As a physical therapist in Texas, I have watched the continued struggle with direct access to Physical Therapy. Texans can see a Physical Therapist for an initial evaluation, but cannot subsequently receive treatment without a physician referral. As a McKenzie practitioner, not having direct access is an enormous barrier to caring for our patients. With an assessment process that naturally shifts to treatment, we are faced with a dilemma. If the assessment reveals a directional preference, then instead of simply taking the next step and educating the patient regarding the importance of this, we must then interject "you need to see a physician for a referral."

In an era of “evidence”, there is plenty to indicate that direct access to Physical Therapy would increase a patient’s access to appropriate and necessary health care, decrease their cost of care and restore the patient’s right to choose.

In order for our health care system to move forward, it is time for all of us to put our best foot forward and foster a medical system that is truly patient-centered.

Studies have shown that there is a direct cost benefit to the consumer by seeing a Physical Therapist as the first line of assessment, with some estimates as high as a savings of 55%! This cost extends not only to the individual, but to the state's Medicare system as well. In a state like Texas where one out of four people are uninsured, this is critical.

Moreover, according to the Texas Medical Association, there is a significant shortage of physicians in the state, which only underscores the need for additional qualified first line practitioners.

A Physical Therapist’s training is focused on the use of therapeutic exercise in the treatment of disorders of the musculoskeletal and neurological systems. We possess the knowledge and skills for autonomous practice - to evaluate, to make functional and mechanical diagnoses, and to establish a plan of care for our patients. APTA Vision 2020 alludes to this as a future goal when this is already a part of our current scope of practice.

When I was trained in Canada, I was taught to think as an autonomous professional. It wasn't questioned. I was considered the "expert" in what I did by everyone in the system (doctors included). Direct access has existed in the province of Ontario since the early ‘90’s with no adverse effects on the health care system.

But none of this matters unless the consumer knows what we do, why we do it, and how it improves their quality of life and health care. We need to speak to the consumer effectively and in the end, provide a good consumer-centered experience.

Ultimately, consumers are faced with a clear reality:
- Choice of health care is limited by regulatory practice.
- Legislators define regulatory practice.
- Consumers vote for legislators.

It is really quite a simple process. This is where the consumer can speak up and be heard.

As McKenzie practitioners, we are intimately aware of our role as diagnosticians and as mentors in the process of self care. We have the training to do so, and we know that MDT outcomes save money for the patient and for the payer. There is no question that in the long term, McKenzie practitioners must lead the way in the pursuit of direct access.

Perhaps this reveals the true benefit of the McKenzie practitioner – as one of patient advocacy in an era of evolving health care and future reform.

Note: The content of this post originally appeared in the “MDT Bulletin of the McKenzie Institute Americas Region”. The full article can be found here. Further information on the McKenzie method can be found at http://www.mckenziemdt.org.

Photo credit: roomman