Last week, the Symmetry Physical Therapy team visited the Texas State Capitol. We were there to speak to our elected officials, voicing our support for Senate Bill 728 and House Bill 2118. This legislation would allow Texas citizens to directly access physical therapists for the prevention and treatment of conditions affecting movement and function by removing the requirement of obtaining a referral prior to beginning physical therapy treatment. This link connects to a petition in support of this legislation. If you are already a proponent of direct access to physical therapy, please take a moment to connect and add your name. If you are not familiar with this issue, or would like some further background, please continue reading.
Currently, Texas is one of only 3 states in the country that still requires a referral for physical therapy treatment. As a health care consumer, you may choose to directly visit practically any other health care practitioner – a dentist, podiatrist, chiropractor, massage therapist, acupuncturist, nutritional counselor, and so on – all without a referral. The requirement to obtain a referral for physical therapy is an outdated relic of a law that unnecessarily creates barriers to care that could be of significant benefit to a multitude of Texas citizens. 200 million other Americans have better access to musculoskeletal health care. It seems high time for Texas to catch up.
It is well supported in medical literature that enabling patients to access primary care early in the process of injury or illness leads to significant medical cost savings. The time and dollars spent on a health-care episode – both by an individual and by the global health care system – can be reduced drastically. Early musculoskeletal care provided by a physical therapist can reduce the need for and use of addictive opiod pain medications, which are currently being prescribed at unprecedented levels and are resulting in significant societal problems. Physical therapy can also reduce the need for costly and often unnecessary imaging assessments. Early access to a physical therapist can save patients missed work and enable patients to also maintain their normal social and recreational activities – thus contributing to better general mental and physical health.
Average wait times to see a primary care practitioner in the major cities in Texas is about 2 weeks. It often takes well more time than that – on average 30-60 days – to obtain an appointment with a physician specialist. An average wait time for a new patient appointment in a physical therapist’s office in Austin and in many other areas of Texas is 24-48 hours. Same-day appointments are even often an option. It simply does not make sense for health care consumers to be forced to delay initiating the care that they need when they have musculoskeletal movement and function issues that do not require specialty care.
The primary concern typically voiced by opponents to direct access to physical therapy in Texas has to do with diagnostics. An example would be the question of how a physical therapist (without a medical doctorate) would know if a patient has a condition like cancer that might ‘act’ like a musculoskeletal issue but truly be something more sinister? The stated concern has to do with whether or not a medical doctorate degree (MD) is necessary in order to ‘make sure that patients are candidates for physical therapy.’ This is unfounded concern. Physical therapists across the nation have graduate school, doctoral degrees. Training consists of over 3000 hours and a multitude of subjects, including education in how to effectively screen for signs and symptoms that would warrant further in-depth medical assessment. Who better would be able to identify a patient that qualifies for musculoskeletal treatment than a physical therapist that has spent their entire graduate school training working on how to best identify and treat this type of issue? And if a patient can access a physical therapist in 24-48 hours, rather than waiting 2-6 weeks for an appointment with another medical practitioner, who do you suppose might notice most quickly if anything looks ‘amiss’ with a patient that would warrant further evaluation? Physical therapists would not be attempting to determine medical diagnoses of cancer or other disease processes. They would, however, be recognizing when a patient’s circumstances would NOT qualify them as a physical therapy candidate, and WOULD qualify them for further evaluation by another medical practitioner. Another point to consider is that when patients undergo treatment with a physical therapist, they are typically returning for follow-up visits on a fairly regular, short-term time interval – possibly more than once each week, or maybe weekly, or at least every several weeks. If a patient’s symptoms are not responding as expected to physical therapy treatment, it is going to become evident fairly quickly. Conversely, the interval between visits to many other primary care providers is typically much longer. This frequency is appropriate for management of other non-musculoskeletal health issues. But if a patient’s symptoms are not changing as expected in these situations, it may be months and months before it is noticed and further assessment can be provided.
Physical therapists are one piece of a global health care system. The physical therapy specialty complements the care provided to patients by their primary care provider, or their cardiologist, or their ob-gyn, or their endocrinologist. Access to physical therapists enables patients to efficiently care for issues that physical therapists treat. Allowing patients to go directly to physical therapy without stopping first in other medical providers’ offices also enables other providers to more efficiently spend their time treating patients for conditions in their own specialty area. If people with musculoskeletal issues went directly to physical therapy, the wait times for appointments with other specialists would be shorter, and other medical conditions would be managed in a more timely fashion. This sort of efficiency and effective collaboration between health care providers is of benefit to everyone.
If you are in support of allowing Texans better, more direct access to physical therapy, the Texas Legislature needs to hear your voice. The physical therapists at Symmetry are all currently actively engaged in discussions with their regional legislative representatives as well as with the legislators that filed SB 728 and HB 2118 (Senator Taylor of Plano and Representative Klick of Fort Worth) – encouraging their support of these bills as they wend their way through the legislative process. Sending letters and making calls to these legislators, as well as to your own local representatives, would be a great way to facilitate the forward movement of this legislation. If you do not know who your local senator or representative are, you can find out HERE. Also – here again is the link to the petition mentioned earlier demonstrating support for direct access to physical therapy in Texas. It would take less than 1 minute to take this step to make your voice heard on this issue.
Symmetry will be following the Texas Legislature as this session continues to unfold. We will be happy to provide updates as Senate Bill 728 and House Bill 2118 move forward. Please feel free to contact us if you have any questions about this issue.