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More needs to be done to improve direct access in states across the country.

Direct access means the removal of the physician referral mandated by state law to access physical therapist services for evaluation and treatment. Every state, the District of Columbia, and the US Virgin Islands allow for evaluation and some form of treatment without physician referral. However, many of those states continue to impose arbitrary restrictions on direct access, or only allow for treatment without referral under very limited circumstances.

Why It Matters

Direct access restrictions cause unnecessary delays for people who would benefit from treatment by a PT. Delays in care result in higher costs, decreased functional outcomes, and frustration to patients seeking physical therapy treatment. Eliminating arbitrary barriers results in timely, more effective care.

Our Position

Allowing individuals to make decisions regarding their health care is good policy. Eliminating the referral requirement makes health care more accessible to more people. We must amend current statutes at the state level to remove arbitrary limitations on direct access to physical therapy services.


Recommended Content

Improving Direct Access at the State Level

Feb 12, 2020 / Article

Direct Access By State

Sep 23, 2021 / Resource


Additional Direct Access Advocacy Content

Study: Early Physical Therapy Provides a Leg Up on Knee Pain

Aug 11, 2021 / Review

Research in the military health care system revealed lower costs and symptom recurrence for patients who saw a PT within 30 days.

APTA 2021 Statehouse Roundup: New Prepayment Review Law, Imaging Wins, More

Jul 26, 2021 / Roundup

From better insurer responsiveness to direct access improvements, to breakthroughs on PT use of imaging, lots of state-level achievements.

State Legislative Advocacy: ND Imaging Win, Compact Growth, and More

Apr 16, 2021 / Roundup

Many state legislatures are still in session, but positive changes are already in the works. Here's a progress report.

Seven Hot Issues Getting Attention in State Legislatures

Feb 23, 2021 / Roundup

The fight to improve direct access continues, use of the licensure compact grows, and telehealth is being discussed just about everywhere.

Direct Access Once Again Boosted by National Policy Organization

Dec 9, 2020 / News

ALEC has reauthorized a resolution that backs unrestricted direct access to physical therapy as important to "free-market health care."

Researchers: Direct Access Works in the U.S. Civilian Health Care System

Dec 7, 2020 / Review

A new study affirms that direct access to physical therapy improves outcomes and lowers cost for patients with back pain.

Philia. Pragma.

Aug 13, 2019 / Perspective

I knew this opportunity was bigger than our anatomy exam.

Study: PTs, Family Physicians Similar in Knowledge of LBP Management

Dec 10, 2018 / Review

When it comes to management of low back pain, PTs know just as much—and sometimes more—than the family practice physicians who often are sought for primary care.

Study: Seeing a PT First for LBP Lowers Overall Costs, Reduces Chances of L...

May 24, 2018 / Review

A new study finds additional benefits to receiving physical therapy for LBP as a first-line approach.

APTA Report: Direct Access Widespread, But With Barriers

Oct 20, 2017 / News

Most of the use is occurring in private and hospital-based outpatient clinics and group practices.