Perceptual correlates of physician referral to physical therapists: implications for role expansion

From an interprofessional role boundary maintenance perspective, this paper traces the historical development of physical therapy relative to physicians. Then, using survey data of 206 physicians in a metropolitan area of the United States, two hypotheses are tested regarding the prospects of physical therapy expanding its role to include highly autonomous skills. The first, from a set of structural-functionalist assumptions about role differentiation, posits that role expansion will precede status enhancement. The other, from conflict-theory assumptions about status politics, posits the opposite. A panel of physical therapists rated 24 procedures as requiring high, moderate and low skills. There was no significant difference in frequency of physician referral for the three levels; referral was associated with patient needs rather than physicians' perceptions of practitioner competency and status. The structural-functional hypothesis was supported, and two policy implications are noted: (1) an expanding physical therapy role is not likely to stimulate 'turf battles' with physicians, and (2) currently, greater professional autonomy is likely to be acquired by physical therapists making physicians aware of the extent of therapists' capabilities (role expansion), rather than through legislating more stringent curricular and license standards (status enhancement). The study is preliminary due to a small response rate.