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  • Study: Primary Care Physician PT Referral Rates Dropped 50% Between 2003 and 2014

    Over the past 20 years, there have been vast gains in direct access to physical therapists (PTs), and most providers and clinical practice guidelines recommend physical therapy as a "first-line treatment" for many musculoskeletal conditions. However, researchers found that physician referral to physical therapy for these conditions declined between 2003 and 2014, while referral to specialist physicians increased.

    In an article published in the Journal of General Internal Medicine (citation only available for free), authors analyzed 12 years of primary care physician (PCP) data from the National Ambulatory Medical Care Survey. The survey includes patient and visit characteristics, physician diagnosis, services, and tests ordered, including physical therapy. Authors included APTA members Janet K. Freburger, PT, PhD, and Samannaaz Khoja, PT, PhD.

    For all musculoskeletal-related visits, the rate of referral to a PT dropped by 50%, from 94.4 per 1,000 visits, to just 42.9. The decrease in referral rates "followed similar trends" for each of the 3 diagnostic subgroups that researchers examined: arthropathy, spine, and soft tissue disorders. At the same time, referrals to specialist physicians increased at approximately the same rate.

    Authors are unsure whether the results are due to "more appropriate" physical therapy referral or "missed opportunities" for referral, but they note, "Had the decrease in [physical therapy] referral rates reflected more judicious use of specialists by PCPs, we would have expected a similar trend for referrals to physicians."

    Whatever the underlying cause, researchers think the trend isn't exactly in sync with the way health care is evolving.

    "As primary care moves to value-based payment, the need for multidisciplinary, team-based care and care delivery by non-physician providers will be necessary to deliver high-value care," authors write.

    Comments

    • I think a large part of this is due to many owners of PT practices focusing mainly on income generation rather than quality clinical outcomes..There is a persuasive culture in many clinics of focus on billings rather than outcomes, and it is not helped by the corporatization of many clinics, whose main function seems to be generation of income for the practice principals and accountants. All the while attempting to hold down the salaries and conditions of their 7 year Doctoral qualified practitioners. MD/DO's can see through this, as can smart DPT's who move elsewhere due to the corporate control and lack of appreciation attempted to be put on them by company accountants and principals. There is little equitable outcome for the practitioners who become overworked and over governed by the pursuit of more dollars for the boss.. Hence patients suffer, and doctors refer elsewhere where they will be a little less shaking and baking. Just a part of the picture, but a part none the less, IMHO.

      Posted by Kevin Mulvey PT RN on 4/14/2018 8:55 PM

    • Could it be that we have not marketed the value of our profession well enough? Search to top 5 conditions we treat, and see where PT falls in the search results.

      Posted by Leslie Williams on 4/17/2018 1:17 AM

    • To follow up in Mr Mulveys comment. To be profitable, many clinics require clinicians to see two patients per hour using techs as therapy extenders, which is not only bad practice but Medicare fraud. I see this as a big problem and the primary reason I practice in other settings

      Posted by Brent on 4/18/2018 6:59 PM

    • I suggest that we could also look at the way healthcare is changing and how vertical integration in hospital systems is destroying independent private medical practice. This trend has dramatically affected our referral patterns (we are a small private practice) Many medical primary care providers, who are now practicing in a hospital based medical groups are expected to refer within “the system” (lab, imaging, PT/OT, counseling, etc.). This often includes medical specialties as well. So, the proper question should be: did the referrals from PCPs drop, but did the referrals from medical specialists increase? It could turn out that the PT’s are just as busy, but that the referrals are simply coming in via a different type of medical provider. It sure looks that way in my practice.

      Posted by Gerard Breuker, DPT on 4/19/2018 10:09 AM

    • I agree with Gerard that backwards integration and POPTS have significantly decreased referrals but in my experience, and to echo Leslie's comment we don't sell our services to GPs and internists enough and educate them about the value of referring to a physical therapist first. Even with the appropriate use of care extenders, I know there are thousands of excellent private practice PTs out there that save patients from unnecessary narcotics, needles, and knives. We have successfully educated our doctors in our community and the opportunity is still available for many.

      Posted by David Straight on 4/20/2018 2:31 PM

    • Thanks for sharing these interesting stats regarding primary care physicians.

      Posted by Primary Care Physician Houston TX on 7/26/2018 7:43 AM

    • Where did they go? I think the operative word here is "specialists." The patients were referred to specialists, not generalists. PTs and OTs may pride themselves in being holistic, but primary care docs and their patients apparently are looking for specialists when the pain cannot be resolved generally. Note that every orthopedic specialist is an MD first, but identify themselves as "specialists" when it comes to attracting patients for their specific services.

      Posted by Rob Allen on 8/9/2018 9:45 PM

    • This snippet does not delve into the why of this data. Could the possibility be that PTs are staying busy due to less emphasis on PCP/GP marketing and more on social media, local outreach and education on “direct access” and the savvy consumer driver in our dynamic and volatile healthcare system for self-referrals? I would love to hear physicians weigh in on this study’s outcomes.

      Posted by Cristina Bracamonte, PT on 9/1/2018 12:23 AM

    • Wouldn't this be at least partially because patients may be seeking out PT directly without going through their PCP for a referral? Also, there is still not a lot of efficacy to some of the treatment that continues to be provided by PTs. Perhaps some PCPs realize this and are no longer just 'dumping' pain cases on PTs for lack of a more efficacious solution. Also, PTs were providing palliative interventions for decades, now PCPs realize that these interventions are no longer being widely performed.

      Posted by Julie Jeung on 10/22/2018 4:29 PM

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