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The practice of physical therapy in the United States has changed dramatically since its beginnings in the early 1900s. Today´s physical therapist is a graduate of an accredited degree granting program, and is required to be licensed by the state in which physical therapy is practiced. Physical therapists are employed in diverse settings including hospitals, rehabilitation centers, private offices, schools, home health agencies, extended care facilities, and academic institutions. In addition, physical therapists may be formally recognized and certified in seven specialty areas of physical therapy practice. Direct access to physical therapy services is a relatively new issue within the profession of physical therapy. As of 1993, 30 states permit patients to have "direct access" to physical therapy services. Stipulations found in many of the direct access laws limit the autonomy of the physical therapist practicing in a direct access mode. Direct patient access to physical therapy increases the degree of professional, legal, and ethical accountability for all physical therapy practitioners. The dynamics of the health care delivery system and the ongoing changes in physical therapy practice constantly challenge physical therapists to ethically manage their practices, businesses, and conduct. Competent practice and compliance with all applicable laws are essential for each individual practitioner. Referral to, and consultation with. fellow therapists, physicians, and other clinicians will increase in frequency as the trend toward direct access practice continues to grow. Managing these new relationships in an ethical fashionwill be a challenge for therapists who work through direct access. In summary, this has examined the issues of diagnosis and referral in physical therapy practice. However, many questions remain unanswered. It does, however, begin to examine these issues by documenting the actual use of direct access as a practice mode.
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