Good Practice: Ethical Advertising

Although our mandate is protecting the public interest, the College of Physiotherapists of Alberta understands that health care is a business. Whether the business is for-profit or not-for-profit may vary, but the basic rules of business apply; no organization will continue to operate if people do not know it exists. That’s where this discussion on advertising comes in. There are specific advertising requirements that apply to all Alberta physiotherapists. You can find these in the Advertising Standard of Practice¹. Unfortunately, a quick survey of Alberta’s physiotherapy advertising world suggests that these standards are not consistently followed.

If you work in a group practice or multidisciplinary environment you may think that the advertising standard doesn’t apply to you, after all, you don’t write the advertisements. But the fact is all of the standards apply to all physiotherapists working in the province. If your employer’s actions are not consistent with the standards, it is up to you to address this with them, to inform them of the problem and to correct the situation.

Some of the most common advertising issues include promotion of unnecessary services, pricing issues, free services, and giving away prizes or offering inducements. 

1. Promotion of unnecessary services

One example of this is when physiotherapy businesses employ advertisements encouraging people to “use up” their health care benefits before the end of the benefit year, rather than letting the funding “go to waste”. This type of advertisement is inconsistent with the standard as it encourages people to attend physiotherapy not because they have a problem which physiotherapy can address, but rather because of the existence of funding to reimburse the provider for physiotherapy treatment. 

Another way that unnecessary services are promoted is by offering “free” services to get patients in the door with the intent of selling them a product. Gait assessment and orthotics may be an example. That’s not to say that some patients do not benefit, but human biomechanics suggest that we all may have some gait issues that may or may not respond to a product. Assessing and providing expensive products to otherwise asymptomatic patients is problematic.

2. Pricing issues

When it comes to pricing and fee schedules, the Standards of Practice clearly set out several expectations that create clarity and transparency around the prices that a physiotherapist may charge. Firstly, there must be a fee schedule that is easy to navigate for the patient or 3rd party payer. The fee schedule itself needs to be user friendly so there is no confusion or misunderstanding. The public should be able to find it prior to agreeing to treatment and there shouldn’t be any hidden or unexpected costs. If a clinic or therapist chooses to offer discounts to students, seniors, or other user groups then it must apply to everyone who is a member of that group and should be documented on the fee schedule for all patients to see. In this matter having a clear and easy to find fee schedule will create much less frustration for the patients attending the practice setting.  

Time-limited pricing promoted through advertisements is prohibited because it is a deviation from the requirement to have a documented fee schedule and serves to induce people to seek treatment within a set time frame, whether that treatment is needed or not, thereby promoting unnecessary services.

3. Free Services

The Standards stipulate that free services may only be offered for the purposes of:

• Providing general education or health promotion
• Informing the public about physiotherapy services offered
• Rendering an opinion about the propriety of physiotherapy services for an individual patient¹

The Standard also indicates that if free services meeting these requirements are offered, no paid physiotherapy services can occur on the same day, and that when providing free services, the physiotherapist must comply with all of the Standards of Practice.¹

The College has heard of instances where patients are offered free initial appointments that do not include an assessment. This is misleading. It is not reasonable to expect a patient to understand the difference between an initial appointment and an initial assessment. From a patient's perspective, if I have taken time out of my schedule and am expecting a free assessment and receive only a tour of your clinic, I will feel mislead. Additionally, how could a physiotherapist expect to provide an opinion to a potential patient about the appropriateness of physiotherapy services without undertaking at least a cursory assessment?

The Competition Act contains provisions addressing false or misleading representations and deceptive marketing practices in promoting the supply or use of any product or business.² To determine whether a representation is false or misleading, the courts consider the “general impression” it conveys, as well as its literal meaning. In other words, truth in advertising counts!

4. Prizes

Prizes and gifts are also expressly prohibited, because they serve as an inducement for unnecessary services. “Refer a friend for a chance to win…” or “come in today to be entered for our draw” type advertisements clearly offer an inducement to purchase services. It can also be argued that these types of advertisements belong in a retail environment, not a professional one. That’s where the Code of Ethical Conduct³ comes in.

In addition to the Standards of Practice, the Code of Ethical Conduct is another foundational document that guides physiotherapy practice in the province. The Code is the document that we look to for guidance about the ethical values expected of physiotherapists. 

With the changing landscape of physiotherapy practice and ownership and the increasing use of social media and online marketing, the Code has been referenced quite a bit lately, specifically the sections related to integrity, professionalism, and enhancing the reputation and standing of the physiotherapy profession. The Code of Ethical Conduct calls on physiotherapists to act in a manner that creates and maintains the public’s trust and confidence. Whether we are talking to the public face to face or through online means we should always look to meet and exceed expectations regarding professional conduct. So, the next time you’re looking at an advertisement for your physiotherapy services, ask yourself if you can honestly say that you’ve met these expectations.
If not, you’re not engaging in Good Practice.

Page updated: 02/12/2022