Physician referrals to physical therapy for the treatment of musculoskeletal conditions

Objectives: To identify factors associated with orthopedic surgeons' and primary care physicians' referrals to physical therapy (PT) for musculoskeletal conditions. Design: Cross-sectional analysis of National Ambulatory Medical Care Survey data. Setting: US office-based physician practices. Participants: Visits to primary care physicians (N=4911) or orthopedic surgeons (N=4201) for musculoskeletal conditions. Interventions: Not applicable. Main Outcome Measure: Whether a PT referral was made. Results: After controlling for diagnosis, illness severity, and PT supply, insurance status and physician characteristics remained strong predictors of PT referral. Primary care visits covered by Medicaid or a managed care plan were less likely to result in PT referral than were visits covered by private insurance or a nonmanaged care plan. Orthopedic surgeon visits covered by workers' compensation or managed care were more likely to result in PT referral than were visits not covered by workers' compensation or not covered by managed care. Osteopathic primary care visits were more likely than allopathic primary care visits to result in PT referral. Given identical visit characteristics, orthopedic surgeon visits were more likely than primary care visits to result in PT referral. Conclusions: Significant differences exist in orthopedic surgeons' and primary care physicians' referrals to PT, both within and across specialties. Variation in PT referral may be indicative of problems with access and/or inappropriate referral.