051 - Direct Access, Direct Impact: Why PTs Should Be the First Line of Defense for MSK Injuries
In a system strained by provider shortages and rising costs, military treatment facilities offer a glimpse of what’s possible when physical therapists step into the role of primary care providers for musculoskeletal (MSK) injuries.
The result? Faster care. Lower cost. Same outcomes.
This retrospective study reviewed over 8,000 cases at an Air Force clinic, comparing physical therapists to MDs, DOs, PAs, and ARNPs.
The question: Who provides better value in treating MSK issues?
WHAT THEY FOUND:
Lower Imaging Rates: PTs ordered significantly fewer radiology studies than any other provider group.
Reduced Medication Use: PTs prescribed far fewer NSAIDs, by $10–$16 less per visit, without compromising outcomes.
Half the Cost of Care: MSK patients treated by PTs cost the system ~$222 per episode vs. ~$330–$430 for other providers.
Return to Work (RTW): No significant difference in number of visits or RTW rates between PTs and other PCMs.
Improved Access to Care: PTs enabled same-day care via direct access, reducing bottlenecks in appointment scheduling.
WHAT THIS MEANS:
When PTs operate as primary care managers for MSK complaints, they deliver equivalent outcomes with significantly reduced imaging, meds, and overall costs. This challenges the assumption that non-physician providers are simply triage layers. In military settings, PTs are full-scope, front-line providers, and they’re outperforming expectations.
Direct access isn’t just efficient, it’s effective. And with mounting shortages in primary care and rising healthcare costs, it may be the model that civilian systems need to watch more closely.
TACTICAL IMPLICATIONS:
Elevate PTs as First-Contact MSK Providers: Let PTs take the lead in musculoskeletal care—especially in high-volume systems.
Reduce Over-Reliance on Imaging & Meds: PTs demonstrate prudent, guideline-aligned decision-making with fewer unnecessary interventions.
Expand Direct Access Beyond the Military: State legislatures and hospital systems should take notes from DoD models.
Use PTs to Unclog Primary Care Bottlenecks: Same-day MSK care improves readiness, patient satisfaction, and system efficiency.
Quantify and Share These Outcomes: Push for tracking and publishing cost, utilization, and outcome data to support wider adoption.
QUESTIONS TO CONSIDER:
Are your MSK patients still waiting weeks to see a provider, when a PT could see them today?
What would your healthcare budget look like if you cut imaging and NSAID use by half?
McGill TE, Stern DF, Kolber MJ, McGee J. Cost Outcomes of Physical Therapist Providers Compared to Primary Care Providers in the Treatment of Musculoskeletal Patients in a Military Treatment Facility: A Retrospective Chart Review. The Internet Journal of Allied Health Sciences and Practice. 2021 Jan 01;19(2), Article 4.