Over the years, I’ve heard a lot of excuses as to why PTs who don’t practice in states with unrestricted physical therapy direct access shouldn’t bother marketing to patients or even accepting direct access patients at all—excuses like:

  • “We can't see patients without a referral.”
  • “Our physicians send us plenty of patients.”
  • “Our payers make us obtain referrals, anyway.”
  • “I couldn’t possibly charge cash for my services.”
  • And my personal favorite: “There’s no point in marketing to patients when their physicians make all the decisions.”

But, the truth of the matter is that even if your state requires you to obtain a physician referral before you begin a plan of care, limiting your marketing to physicians is no longer a sound business strategy (if it ever was)—especially as payer reimbursements continue to shrink and the number of high-deductible health plans continues to rise. In this new era of health care, the traditional referral-based practice model simply isn't as conducive to success as it once was, which is why savvy providers are starting to think outside of the proverbial box. After all, it’s about making the rules work for you—not letting them prevent you from helping as many patients as possible and building a business that’s successful not only today, but for decades to come. Here’s why PTs are doing direct access wrong (and the truth about all those flimsy excuses):

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Patients can influence referrals.

Of course, maintaining physician relationships is still important (as we’ve mentioned before, this new healthcare paradigm is all about collaboration, not competition—and we absolutely must play nicely with others). But every rehab therapist—whether you practice in a full direct access state or not—should also be marketing directly to patients. Otherwise, you’re missing out—on physician referrals and self-referrals alike. Remember: Patients are taking greater control of their healthcare decisions—not only because they have access to more information than ever before (hello, Google), but also because they now foot a greater portion of the bill. Thus, they’re doing their research on treatment and provider options well before they ever set foot in their physician's office, which means they’re now in a position to influence referral decisions.

If you’re able to connect with patients directly—and objectively demonstrate your value—then those patients are much more likely to request from their physicians a referral to see you, specifically. And if patients are requesting you by name, you better believe those physicians are going to be researching you as well. If they like what they see—and their patients have positive outcomes—then there’s a good chance they’ll send even more patients your way.

Many patients still don’t know the value of PT.

As it stands now—and as I wrote here—of all the patients with neuromusculoskeletal issues who could benefit from seeing a rehab therapist, only about 8% end up seeking out rehab therapy treatment. That means that about 92% of the patients we could help never make it to our clinics. And that’s more than just unfortunate; it’s tragic.

And there are plenty of would-be direct access patients who don’t seek out therapy first simply because they don't know they should—or even that they can. Why? Because they aren't informed on the benefits of PT or assume they must visit their physicians first. That’s a whole lot of potential patients we’re missing out on serving, and ultimately, it’s our responsibility to remedy that—to get the word out to the general public and raise awareness about the value we provide to our patients. Well, here’s our chance—and just in time for National PT Month. I can’t think of a better way to celebrate the occasion than to develop a patient-facing, patient-centered marketing game plan that’ll tell the world how wonderful you really are.

Strategies for communicating your value:

Ultimately, you’ll want to adopt marketing strategies that address the things patients care about most—you know, things like getting better faster. Here are three tips to help you accomplish that (adapted from this post):

  1. Understand your practice’s strengths and weaknesses using outcomes data. This will help you pinpoint the services you want to highlight—and the ones that may need a little more work before they’re marketable. For example, if you have a top-notch shoulder rehabilitation program that consistently produces exceptional outcomes and extremely satisfied patients, then that’s a great a place to start.
  2. Use your data to craft messaging that entices patients to select your services. As you craft your messaging, put yourself in your patients’ shoes—and minds. They don’t have the clinical background you do, so you’ll want stick to jargon-free language that they can easily understand. Ask yourself: what do your patients really value? And how do you deliver that value? These are the points you want to get across. So, keep things clear and simple—and never promise what you can’t actually deliver.
  3. Take it to the interwebs. Today’s patients are doing their research online, which means you absolutely must have a solid online presence—that includes a professional website, active social media channels, and positive reviews. (You should also join us for our free October webinar, during which WebPT marketing experts Shawn McKee and Charlotte Bohnett will discuss strategies you can use to help your patients find you online.)

The future of physical therapy direct access looks bright.

According to the APTA, as of 2015, some form of direct access exists in all 50 states, DC, and the US Virgin Islands. While it’s true that some states still restrict patient access to physical therapy services to some degree, we’re at least making headway: no matter where you practice, you can, at the very least, perform an initial evaluation on any patient who seeks your services—no physician referral required. And that puts you in the patient care driver’s seat, because if, during the evaluation, you decide—using your clinical expertise, of course—that a patient would benefit from your services, then you can recommend a PT-friendly physician from whom the patient can easily obtain a referral. Or, if you decide that a patient would benefit from non-PT intervention, then you can refer that patient to the appropriate care provider, thereby strengthening your network of healthcare professionals and your reputation within the greater medical community. Either way, seeing patients first is your opportunity to step into a new role as a care coordinator for patients with musculoskeletal conditions—something PTs are uniquely and exceptionally well-qualified to do. But that can’t happen unless those patients come to you first—which means it can’t happen unless you market yourself directly to them.

A note about state laws vs. insurance requirements:

It's also important to keep in mind that, in some cases, the referral requirement comes from the payer, not the state. If you mistakenly believe it's a state requirement when it’s not, then you could actually be missing out on direct access patients with PT-friendly insurance carriers or those who are willing to pay cash. Thus, it’s important to stay up to date on both specific payer requirements and the legislative initiatives impacting your state. For an updated list of direct access laws by state, check out this APTA doc.


We all know the benefits of first-line physical therapy intervention on patients with musculoskeletal conditions. Our patients achieve amazing outcomes every single day—and they do so via a treatment route that is safer, less invasive, and significantly more cost-effective than many traditional care options (like surgery, prescription pain-killers, or injections). Plus, PTs focus on improving function and reducing pain in the long term, which means our patients go on to experience a better quality of life—for the rest of their lives. With that, let’s make National PT Month 2017 the best one yet by embracing our mission to educate healthcare consumers about the immense benefit of seeing a physical therapist—first. It’s time for the world to #ChoosePT. Who’s with me?

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