Direct access to physical therapy creates medical power struggle in Legislature

AUSTIN (KXAN) — Should you have to get a referral from your primary care physician before you can see a physical therapist? Some 47 states do not require that, but Texas is one of three states that does. Now, a contentious battle between powerful medical forces could bring a showdown vote shortly in the State House.

Austin’s Harry Lundell is one of the 10 million Americans getting physical therapy at the moment. He’s needed it to recover from two separate knee replacements, and now a shoulder injury. In each instance, he and other Texans needed to first get a referral from their primary care doctor.

“It does take time and money; I have to schedule an appointment with my physician,” said Lundell. “She’s pretty swamped and moved to the other side of town, so I would have to drive across Austin traffic — which is not an easy thing to do. This would have saved me transportation costs and time and, of course, an office visit.”

The 15,000 licensed physical therapists in Texas have been lobbying lawmakers for direct access while the medical community has been opposing them. Many medical doctors believe that their extensive training far surpasses what physical therapists go through and that this better protects patients.

“There is the possibility the therapist, with only three years training after college, have the knowledge to make an adequate diagnosis on every occasion,” argues Dr. Marc DeHart, with Texas Orthopedics. “The problem of direct access is that they could miss things.”

Therapists say: Hogwash.

“We’ve trained in aspects of differential diagnosis and red-flag screening,” maintains Mark Milligan, a physical therapist with Texas Physical Therapy Specialists. “When patients present things that aren’t muscular-skeletal, we can get them to the appropriate provider.”

He also argues that if there is an issue why do 47 states permit direct access, “No state has ever rescinded that right for physical therapists so you’d think over time that if this were a serious issue there would be litigation or there would be states rescinding the physical therapist act.”

DeHart counters, “I think the other 47 states don’t have a Legislature with the savvy of the Texas Legislature. No study has ever shown that direct access to physical therapy lowered the cost overall to the population served.”

A recent study done in San Antonio did find direct access saves patients money, but a government GAO report concluded that direct access savings would be offset by patients going to therapy more often. Lundell believes direct access may actually create more referrals, from therapists back to doctors.

“They are extremely well-trained, and they will be making referrals more frequently than the reverse is the case now,” he said.

HB 1263 has cleared committee and awaits a calendar scheduling to get to a full House vote. Therapists have fought this battle in previous legislative sessions but believe this year may be their best hope yet. provides commenting to allow for constructive discussion on the stories we cover. In order to comment here, you acknowledge you have read and agreed to our Terms of Service. Users who violate these terms, including use of vulgar language or racial slurs, will be banned. If you see an inappropriate comment, please flag it for our moderators to review.

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