“Unrestricted patient access” applies to the final 18 states (you know, the cool ones) and is defined by the APTA as having “no restrictions or limitations whatsoever for treatment absent a referral.” This means that patients can come to a PT for treatment off of the street, get an evaluation and treatment, and then be discharged all without necessarily needing to see their physician. The main advantage for the patient, and the PT, with this policy is that it reduces the amount of time the patient needs to wait to get treatment. This is especially nice for relatively simple injuries or aches & pains that are relatively recent and haven’t healed on their own. The main challenge posed by unrestricted direct access mainly falls on the shoulders of the PT. Since they are operating completely autonomously in this scenario, the need to stay vigilant in terms of the effectiveness of treatment, and when to refer out to an MD, is heightened. The therapist needs to be attentive and responsive to what they are doing with their patients to make sure optimal care is delivered. I might know a couple people if you’re looking.
In my view, the limitations on direct access to physical therapy are starting to fall behind the times. This position made more sense in the days before the doctor of physical therapy (DPT) degree was introduced, but makes less now that DPTs are pervasive in the healthcare system. There have been programs to upgrade skills learned at the Master’s level to the Doctorate level since 1992 (shout out to USC!) and an entry-level DPT program since 1993 (shout out to Creighton!). All programs as of 2015 are DPT programs, meaning therapists now are more equipped than ever to tackle the problems presented in the healthcare system head-on. The APTA said it best in 2000 with their Vision 2020 statement (I see what you did there):
“By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.”
Direct access has been shown to yield better outcomes for patients and reduce the overall cost of treatment for a while now. It’s something that is readily available and unrestricted here in AZ and, hopefully soon, in more states around the country (and DC).