Temporal Trends in Ambulatory Care Physicians Referral to Physical Therapists for Musculoskeletal Conditions: Analyses from the National Ambulatory Medical Care Survey (NAMCS), years 2003-2014

June 21, 2017

Samannaaz S. Khoja, PT, PhD; Janet K. Freburger, PT, PhD

Poster presentation, 2017 CoHStar Summer Institute on Health Services Research

Carolina HWRC Project: Integration of Rehabilitation Care from the Acute to Community Setting: The Role of Physician Referral



  • To examine primary care physicians’ (PCPs) and orthopedists’ referral patterns to physical therapy (PT) for patients with musculoskeletal conditions.
  • To investigate patient and health provider characteristics that are associated with a PT referral.

Conclusions and Significance

  • These data provide national estimates on PT referral by PCPs and Orthopedists for managing musculoskeletal conditions.
  • PT referral rates by PCPs are low relative to Orthopedists and are declining over time.
  • A greater number of provider factors (i.e., time spent with PCP, PCP’s specialty, whether PCP seen was the patient’s primary provider) predicted PCPs’ referrals to PT compared to Orthopedists.
  • Demographic factors (i.e., age, race, region, Insurance type) also predicted PT referrals. Insurance type significantly predicted PT referrals by PCPs but not by Orthopedists.
  • Association of non-clinical factors with PT referral are suggestive of an under or over-referral to PTs, and potential sub-optimal management of patients with musculoskeletal conditions.


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This work is funded through cooperative agreement U81HP26495, Health Workforce Research Centers, with the National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services. The content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.