Direct Access, HowThat Benefits the Patient
Direct Access is a term used in many different professions,but for physical therapists it gives us the ability to evaluate and treat a patient without the need of a referral from a MD, PCP, or OrthopedicSurgeon. Though it may be a new term to some, the direct access laws have been around for over 10 years now and throughout that time, the laws have changed in the level of access for physical therapists. For example, in the state ofPennsylvania the law states that a physical therapist can treat a patient for30 days (from the initial evaluation) before they are required to get a script from a physician so treatment can resume, but in the state of Arizona their access is “unrestricted” meaning they can see a patient as long as necessary as long as it falls within the scope of physical therapy (APTA, “Direct Access ByState, 2021).
What makes this more difficult is each state dictates the level of restriction or provision. That means that each state’s physical therapy association must fight a different battle to either keep their level of access, or gain new access based on new evidence and education. So, the question is why fight so hard for this level of access? Well to figure this out we must start at the beginning of a patient's journey through the healthcare system. When an injury occurs, the traditional route would state like this.
1. Schedule an appointment with your PCP (A few days to a week timeline)
2. Referred to an orthopedic specialist (2 weeks to a month)
3. Sent for Imaging if not easily diagnosed (1 –2weeks)
4. Visit back to the Ortho to review results (1week once results are received)
5. Referred to PT
Going by this timeline from the initial injury, or first time you noticed pain you have spent 4 – 7 weeks dealing with his pain either not knowing what you have, receiving cortizone injections, or just waiting it out. Not very efficient, very expensive(in some cases), and time-consuming.
Utilizing the direct access model, the physical therapist becomes the first line provider and is able to evaluate a patient for a musculoskeletal disorder that only requires physical therapy and no follow up imaging or medical treatment. So, the timeline looks like this:
1. Patient gets injured or notices pain, schedules with a physical therapist who has a direct access license.
In the case of this patient who has a musculoskeletal injury, they are seen sooner, provided the correct care while also saving time and money. Seems simple right? In most cases it is, but if physical therapists are going to be first contact providers we need to hold up our end of the bargain and provide quality evaluations to screen for red flags, make good clinical decisions regarding our patients, and refer out when necessary.
Direct access is still a work in progress and gets hung up at the legislative level with other providers, but at the end of the day every healthcare provider is trying to do what is best for the patient in terms of their care, and their financial situation. Utilizing this law more will allow our patients to get the care they need faster and save money while doing it.