I can’t comment on Burger King or McDonald’s since I’ve never eaten at either, however I’d like to address a common question that comes my way.

Who Should I See First? My Doctor or a PT?

Patient Examination

Many patients continue to ask if a visit to the internist is required prior to seeking an evaluation from a physical therapist. About 15 years ago a study revealed that 70% of the American public is comfortable seeking care from a physical therapist directly without seeing a physician first (1). Consider an article published in BioMed Central BMC Musculoskeletal Disorders in (https://www.biomedcentral.com/1471-2474/6/32), a scientific peer reviewed medical journal discussing physical therapist knowledge of musculoskeletal conditions compared to medical doctors. It is important to clarify at this point that physical therapists are in no way to be compared with physicians with regard to pharmacology, internal medicine, health managemen, or any area of medicine except for orthopedic examination, evaluation, and treatment of these disorders. These are some of the amazing findings:

• Almost 50% of all American medical schools do not require formal training in musculoskeletal medicine for the MD students (2.)
• A 2003 study found that Less than 20% of physicians who are not orthopedists have the necessary musculoskeletal experience to effectively treat patients in primary care (3)
• 39 states have passed legislation allowing direct access to physical therapists. That means no need to call your doctor, wait for an appointment and then make the trip to your doctor for a prescription from the doctor, and then head to the PT for things ranging from your stiff neck to your ankle sprain (4)
• Multiple studies have demonstrated that physical therapists can provide safe and cost-effective care for patients with musculoskeletal conditions in direct access practice settings (5-10)
• This one is a bit detailed but important. When a physician refers a patient to his or her owned PT, this increased the cost of the PT services by 123% compared to when patients directly accessed physical therapy without physician referral (8). 

If you are a physician reading this, please do not feel offended. Physical therapists are not physicians. We do not prescribe medicine. We do not refer for imaging. We do not recommend surgical interventions. Physical therapists are expert clinicians for musculoskeletal examination, evaluation, and rehabilitation. Physical therapists are experts at restoring form and function using neuromuscular reeducation exercise. Physical therapists are the choice providers for reducing and eliminating pain using non-pharmacological interventions such as manual medicine. Physical therapists rely on physicians in this healthcare economy and it would be foolish to upset the relationships. Nevertheless most physicians, let alone patients, are familiar with what a physical therapist can offer in their time of need. PT’s can determine the cause of the dysfunction, pain, or impairments. The purpose of educating the patients and physicians about what physical therapists do is to increase awareness, improve access to the most appropriate and cost effective treatments. Many physicians still believe PT’s just do “massage, TENS, and ultrasound.” It is up to us to educate the public about the role of a good physical therapist in the present healthcare community.

Come in for your evaluation and get back to life.

STAR Spine Therapy & Amputee Rehabilitation, PLLC

1. Snow BL, Shamus E, Hill C: Physical therapy as primary health care: public perceptions. J Allied Health 2001, 30:35-38
2. DiCaprio MR, Covey A, Bernstein J: Curricular requirements for musculoskeletal medicine in American medical schools.J Bone Joint Surg Am 2003, 85-A:565-567
3. Freedman KB, Bernstein J: The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am 1998, 80:1421-1427
4. Association APT: Direct access to physical therapist services: Is yours a direct access state? American Physical Therapy Association website 2004.
5. Overman SS, Larson JW, Dickstein DA, Rockey PH: Physical therapy care for low back pain. Monitored program of first-contact nonphysician care. Phys Ther 1988, 68:199-207.
6. Byles SE, Ling RS: Orthopaedic Out-patients: A fresh approach. Physiotherapy 1989, 75:435-437.
7. Weale AE, Bannister GC: Who should see orthopaedic outpatients–physiotherapists or surgeons? Ann R Coll Surg Engl 1995, 77:71-73.
8. Mitchell JM, de Lissovoy G: A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther 1997, 77:10-18.
9. Daker-White G, Carr AJ, Harvey I, Woolhead G, Bannister G, Nelson I, Kammerling M: A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. J Epidemiol Community Health 1999, 53:643-650.
10. Hattam P, Smeatham A: Evaluation of an orthopaedic screening service in primary care. Clin Perform Qual Health Care 1999, 7:121-124