Direct access use among experienced therapists practicing in states with 3 years' experience with direct access was studied, as were differences between therapists who had and had not practiced through direct access. A questionnaire was mailed to 250 members of the North Carolina, Nevada, and Utah chapters of the American Physical Therapy Association. Almost half (44.5%) of the respondents had practiced through direct access; an estimated 10.3% of their caseload was seen through direct access. Reasons for not practicing through direct access were that the employer does not permit direct access practice (49.1%), insurance does not reimburse for direct access practice (43.6%), no patients have been seen without referral (25.5%), and personal preference to treat by referral only (23.6%). Therapists who had treated patients through direct access were significantly more likely to believe that direct access had benefited them professionally and benefited their patients than were therapists who had not practiced through direct access.