Do We Really Want Direct Access?
Last month at the SED (southeast district) of the TPTA meeting, the topic of discussion was the status of direct access in Texas. Both speakers encouraged the membership to get involved by contacting state representatives in support of the measure. They said the bills weren't getting much attention for two reasons. One reason was the strength of the physician lobby. The second was that they weren't getting any voter feedback in support of the bills. In Texas there are two bills. One is in the house and the other is in the senate.
It turns out the chairperson of the committee that would hear the bill and recommend it for debate is a physician. The person behind her is also a physician. So far they have been turning a deaf ear to the problem. It's no better in the senate where the committee chairperson is married to a physician. That sounds a lot like conflict of interest to me but apparently it isn't. Neither chairperson has done anything with the bills. It isn't expected either will even make it to the floor for debate. There has been some debate. A compromise was offered. I will paraphrase what it said. They will allow PTs to treat patients without referral who they've seen in the last 2 years from the same physician for the same diagnosis provided the physician is notified the patient is seeking treatment. I don't see much compromise in that.
One reason this is happening is because there hasn't been much support forthcoming from the rest of us. The representatives and senators aren't getting tons of emails and faxes in support of the change. Every week some therapists travel to Austin (the state capitol) but have yet to see anyone plead our case. Now I'm asking myself if physical therapists, as a profession, really want to have direct access. It doesn't seem to be getting grass root support. There are some very dedicated people working on this but it will take more than that. But no one else seems to be making the effort. Why is that happening? As a rule, PTs aren't passive people. We're all busy, but sending emails don't take that long, especially if you already have the addresses. Maybe we, as a whole, just don't care.
I did a mini poll today at work. None of the PTs I spoke with had a clear idea of what direct access means. Everyone said practice without referral but no one could really describe what that means. Some told me it only applies to those practicing in OP settings. That's true to a point. If you read Vision 2020, it sounds like they want direct access in all settings, hospitals, SNFs and OP clinics. I also discovered no one had thought about how patients would know what PTs do and when it's appropriate to seek our treatment. Accomplishing that will require a nationwide push of education and probably several years of effort.
I'm think there are two issues for this. On one hand, those that want direct access are willing to sit back and let someone else do the work. Simply saying I want direct access isn't enough. We can't sit back and let someone else get this done. It's going to take a group effort. The second issue is lack of understanding of what direct access is. I think these are the "old school" therapists who don't see the need to change a system that is working. On one hand, these PTs might agree direct access is a good thing but they haven't bought into the need to have it and probably never will. I know PTs that fall into this category. They're good therapists. They've kept up their skills. They just don't see the need to do anything differently. There is a subset of both of these groups composed of those who oppose the DPT. To them you only need a DPT if you're going to have direct access. So if there isn't direct access, why have a DPT? I'm going to skip that can of worms this time.
If we want direct access now is the time to jump in with support. If you want it, send an email. Explain to others what direct access means and why it's important. Vision 2020 may be too optimistic but we have to start somewhere. This isn't going to happen quickly. Based on what I've heard when working in different locations, I think the APTA might be better off focusing on educating practicing therapists about what direct access means to them and eliciting their support. Then we should put the push on congress. I've come to this realization slowly. Now that I have, I will be sending emails when requested. I'll support the effort as much as I can. It isn't much, but it's a start.