High-Quality Referrals in Primary Care: 5 Strategies for Physical Therapists

Referrals are a vital part of physical therapy practice, especially in primary care settings where physical therapists (PTs) are often the first point of contact for a wide range of patient concerns. Whether practicing independently or as part of a larger care team, PTs must be equipped not only to assess and treat but also to recognize when to involve other providers. Doing so effectively supports better outcomes, enhances care continuity, and reduces overall system costs.

The evolving role of physical therapists in primary care

Physical therapists have a unique role in today’s healthcare landscape, offering specialized expertise in the movement system and functional mobility. As direct-access providers in many states, PTs are uniquely positioned to evaluate, treat, and guide patients, often serving as the first touchpoint for musculoskeletal and related concerns. 

Incorporating physical therapists into primary care settings improves access and convenience for patients, contributes to better outcomes, and reduces healthcare costs.¹ Whether practicing in rural or urban environments, PTs frequently act as essential care navigators. In rural care, they may be the sole provider overseeing a patient’s rehabilitation. In urban settings, they may lead a team of providers, coordinating care over a longer period than many other clinicians.

In both contexts, primary care physical therapy supports whole-person care across the lifespan. A critical responsibility in this setting is knowing when—and how—to get the patient to the right place at the right time, including recognizing when to involve another provider. To do this effectively, primary care physical therapists must develop clear, efficient referral paths that strengthen care coordination and enhance continuity.

The following five strategies can help you strengthen your referral process and improve outcomes for the patients you serve.

5 strategies to improve your referral process

1. Get the patient’s input

Effective referrals start with understanding your patients’ values and preferences. Let's say an 80-year-old patient enters your practice with a common musculoskeletal condition: foot drop. They have an MRI of the lumbar spine that seems to be impacting the L4 nerve root on the involved side, which could explain the neurological deficit. While you know that many cases of radiculopathy improve with conservative care, you also know that surgery may be more effective if done early rather than later.

This is a key decision point where shared decision-making is essential. You might discuss the option of referring the patient to a neurosurgeon. Some patients may be willing to have surgery. Others see the risks as too significant, even if it means permanent weakness and using an ankle-foot orthosis.

Other scenarios may require even more nuanced discussions:

1. Should the patient pursue aggressive intervention for a newly discovered condition?

2. Are they open to specialist care in another city or region?

3. Do they feel prepared to act on the referral at all?

As a primary care PT, your role includes guiding these conversations thoughtfully and respectfully.

2. Define the type of referral clearly

Not all referrals are the same. Knowing exactly what kind of referral you’re making helps you communicate more effectively with both the patient and the receiving provider.

Ask yourself:²

• Are you referring to imaging for confirmation or exclusion of a diagnosis?

• Are you directing the patient to a cardiologist due to concerning side effects, such as lightheadedness or hypotension, from new medications?

• Are you seeking evaluation by a neurologist or movement disorder specialist based on clinical suspicion?

Each scenario requires different documentation, urgency, and communication style. In our paper, Referral Decision Making and Care Continuity in Physical Therapy, we discuss these types of referrals and provide a supplementary referral template to help your practice.

3. Communicate quickly when needed

There are two key reasons to communicate promptly with other providers. First and foremost, it helps the patient. In urgent or emergent situations, time is critical, and a delayed referral can lead to delayed diagnosis or treatment. Second, timely communication helps preserve the relationship between the patient, the receiving provider, and your clinic. When referrals are handled with urgency and professionalism, they reflect positively on your practice and support ongoing collaboration.

In the International Framework for Red Flags for Potential Serious Spinal Pathologies, the authors present a “level of concern” tool that helps clinicians evaluate urgency and align their actions accordingly.³ You might consider this concept and the level of concern when determining the speed of your referral communication.

Examples of when to expedite communication include:

• Signs of systemic illness or infection

• Neurological decline

• Suspected fracture or malignancy

In these cases, a quick phone call, secure message, or follow-up note can make all the difference for your patient’s safety and the strength of your care network.

4. Be clear and concise

Many healthcare providers today are overwhelmed with documentation, and cognitive load is nearing a breaking point. In this environment, effective communication often means succinct communication.

One way to facilitate this is by using the SBAR framework: Situation, Background, Assessment, Recommendation.

Instead of referring a patient with low back pain and some red flag findings back to their primary care physician without context—or with an entire three-page examination—consider typing a few brief, targeted sentences like the following:

• Situation: I’m referring Mrs. Johnson back to your office.

• Background: She developed low back pain three months ago, shortly after her last oncologist assessment for bladder cancer.

• Assessment: Her pain cannot be reproduced mechanically, and her recent (three months) unexplained weight loss is concerning for neoplastic processes.

• Recommendation: I recommend magnetic resonance imaging of her lumbar spine to rule out metastasis.

5. Follow up to close the loop

“Closing the loop” after some time is good practice and a generally recommended step to ensure care continuity. This means checking in with the patient to confirm whether everything went as expected, whether their issue was resolved, and what further steps, if any, are needed in their plan of care.

This step can be challenging, especially given the time constraints in many physical therapist practices. But even simple systems can make a difference. Consider:

• Delegating follow-up calls to support staff

• Scheduling automated patient check-ins via email or SMS

• Setting aside a recurring time block each week for follow-up

Referrals shouldn’t be the end of the story. Following up helps ensure quality care, builds trust, and gives you valuable insight into patient outcomes.

Takeaway: Referral quality reflects care quality

Hopefully, we’ve provided a few tips to help kick-start the quality of your referrals. Think of it as an ongoing process that starts and ends with the patient, the true focus of every referral. As physical therapists continue to expand their role as primary providers for musculoskeletal conditions, we must also level up our referral game beyond the traditional “treat, refer, or treat and refer” approach that too often bookends clinical cases and test questions.

We explore these ideas further in our Medbridge course on Primary Care PT, where we walk through real-world examples of referral decision-making and care coordination. We hope that ongoing discussion and consistent practice will continue to improve the quality of care delivered by physical therapists across all settings.

References

1. Petition to ABPTS and ABPTRFE for recognition of Primary Care as an area of specialty and residency. 

2. Peterson, S., & Heick, J. (2023). Referral Decision-Making and Care Continuity in Physical Therapist Practice. Physical therapy, 103(5), pzad030. https://academic.oup.com/ptj/article/103/5/pzad030/7075685

3. Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International Framework for Red Flags for Potential Serious Spinal Pathologies. The Journal of orthopaedic and sports physical therapy, 50(7), 350–372. https://www.jospt.org/doi/10.2519/jospt.2020.9971