In many countries around the world, the practice of physical therapy is contingent on the prescription or referral by a physician, a requirement that effectively limits access to physical therapy services. The ability of a health care consumer to freely visit a physical therapist without first securing a referral has been a long term concern to both patients and physical therapists worldwide. Although direct access is now available in some areas in the united states which were categorized by setting limitations based on number of visits and level of significant improvement of the patient, which once exceeded must be referred to the physician. Advocates for physical therapists for direct access argue that direct access extends consumers choice of health care providers, improves access to service that promote prevention and rehabilitation, increases the patients functional outcome due to early intervention and reduces delays before commencing therapy. Proponents further argue that direct access may result in cost savings by avoiding the referring physician’s fees and related laboratory charges.

Critics of direct access argue that physical therapists may overlook serious medical conditions such as infection, mild fractures and even cancer, for this reason insist that all patients should be screened initially by physicians. Most medical associations contend that although allied health care professionals are useful as physician extenders, they would not serve the public as well standing alone or in an autonomous role. Concerns about improper diagnosis, inappropriate line of management and the possibility of this leading to increased treatment costs are part of the reasons why this is opposed by physicians. Another concern being purported is that direct access may lead therapists to diagnose and treat beyond their level of competency and scope thereby acting as a physician erroneously.

Now physical therapists argue that the arduous hoops consumers  have to jump through;  such as being referred to a physician , who then refer to an orthopedist or chiropractor as the case may be and the finally to the physical therapist which may take several weeks and very costly can be tedious for consumers .They also argue that a physician signing off on a physical therapy plan of care cannot control treatment errors such as burning a patient with a modality or being overly aggressive with a manual therapy technique. Thus, appropriate screening must be the core issue of concern to the physicians. They argue that physical therapists LIKE physicians look for warning signs in every patient’s history and physical examination that could indicate the need for further testing or referral to the appropriate physician. This is a skill acquired by all physical therapist at graduate level. In instances where the presence of a serious pathology is actually absent or rare, Physical therapist possess the tools to treat patients and also tools to identify individuals in need of medical referral. Not every patient in need of medical referral would bypass their physician to see a physical therapist. In some studies on direct access to physical therapy, the studies showed minimal impact on physical therapy practice but showed patients preferred the more expedient treatment received and physical therapists expressed greater job satisfaction, while some studies showed patients preferred seeing their physician before being referred.

These are compelling arguments for both the physicians and physical therapists. We would love to have the opinion of Physical Therapists, Patients and Physicians on this issue. Please drop comments on your experiences and how it’s being practice in your country.

Physiogram (Admin Account)


  1. Wren John Fabian says:

    Some Physicians doesn’t have knowledge that us Physical Therapist can might as well do our own differential diagnosis, to filter patients who needed a medical treatment rather than getting a Physical Rehabilitation per se.

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