While I am in full support of PTs performing DN, I am bothered by the fact that a physician referrral is still required. In the state of Virginia, since we have expanded direct access, that should cover all treatment "modalities" that we deem appropriate for the patient, in accorance with informed consent from the patient. A physician referral should not be required for DN and only adds to a bearocratic issue that often serves only to delay treatment. Most physicians have little to no understanding of the practice of DN. We are an autonomous profression that needs to get out from under the thumb of the medical "establishment" if we truly are to push forward.