Once upon a time, the relationship between physicians and physical therapists was almost entirely linear, and it looked something like this:

pain/injury → doctor visit → referral to physical therapist.

But now that direct access to physical therapy is pretty much the norm, the path from one of these providers to the other has morphed from straight-shot to circle—which means PTs don’t always have to fall at the end of the line. Why is that important? Well, among other things, it has turned the tables in the referral game. Yes, it might sound crazy, but with direct access, physical therapists can actually become referral generators rather than just referral recipients.

As this APTA article mentions, some physical therapists are grappling with the myth that this development will shake up the relationships they currently have with referring physicians. In reality, though, the potential benefits far outweigh the negatives. Think of it this way: how do you feel when one of your docs refers a patient to you? Pretty happy—and grateful—right? Now’s your chance to reciprocate that feeling. And when the good vibes are flowing equally, it makes for a much stronger partnership. (Rising tides raise all boats—am I right?) Plus, it ensures that you’re providing the best patient care possible. Just consider the following examples of situations in which physical therapy practices and patients alike can benefit from PTs flexing their referrer muscle:

  1. Let’s say you’re treating a marathon runner suffering from foot pain. At first, she thought it was a sprain, but after examining and testing the affected area, you believe a midfoot fracture might actually be to blame. You recommend that the runner visit a local orthopedist for further examination. And actually, you should make it a point to cultivate relationships with a few select orthopedic providers; that way, your referral stream is much more likely to evolve into a two-way street.
  2. Perhaps a self-referred patient comes to your clinic to treat her urinary incontinence. When she explains her symptoms during the initial evaluation, you suspect that she may be suffering from a condition outside of your scope of practice—bladder stones, for example. So, you give her the name of a local urologist and suggest she make an appointment there. At some point, that urologist is bound to see a patient who could benefit from physical therapy treatment, and when that time comes, guess whose name will be top-of-mind? You could even take it a step further and help the patient make the appointment or accompany him or her to the first visit so you have an opportunity to introduce yourself to the MD. Maybe you could even form some kind of partnership in which the patients you refer get VIP scheduling. And of course, be sure to make it clear that you expect the physician to send your referral patients back to your clinic if they end up needing more physical therapy.
  3. A parent seeking physical therapy treatment for her child’s balance problems books an appointment at your clinic without a physician referral. Based on the initial evaluation, you believe an underlying inner ear issue may be contributing to the child’s symptoms. So, you suggest that the child visit a local otolaryngologist for further consultation as he or she may need ear tubes. And when that doctor sees patients whose balance issues fall into your realm of treatment, chances are good that he or she will send them your way. Additionally, you could take this as an opportunity to visit the doctor’s office in person and possibly even leave some business cards at the front desk. And of course, be sure to send your initial eval note—which should feature a clear, concise description of the patient’s background and current symptoms—with the patient so that the physician has a good idea of where to start.

It’s important to note that in some cases, patients like those described in the scenarios above may have to visit a primary care physician before seeing a specialist, but if they already have the name of a particular specialist in mind, they’ll be more likely to request a referral to that provider. The main thing to keep in mind is that what goes around, comes around—and now that direct access empowers physical therapists to be on the giving side of the equation, they have one more way of getting to the receiving side.


Have you ever referred a patient out to another provider? Did it eventually result in a referral to you? Share your thoughts in the comment section below.

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