Did you know that you can see a physical therapist in Texas without a referral? But there is a catch; you cannot be treated without a referral. Are you confused yet? Well, welcome to the party. Under current Texas law, a physical therapist in Texas may do an evaluation without a referral but cannot treat without a referral from a qualified healthcare provider that includes a physician, a physician assistant, dentist, podiatrist, nurse practitioner or chiropractor. Evidently, our fine Texas legislature feels that these qualified healthcare providers know more about physical therapy and who should or should not be receiving treatment than your actual physical therapist. Go figure!
Direct access to physical therapy is the ability to go see your physical therapist for evaluation AND treatment without a physician referral or prescription. Currently there are 47 states that allow evaluation and at least some treatment. That’s 47 other states plus the US military, Washington DC and the US Virgin Islands that have significantly better access to physical therapy services than we do here in Texas. Every state that borders Texas has a Physical Therapy Direct Access Law that includes both evaluation and treatment. Yes, even Oklahoma! Seriously Texas, Oklahoma beat us to direct access. Well good for them. Let’s hope our state rivalries get into the heads of our lawmakers on this one.
While the Texas Physical Therapy Association (TPTA) has been pushing for direct access for evaluation and treatment for well over a decade, sadly we have been unsuccessful in convincing our state legislature to change the current laws.
Why is that, you ask? Well the simple answer is politics. Several large physician-lobbying groups have been lobbying against our bills and have traditionally had a stronger influence down at the State Capitol than we have. These groups argue that there are public safety concerns with direct access and a lack of education on the part of physical therapists to be able to treat without a referral. The truth is that in every state that allows direct access evaluation and treatment, there has been no evidence of increased risk to patients. And some of these states have had direct access for many years. In fact, there is even significant evidence of lower cost and improved outcomes for patients that were seeking physical therapy first. Why wouldn’t everyone want that?
As for the education and qualification of a physical therapist to be able to treat without a referral, the current education standards and curriculum for physical therapy is better than it has ever been. Upon graduation from a three year doctorate-degree physical therapy program, each physical therapist in the state of Texas is required to pass a national licensing exam. In fact, every PT in the country takes the same national licensing exam, and the only determination of whether you are allowed treat without a referral is the state you end up living in and working in. Because of this reason, many physical therapists graduating from Texas programs decide to move to other states that allow them to practice without restrictions. We need to keep our hard-working physical therapists practicing in Texas.
So what can we do about it? Please don’t drive to Oklahoma for physical therapy. You can at least start with your local physical therapist for an evaluation. They should at least be able to get the ball rolling a bit faster for you to actually get treatment. You can also contact your state representative to voice your opinion on this issue. Remember they technically do work for you, and if we are able to get enough constituents bringing up the direct access issue, we can hopefully make a change, sooner rather than later. One thing is for sure; we at Austin Manual Therapy Associates will continue to advocate for our profession and for you, our patients.
And don’t forget- you can still come see us without a referral. We will then help you jump through all the hoops to get you started on treatment.
- Benjamin Keene, PT, DPT, OCS, FAAOMPT