Most states now have laws on the books that allow physical therapists some form of direct access without a doctor’s referral. So why are some clinics holding out on treatment when insurance isn’t the issue? Of course it’s important to communicate with and coordinate treatment plans with a patient’s primary care physician, especially if the injury or condition is severe. But does that mean physical therapists aren’t equipped to assess a patient’s non-life-threatening problem and treat accordingly? What’s your take on it? Does your clinic see patients without a doctor’s referral? As you see it, what are some reasons for or against it?
naiomt.me 
These comments represent PT’s who have not kept up with postgraduate education. As DPT’s we are trained to differentially diagnose MSK pain and do it better than ANY medical practitioner. Solution, require all PTs to show postgraduate education in differential diagnosis to force any BSPT or MSPT’s who have not kept up with the education and are, in making comments like this, holding the profession back.
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Very well could be the case Kathy.
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I am always willing to treat without diagnosis/ referral. The main issue is most insurances require one. So when I tell the patient if they want use their benefit they need a referral, they will get one. If they want to roll the dice on coverage I’ll see them … No problem:) the first thing everybody needs to remember is they can’t fix every person so be ready to send them to the doc if they need it.
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We also evaluate patients without referral with the same insurance stipulations. When a patient’s condition is not appropriate for PT it is a great opportunity to become a referral source instead of only relying on them. This has improved mutual respect between healthcare providers.
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I wonder if it is concern on the treating physical therapy clinics part in regards to utilizing our direct access rights, but bypassing the physician all together, which might build the fear of losing future referral sources. This shouldn’t be an issue, but with the lack of communication on the PT clinic’s part to the patient, there can be a number of undisclosed reasons why.
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Good points Anthony.
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There are some good points mentioned above. What comes to mind from the answers provided to the patient was a lack of professionalism, compassion, and confidence. Not so much knowledge. There are many BPTs and MPTs out there that have completed residencies and fellowships. Making them well equipped to take on direct access. The DPT does not automatically prepare an entry level PT for direct access or trump a clinician with a level of education at the BPT or MPT.
This is still fairly new territory that we are not comfortable with yet. We don’t know how it will affect referrals. What happens if we miss the Zebra when we’re so accustomed to listening to the steps of a horse?
I see a high volume of direct access in my clinic (no exact numbers, ~60%). I feel comfortable with it because I have had good training by a FAAOMPT in differential diagnosis. Plus knowing that after improvement has not been made in 2-3 visits, it’s time to see a specialist. Just saved them a visit to the PCP either way. Or it does go back to the PCP in some cases. That has rarely ever happened. What’s key, is clinical intuition and recognition. Not everything can be taught. Experience and common sense go a long way.
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Some really great thoughts on this Michael. Thanks so much for sharing them with us!
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