While college football was playing itself out for yet another weekend, I was crewing an endurance run in rural Alabama - the Talladega National Forest, to be exact. More on that later ...

But from what I've read, I didn't miss much.

Technological advances in cellular coverage gave me the ability to check in on the games. Yes, I know, crazy as it sounds, I was checking in on games with a big national impact.

Guess what? A lot of non-surprises took place while I was gone.

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According to the American Physical Therapy Association (APTA), 46 states currently have what they call “some form of direct access”. I am not sure what, exactly, “some form” means. If you look at the states that have “unfettered direct access” – which is also a misnomer unto itself – you are looking at about 16 at last count.

Texas is considered a “direct access” state. I can tell you right now – it simply is not, in any way, shape, or form. But the APTA continues to put Texas (and many other states) in this nebulous category of “some form of direct access”. Sure, you can do an evaluation of a patient without a referral – but what good is that if you can’t then treat the patient without someone else’s consent or approval?

Telling the media, legislators, lobbyists, and worst of all, patients – that patients have “direct access” to physical therapy – is simply not telling the truth. When we go back to legislators and tell them we only have “some form of direct access, but we need to expand it”, should we really expect them to do so? “Well, you already have it according to your own professional association”, I can hear them saying. One would have to wonder if this in fact impairs our position in the health care world instead of enhancing it.

You either have direct access to a physical therapist – or you don’t. There’s no in-between. You can either access a physical therapist, by patient choice, without limitations and referral requirements and other silliness – or you can’t. You can either make full use of their skills and training within their scope of practice – or you can’t.

It’s that simple.

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The airline industry has been heard to proclaim of great financial losses in the recent past. Fuel prices are up as are operating costs. The airline industry is seeking assistance from the federal government. Times are tough, we are reminded.

Oh, woe is the airline industry.

You know why they can't earn a profit? I think it's pretty simple - because they provide crappy service. Period. Let's face it - the average traveller is hit with hidden costs in their fares. They are faced with flights that are canceled for no apparent reason - at the whim of the airline. They experience long waits and delayed flights. They experience absolutely abysmal customer service, even if they do need to re-book a flight due to a problem of their own making.

This was brought to my attention yet again today. My task: to fly from Austin to Huntsville, Alabama, a total of 920 miles. Should I keep the airline nameless? Hell no - American.

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This would require a patient having access to health care first and foremost, something that in the state of Texas is a significant problem. Texas ranks dead last in access to health care. The primary care physician supply ratio ranks 47th in the nation.

Two groups of practitioners – physical therapists and advanced practice nurse practitioners – have proposed valid solutions to this growing dilemma. If a patient has direct access to appropriate care within these providers’ current scope of practice and education, more patients will have access to necessary care and patients will have choices regarding their care.

In Texas, the 82nd Legislative session is upon us. Health care will almost certainly be an important issue. Once again, direct access to physical therapy will be a topic of discussion amongst legislators. But there is another debate being waged on similar battle grounds - with a common foe.

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