Licensure, Scope of Practice, and Supervision
Scope and direct access
Maryland PTs examine, evaluate, treat, and prevent movement dysfunction; establish plans of care; perform manual therapy, therapeutic exercise, modalities, and selected tests; and educate patients. Maryland permits limited direct access: a PT may evaluate and treat without a physician referral, but must refer or consult when the condition is outside physical therapy scope, when progress stalls, or when red flags appear. The exact time and condition limits should be checked in the current Act and COMAR. PTs do not prescribe drugs or perform surgery.
Supervision
PTAs are licensed, not assistants at large. A PT must evaluate the patient, establish the plan of care, and supervise the PTA; the PTA may deliver delegated interventions and report changes but may not perform initial evaluations, interpret findings independently, or alter the plan. Unlicensed aides may assist with non-skilled tasks such as transport, setup, and cleaning, but cannot perform skilled interventions or apply modalities. Supervision must be adequate for patient safety and consistent with COMAR; the PT remains responsible for the patient.
Worked example
A PTA is asked to see a new patient with acute low back pain and start the usual protocol. The PTA must decline the initial evaluation because no plan exists. The PT must examine the patient, screen for red flags, evaluate within physical therapy scope, and establish a plan; the PTA may then treat under supervision.
Traps
- Letting a PTA perform the initial evaluation or change the plan.
- Letting an unlicensed aide apply ultrasound or other skilled modalities.
- Assuming supervision means the PT need never be available.
- Treating direct access as unlimited or referral-free forever.