True, but many times the referral doesn't happen unless the patient asks for it. No matter what happens with direct access for PT, the vast vast majority of referrals will come from physicians. I understand the difficulty of defining what PMand R docs do, because it is very similar to what PTs do (obviously just the physical stuff, MD/DOs do some things that are well outside PT scope of practice) However, in most areas, where PM and R has no presence, the PT is the professional that best deals with many of the things that they referenced in their advertisement.
Really, do you order MRI for every case of LBP? Of course not. you say to them, yup, you have low back pain. Go see the PT. Great, thanks for the referral, but we can do the same screening you can except without the imaging. There was a study a couple years ago where they compared the difference between FP, ortho, and PTs in what imaging they ordered (it was a military study) and the PT and orthos were nearly the same, both better than the FP. If we see something that doesn't fit, off they go to you.
Small town Minnesota, 5500 people, 9 family practice docs, two NPs, one orthopedist day per week, and 6 chiros. The three PTs are best suited to do the day to day management of most ortho cases. The Neuro cases always need a doc to manage, but many ortho cases don't. (mechanical LBP, neck pain, tennis elbow, patello-femoral syndrome, etc . . . ) If they don't fit the normal pattern or if they don't make progress as expected, they get referred anyway. I don't see how the involvement of a physiatrist in the treatment of a hamstring strain enhances the product. It is just one more step that the patient gets billed for. So, they skip it and go the the chiro and get their ultrasound, their back cracked and rack up 3 weeks worth of bills for worthless treatment that didn't have anything to do with their recovery.
I am in no way trying to say that I can do all that you do, I cannot.
But the things that you do in my area of expertise (unless you are a former athletic trainer or PT) I do much better (usually). If we stay in our scope of practice and refer out when the patient reaches the fringes of our scope, we PTs have a good track record of doing the right thing.