CA Private Practice Group/CPTA Take Round One of the Physical Therapy Direct Access Bill Opposed by CMA/COA

May 4, 2011

How could physical therapists possibly win?  The California Medical Association, California Orthopedic Association, and California Chiropractic Association (along with their army of 5 additional lobbyist on top of their current staff lobbyists), were all present Monday, May 2nd in attempts to kill SB 924 – the physical therapy direct access bill authored by Senators’ Walters and Emmerson.  SB 924, if passed, would allow the public to directly access a physical therapists for 30 days.

The reality is that physical therapists pulled off an unprecedented victory with strong testimony from a medical doctor on the physical therapists’ behalf and other extremely well prepared physical therapists.  More that 20 other physical therapists appeared in support of SB 924 as well.

Members of StopPOPTS could not attend but did get a hold of some of the arguments that were used during the committee hearing:

I would like to respond to comments by the opponents to the bill that PTs are not qualified to do medical screening or treat without a medical diagnosis.  As one can clearly see from this graph, PTs performed better on the Harvard musculoskeletal screening exam than every physician specialty except for orthos.  This is not surprising since PTs have a 3 year curriculum dedicated to musculoskeletal examination and treatment.  Identifying serious signs and symptoms that may indicate serious underlying pathology or necessitate tests such as X-rays, imaging, or lab tests is a required part of our training, as Dr. Watts, has indicated.  We are required by this bill to immediately refer a patient to the appropriate medical provider should a patient present with any of the above or risk losing our PT license.

In contrast, only a small minority of medical schools have a musculoskeletal curriculum lasting even one trimester cumulatively.  It is therefore not surprising that a large majority of physicians and physician groups have failed musculoskeletal screening exams in every study published in their own medical journals during the last 20 years.

I’d also like to respond to the CCA comments that PTs don’t know what they don’t know.  Those comments amaze me but does not surprise me.  Chiropractors have not been part of any peer reviewed studies on medical or musculoskeletal screening, but given their core belief that almost all medical disorders are caused by spinal malalignment and should be treated by cracking the patient’s neck or back, I’m betting they would perform very poorly.  Is it good public policy to allow patients direct access to chiropractors, but disallow it for PTs?

Finally, in our hearing of our direct access bill 2 years ago, the Chair of the Assembly B and P Committee opined that PTs were unqualified to treat a patient without a medical diagnosis because they needed to be told what to do by physicians.  There could not be a more absurd statement given the focus and intensity of our education.  In reality, a medical diagnosis is rarely helpful in determining the type of PT treatment, intensity, or duration of the treatment. PTs are required by law to independently evaluate patients and base their treatment upon our (movement/functional-based) assessment, not a medical diagnosis or generic label that tells us nothing about how a patient’s pain and function can be optimized with a non-invasive/conservative approach.

I submit that it is time for the opponents of this bill to “wake up” and join the 21st century.  All sides of the political spectrum want smarter and more efficient health care delivery, instead of the waste and abuse that have led staggering health care costs that have crippled our economy.  The treatment of LBP, which is the 2nd most common problem seen in MDs offices and costs our economy billions per year, is a prime example of  the medical system throwing more and more money at a problem with no better, and possibly worse results.  There is broad consensus among health care economists and physician researchers that we cannot continue down the path of pushing ineffective drugs, surgery, injections, and unnecessary imaging.  While these things all have their place, it is disappointing that in a 2010 study performed by physician researchers and published in the highly acclaimed Spine Journal, only 18% of patients with acute LBP were prescribed PT by their MD and that more expensive and often ineffective invasive solutions were favored.  The study also showed that the patients who were able to access a PT within 30 days had a over 50% less chance or needing injections and surgery.  One could reasonably wonder if THAT is the reason why the California Orthopaedic Association is so opposed to PT Direct Access!

Yes, we have a patient access issue here as well as a health care crisis, and crippling debt. In summary:

* PTs have intensive training in medical screening and indications for MD referral
* Appropriate PT treatment is not determined by a medical diagnosis or label
* Direct access to PT has been proven safe, effective, and superior in terms of yield of the health care dollar.  Patients should have the right to “Try PT first”.

Those that voted for it:

  • Bill Emmerson
  • Gloria Negrete McLeod
  • Curren Price
  • Mimi Walters
  • Mark Wyland

Those against:

  • Lou Correa
  • Juan Vargas


  • Ellen Corbett
  • Ed Hernandez
It seems the some of the CA State Senators, who are fully aware of the POPTS bill (AB 783) aren’t too keen on the CMA completely controlling the physical therapy profession.

Great News – a small victory for the time being, but there is a long way to go.

More to come.

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