Q. Is it legal for me or one of my employees to perform “physical therapy” (PT) within the confines of my medical practice office, or would that violate a licensing code?
A. The answer is generally no, but with important qualifiers.
The Texas Occupations Code (in Chapter 453) prohibits any person from practicing or representing himself or herself as being able to practice physical therapy unless licensed by the Texas Board of Physical Therapy Examiners. However, the statute also specifically states that this rule “does not restrict the holder of a license issued by another state agency from performing health care services within the scope of the applicable licensing act.”
Physicians, who are licensed by the Texas Medical Board, fit this exception, says TMA’s recently updated white paper, “Delegation of Duties by a Physician to a Nonphysician” 
. A 1986 Texas attorney general’s opinion essentially concurred that a physician, and a person who is not a licensed physical therapist but who is acting under a physician’s supervision, may perform medical acts that come within the definition of physical therapy.
However, there are some restrictions:
- The exception applies to physicians as long as they do not represent (e.g., advertise) to others that they are physical therapists or that they perform “physical therapy.”
- It is also a violation of the PT licensing statute to advertise the ability to perform physical therapy unless the person actually providing the physical therapy is licensed as a physical therapist.
What if you decide to employ a licensed physical therapist in your practice? The PT board provides licenses to and regulates “physical therapy facilities” (any place where the practice of physical therapy takes place).
Further, the white paper says, a physical therapist employed by a physician was disciplined by the PT board because of failure to comply with PT board rules regarding charting, patient assessment, and other matters. The Executive Council of Physical Therapy and Occupational Therapy Examiners, in an FAQ regarding PTs and PT assistants in a physical medicine setting, states the following:
"The services a PT may provide, and the rules under which they are provided, are the same regardless of setting. The presence of a physician, or a licensee of any board besides [the PT board], does not [affect] the requirements for the provision of physical therapy services. If physical therapy is being provided, the facility must be registered if it is not exempt … and a PT or PTA [i.e., a physical therapist assistant] must be onsite when treatment occurs. If a PTA is providing services, they must work from a PT Plan of Care developed by a PT, and must be supervised by a PT."
Physicians who employ licensed physical therapists should consult legal counsel regarding these matters.
For citations of the laws referenced above, see the white paper. The 18-page paper covers the law, ethical considerations, billing, standing orders, delegating duties and prescriptive authority, supervisory requirements, administration of anesthesia, and other practical considerations. It discusses supervising and delegating duties to advanced practice registered nurses, physician assistants, physical therapists, medical assistants, pharmacists, and midwives.
Published March 15, 2017
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