Direct Access to Physical Therapy is the Right Move For Patients, Practitioners, and Society
Our healthcare system faces an unprecedented increase in size, as a result of a shift towards a more nationalized model of healthcare and a shift towards and older population, due to our increased lifespan and aging “baby-boomer” population. Alongside these drastic increases in magnitude, patients have a justified right to demand a quality of care that is the same or higher, concomitant with this increase in magnitude. This presents a situation with two conflicting principles: how can a society provide care to more people, while maintaining or increasing the quality of that care? In essence, there are two possibilities: increase the number of patients that each primary care provider sees (which might also interfere with quality of care) or increase the number or scope of who can provide primary care. With regards to physical therapy, PTs are fully trained and certified to provide primary care for patients suffering from a variety of ailments—and in many instances are better positioned, as a result of their expertise in certain fields, to make recommendations and decisions for patient recover than primary care physicians. While many states have shifted towards a model of direct access to physical therapy, that is, a model where patients don’t need a prescription from a primary care provider (i.e. physician, dentist, or podiatrist), many states, including the state of Illinois, still limit this access—requiring a primary care diagnosis or referral to treat.
In the military model of physical therapy, PTs are treated as the “first-line” of defense when screening the need for patient referral. An army PT, for example, will be assigned to an entire division of several hundred or even thousands service members, and will them determine whether a patient is an appropriate candidate for PT or requires medical or surgical intervention. As a doctoring profession, which focuses much of the educational curriculum towards the screening of red-flags to make adequate referrals, it seems more than appropriate to opt for a healthcare model that places physical therapists as primary providers.
The foremost goal of a primary care provider should not be to treat, per say, but to determine the best individual/professional to provide that treatment—which may or may not be the primary provider. Taking this principle, the idea that PTs are suited to serve as primary care providers should not be conflated with the fallacious belief that PT is a panacea. Rather, it should be taken as a reflection of the fact that PTs are well educated on a variety of medical pathologies and are adept at screening, identifying, and referring for “red-flags.” Given the financial strains currently afflicting our healthcare industry, we, as a society, should be open to any idea that reduces the overall cost burden, while not reducing the quality of care. “PT First” is a movement that addresses both of those concepts. Just as one would not walk into an orthopedic surgeons office, first, if they rolled an ankle, we should seek a healthcare system that places the most cost-effective generalist as the primary provider and determiner of a patient’s need for further care. As our system currently stands, there is no profession better placed, better educated, and better prepared to take on this challenge than that of physical therapy.