Direct Consumer Access to Physical Therapy in Michigan: Challenges to Policy Adoption

Michael J. Shoemaker


Background Despite the ability of consumers to receive treatment from a physical therapist without a physician referral or prescription in 45 states, Michigan continues to require a physician prescription. Given the impending primary care provider shortage, direct access should be considered as a potential solution to barriers that prevent patients from accessing timely musculoskeletal care.

Objective The purpose of the present policy analysis was to analyze why an attempt in 2006 to remove the prescription requirement in Michigan was not adopted.

Methods The Policy Analysis Triangle approach, which considers the relevant actors, processes, and context in which a policy must be considered, was used to analyze why Michigan House Bill 5618 was not passed. Data sources included position statements from relevant stakeholders, state government documents, stakeholder analysis, and a systematic review of the literature.

Results Multiple data sources, including a systematic review of the literature, revealed that direct access does not pose a risk to public safety and may result in better outcomes with regard to cost and quality of care. Failure of Michigan to adopt direct access in 2006 was due to scope of practice conflicts and various political contexts and processes.

Conclusions Direct consumer access to physical therapy services appears to be sound health policy that should be reconsidered by Michigan's legislature to alleviate the primary care provider shortage for those with musculoskeletal disorders.


  • The author thanks Kieran Fogarty, PhD, Nikola Nelson, PhD, CCC-SLP, and Mary Lagerwey, PhD, RN, for their guidance, insightful comments, and suggestions for the development of this article.

  • This article was completed in partial fulfillment of Dr Shoemaker's pursuit of a PhD in Interdisciplinary Health Sciences at Western Michigan University.

  • Received December 14, 2010.
  • Accepted September 19, 2011.
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