Letter To Texas Legislators - Direct Access To Physical Therapy
Written by Allan Besselink, PT, Dip.MDT   
Thursday, 12 March 2009

Texas HB 607 and SB 433 are, simply put, consumer access bills. They don't change the scope of practice of physical therapists (i.e. what they can and cannot do as part of their clinical practice). These bills simply remove the current gatekeeper status of physicians. As it currently stands, physical therapists in the state of Texas are the only health care providers remaining that require a referral from a physician. With this having a direct impact on access to care and cost of care for consumers, it is important for everyone to write to their representatives in the House and Senate to support these bills. I sent the following letter to all members of the House Public Health Committee and the Senate Health and Human Services Committee this past week.

I am a physical therapist in Texas and am writing to you in support of HB 607/SB 433. This consumer access bill would allow Texans direct access to physical therapy services without a referral by another licensed healthcare provider.

There are three primary reasons to support this bill:

Cost: The current regulatory practice - allowing doctors to be gatekeepers to physical therapy in our State - adds enormous costs and waste to our health care system. The added costs are not just to Texans as individual consumers, but also to the State of Texas in Medicare costs. As but one example, a 1994 study by Mitchell and de Lissovoy noted that the total paid claims for "physician referral episodes of care" averaged $2,236, as compared to $1,004 for "direct access episodes". Data such as this has existed for the past 15 years. As costs have continued to skyrocket since then, there is a need to move forward with a regulatory practice that will provide more cost-effective care to all Texans.

Access: The current regulatory practice creates a barrier to health care for Texans. The reality of clinical practice is that when patients are faced with a choice to either 1) go to a gatekeeper (in order to then be referred to a physical therapist) or 2) simply not go at all, they tend to choose the latter option. This creates chronic situations out of acute ones. An acute problem that can be dealt with in a very short period of time can now become a chronic issue that yields years of health care expense.

Training: Physical therapists are internationally recognized as experts in therapeutic exercise prescription. The educational process is extensive and on-going. Under the current regulatory practice, a patient can be advised on therapeutic exercise prescription by virtually any healthcare provider and even personal trainers (none of which have any formal training in therapeutic exercise) - yet a patient requires a gatekeeper referral to exercise the option to see a physical therapist (a healthcare provider who's primary educational background is in therapeutic exercise prescription).

HB 607/SB 433 does not expand the physical therapy scope of practice, nor does it affect the current statutory duty to refer to a healthcare professional for conditions outside of the scope of practice of a physical therapist. The evidence from states that have updated their physical therapy practice act shows that allowing citizens to access a physical therapist without a referral has not negatively impacted liability claims.

I believe it is time for Texas to make a change that benefits all Texans. I would like to thank you in advance for your support of HB 607/SB 433.

If there is any way that I can be of assistance or provide further information regarding this issue, please contact me at 512-914-0871 (email This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ), or the Texas Physical Therapy Association at 512-477-1818 (email This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ).


Allan Besselink, PT, Dip.MDT

Director, Smart Sport International

As I bring this issue to the attention of the consumer, many are absolutely surprised and dismayed that the current regulations exist. For those who have been to physical therapy in the past, they have experienced delays in their care; for those that haven't, they are upset that they don't have the option to access a physical therapist directly - for both issues of access and cost.


For further information on these bills, please refer to my previous post. If you support these bills, please take action! Legislators need to hear a strong voice from their constituents to overcome the political inertia of medical lobbyists.

Last Updated ( Wednesday, 25 March 2009 )