Texas HB: 637 Direct Access to Physical Therapy

[TexasPT]

Please take time to sign the petition for HB 637 which will allow direct access to physical therapy in Texas. Texas residents who support and sign the petition automatically send a letter to their local representative(s). Please help Texas patients and PTs gain direct access!

Please sign at http://www.accessyourphysicaltherapist.com/

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[aggiecjg11]

I'm gonna stir the pot a little on this one...I know most people think Direct Access is the best thing since sliced bread to hit the PT profession, but I have my reservations about it. It's a lot more responsibility on the PT's shoulders, and they don't have a physician to back them up should anything go wrong. Yes, I understand that's why there has been a transition from MPT to DPT, we are expected to have a more holistic knowledge of the human body beyond just the musculoskeletal and nervous systems, but with great privilege comes great responsibility. I'm interested to hear others thoughts on this as well.

 

[TexasPT]

I understand your reservations but lets be clear-If a physical therapist does something wrong,even with another providers referral, the physical therapist holds all the responsibility. A referral is not a safety net;the referring physician will not be held accountable for a PTs mistake. A physical therapists' responsibility is still a physical therapists' responsibility regardless of whether the patient was referred to you or not.

 

[aggiecjg11]

I'm thinking more in terms of disease detection than malpractice as a PT. Sometimes aches and pains that don't get better with therapy are caused by bigger problems--renal disease, ovarian cancer, you name it. It helps to have a medical history/family medical history to refer back to via the referring physician rather than just relying on what the patient tells you in their eval.

 

[TexasPT]

When a patient goes to the MD and ends up needing physical therapy, all that the MD does is order PT. They do not do extensive testing on patients they simply send orders to a PT to 'eval and treat.' Granted MDs have a more knowledge in disease processes, PTs also have knowledge. Furthermore, PTs are experts in musculoskeletal disorders. PTs know when the issue that a patient is presenting with is not PT treatable and will refer out. On a side not, how is it that if we are the experts in the field of musculoskeletal disorders that chiropractors, dentist, and podiatrist can refer to PT? By allowing these professions to refer to PT, the law is stating that it is not necessary to hold an MD to refer to physical therapy. Correct me if I am wrong, but do these professions have more knowledge in disease processes than physical therapists? Also, massage therapist see patients directly. More often than not these patients are getting a massage to alleviate 'aches and pains'. Is their education substantial enough to know whether the pain the patient is experiencing renal disease, ovarian cancer, etc.?

 

[TheOx777]

I believe Direct Access is an integral part of why the APTA has transitioned physical therapy to a "Doctoring Profession." With the responsibility, literally and figuratively, associated with the title "Doctor" then PTs/future PTs should not be afraid to take on more responsibility(maybe more liability and higher pay). Coursework in neuroscience/pathophysiology/pharmocology/advanced physiology/differential diagnosis/histology etc. are there to provide the scientific foundation for understanding why the body functions the way it does on a general level(across the board). Once you go into the specialized PT coursework (i.e. Musculoskeletal/Neuromuscular/Orthopedics/Biomechanics/Integumentary etc then this is what really set us apart.

I imagine that any MD/DO may(on average) wipe the floor with DPTs when it comes to differential diagnosis because of the amount of time spent in residencies and fellowships after school. This is another reason you see residencies popping up for DPT graduates. It certainly is not the norm, yet I could foresee a time when it is. Bottom line is that to get "respect" you have to earn it. By adding more clinical education, advancing the coursework and research, and creating a residency process the APTA is saying to the world and rest of the medical community that we are a viable and irreplaceable piece of the puzzle. Therefore; Direct Access is something we should embrace and take on with pride. If you do a full "work up" and ascertain that your patient's issues are outside of your scope of practice, then pass them along to a professional better suited to deal with it.

Final Note: All practitioners misdiagnose MD/DO/DDS/DPT/DPM/DVM/NP/PharmD the list goes on and on.

 

[jesspt]

I'm thinking more in terms of disease detection than malpractice as a PT. Sometimes aches and pains that don't get better with therapy are caused by bigger problems--renal disease, ovarian cancer, you name it. It helps to have a medical history/family medical history to refer back to via the referring physician rather than just relying on what the patient tells you in their eval.

Yup, but it's pretty easy to determine when spinal pain isn't mechanical/musculoskeletal. In that case, every PT should refer out to the patient's PCP.

In regards to the typical outpatient client, most are very aware of their past medical history. I find it very rare that I need to consult with their PCP about PMH.

Direct access puts only a minimal amount of increased responsibility onto a PT, because we should all be screening every new patient we see, regardless of whether they have seen a physician prior to walking into our clinic.

As state previously, having seen an MD is no parachute for a PT who is negligent/careless/foolish. It will be the PT's license on the line.

 

[aggiecjg11]

Thank y'all for the insight. I love hearing different perspectives on this issue. I applied to programs both in and out of state, so if I end up going out of state where they currently have Direct Access I'm sure I'll get a better feel for what practices are like with it. To the practicing clinicians on this thread: what positive changes have you seen as a result of Direct Access?