Direct Access Over Physician Referral

Before aggressive treatment with potentially harmful side effects, here’s why you should consider physical therapy

If you hurt yourself or start noticing any sort of pain, there are many decisions you’ll have to make next. Do you avoid physical activity or movements that might aggravate the pain? Do you put ice or heat on it, or take any medications to reduce your pain level? If the pain doesn’t improve after a certain period of time, do you see a professional for treatment? And if you do decide to see someone, who will it be?

It may be difficult to find the best answers to these questions, especially the last one about who to see first for  treatment. As a result, many people will end up scheduling an appointment with their primary care doctor, since it probably seems like the safest and most familiar choice when something is wrong. While primary care doctors are expected to always provide patients with the best possible treatments, it doesn’t guarantee you’ll receive treatment from a physical therapist.

Physical therapists are movement experts that are trained to optimize patients’ quality of life through carefully designed exercise and educational treatment programs. They treat a wide variety of injuries and conditions, but the most common symptom that they address is pain, and research consistently shows that physical therapy is effective for reducing it.

This is why most guidelines recommend that anyone in pain sees a physical therapist as a first-line treatment for their condition. Patients can either go straight to a physical therapist because of direct access—which allows anyone to at least have an initial consultation without a referral in all 50 states—or they can go their primary care doctor or some other medical professional and possibly get referred to therapy. Primary care doctors are strongly encouraged to direct patients with painful conditions involving the muscles and bones to physical therapy, but this does not always occur as it should.

Study highlights a major issue with the referral system for physical therapy

One of the many conditions that can benefit from physical therapy is knee osteoarthritis (OA), which has doubled in prevalence in recent years (at least 15 million Americans currently have it). As with other issues, many patients with knee OA visit their primary care doctor first, which may or may not lead to a physical therapy referral. To evaluate how many patients with knee OA are actually being referred and what other treatments patients receive, a study was conducted. Below are some highlights from its results:

  • There were 2,297 visits with a primary care doctor, surgeon, or another specialist
  • There was a significant decline in the number of referrals to physical therapy from orthopedic specialists over three years
  • The number of primary care doctors that referred patients to physical therapy was low and did not change in any significant way over three years
  • There was a non-significant increase in narcotics prescriptions and a significant increase in the number of non-steroidal anti-inflammatory drug prescriptions

This study shows that many doctors are not referring patients to physical therapy, and that the trend is actually going in the wrong direction, with an increase in pain medication prescriptions and a decrease in therapy referrals. That’s why the best way for patients in pain to avoid the risk of not getting referred is by taking matters into their own hands and accessing physical therapy directly.