The Scope of Practice Debate
A topic that often comes up in conversation at our courses, but also more broadly within the health professions is scope of practice.
We’ve probably all be told at some point that a particular treatment approach, the use of certain tools, or a specific modality is outside of your scope of practice.
But what, or who ACTUALLY determines your scope of practice?
Depending on the type of practitioner you are, your scope may actually be quite clearly defined. Physiotherapists, Osteopaths, Chiropractor, Acupuncturists and other registered professions (registered with AHPRA in Australia or the equivalent in other countries) do have more specific scope guidelines. For example, cervical manipulation is only permitted to be performed by Osteopaths and Chiropractors, but Physiotherapists must have completed post graduate specialist training to be able to manipulate a Cx spine.
Likewise, there are specific internal pelvic floor assessment and treatment techniques that are only within the scope of registered health practitioners who have undertaken detailed and endorsed pelvic health training. Beyond modality based limitations, there are also many rules that registered health professionals must follow with regard to how they advertise their services, statements made on their websites, etc.
Being a registered health professional certainly comes with some advantages, but there are numerous limitations on scope of practice and also business practices.
Outside of the registered professions, there are many health practitioners who have less clearly defined scope of practice, such as Massage Therapists, Myotherapists, Naturopaths, Nutritionists, etc. For practitioners of these modalities and others in this category, being certain about what you can and can’t do can be a challenge.
Being an unregistered health professional means that there is no qualification based regulatory body that can by law determine what you are allowed to do, unless of course that thing poses a danger to the public of course.
The down-side of this also means that there are many people out there who are not trained appropriately in the modalities they use, and may be providing sub-standard or even dangerous services.
We do have professional associations, which in addition to existing to support and promote their member’s modalities, also exist to protect the general public by providing codes of conduct, standards of practice and also an association specific scope of practice. However, these rules only apply to those people who choose to become a member of that association.
There are, fortunately, other layers of regulation that sit above associations, these include the National Code of Conduct for Unregulated Health Professions in Australia (a government level code), which sets out clear standards of practice, but does not dictate exactly what is and isn’t within scope of practice.
There is also the Health Complaints Commission in each state of Australia, which can conduct an investigation and hand down restrictions of practice that force a health practitioner to cease practicing for a limited period of time or indefinitely.
The limitation of both the National Code of Conduct and also the HCC, is that the health practitioner has to do something wrong first, and a complaint to be made before anything can be done about it.
If you are a non-registered health professional, and wondering if a certain modality or treatment approach is within your scope of practice, I would suggest doing the following things:
1️⃣ Consider if this addition to scope seems to be in line with the skills and knowledge you learned within your undergraduate Diploma, Advanced Diploma, Degree, etc. If not, go to point 4 below.
2️⃣ Consider if the addition to scope would require you to physically contact or discuss information with a patient that is outside the usual ways you would interact with a patient. If yes, go to point 4 below.
3️⃣ Are you undertaking a formal education process to learn the skills and knowledge that are required for you to perform the new addition to your scope? It is highly recommended that you do undertake formal training. Check if you association and/or insurer requires evidence of this.
4️⃣ Contact your association to ask them about the proposed addition to scope. They will generally have an education committee or board that is experienced in determining what is safe and appropriate for a practitioner with your qualification to do.
5️⃣ Contact your insurance company to clarify if the proposed addition to your scope has been deemed insurable in your policy.
6️⃣ Is there scientific evidence to support the proposed addition to scope? Can you ethically utilise this modality or approach in your clinical practice, with your patient’s best interests in mind?
Remember that practicing in a non-registered profession means that there are very few laws about what you can and cannot do in your clinical practice, however if you follow the 6 steps above, it will generally be quite obvious regarding the suitability of the proposed addition to scope.
Another thing that is essential for any ethical health practitioner to do is to reflect on the proposed addition to scope, and consider if they feel confident that their existing training and knowledge is adequate to support this addition to scope.
At the end of the day, we have an obligation to our patients to Primum non nocere, which means “do no harm”. Consider this first and foremost, as you seek to add new clinical interventions to your toolkit.
