To a large extent, the College of Physiotherapists of Alberta does not get involved in the business practices of physiotherapists. As a regulatory college, we focus attention on aspects of physiotherapy practice that are within our jurisdiction. However, this should not be construed to mean that we don’t care about ethical business practices.
There are several Standards of Practice that directly relate to the business practices of physiotherapists including the Advertising , Fees and Billing, and Conflict of Interest Standards. In addition, the Code of Ethical Conduct contains several statements about how physiotherapists and physiotherapy businesses must conduct themselves in their daily activities, including being responsible to:
- Conduct and present themselves with integrity and professionalism.
- Act transparently and with integrity in all professional and business practices including fees and billing; advertising of professional services; and real and/or perceived conflicts of interest.
- Commit to maintaining and enhancing the reputation and standing of the physiotherapy profession, and to inspiring public trust and confidence by treating everyone with dignity and respect in all interactions.
- Act honestly, transparently and with integrity in all professional and business practices to uphold the reputation of the profession.
As with all activities, it is the individual physiotherapist’s responsibility to be aware of and follow the Standards of Practice that relate to their daily practice. With that said, each month the College of Physiotherapists of Alberta receives several calls from physiotherapists seeking advice about various aspects of business ownership.
They may be planning to open a clinic or considering seeing a patient in the community as a one-time event. The College of Physiotherapists of Alberta often hears from physiotherapists thinking about setting up mobile or home-based businesses. Physiotherapists can be at any stage of planning their business, from simply pondering the idea to making formal plans. Here are some things to think about if this is you.
The Standards:
No matter where you practice, or what type of practice you engage in, the Standards of Practice apply to your practice at all times. If you have never been in the position of setting up a business before, or if it has been a while since you last reviewed the Standards, now is the time to review them again and think about how you will set up your business in a way that meets the expectations set out in the Standards.
Privacy and record keeping
All physiotherapists are responsible for the privacy and security of their patient records. This means having physical, technical and administrative controls in place to protect private information. If you are transferring or transporting records, as in the case of operating a mobile practice, or while moving records from an old location to a new one, they need to be secured while in transit, or while being transmitted (in the case of an EMR).
If you are operating from a home office, it is not enough to lock your home, you need to have your records secured within your home as well, so that, for example, the cleaning lady or someone visiting over the holidays does not have access to private information by virtue of being in your house. You are also required to ensure that you retain records for the required period and that your patients know how they can get access to their records for the duration of that retention period.2,4
Personal security
If you are planning to operate from your home, how will you ensure your own safety and the safety of your patients? Did you realize that this is also required under the Safety Standard of Practice?5 You will now have patients entering your home, knowing where you live. While most patients have positive relationships with their physiotherapists, how will you feel if you have a therapeutic relationship that ends poorly? How can you avoid getting into a difficult situation to begin with?
Similarly, if you are working in isolation from a clinic, or travelling alone to see patients in the patient’s home, how will you ensure the practice location is secure and safe? How will you get help if the patient suffers an adverse event while in your care and there is no one else present to call on for help?
Professionalism
While there is nothing in the Standards to prohibit a physiotherapist from operating from their home or in a mobile practice, the Code of Ethical Conduct does require that physiotherapists
- Conduct and present themselves with integrity and professionalism.
- Commit to maintaining and enhancing the reputation and standing of the physiotherapy profession, and to inspiring public trust and confidence by treating everyone with dignity and respect in all interactions.
How will you achieve this objective if your patient is coming to your home and enters directly into your personal living space?
Physiotherapists should also carefully consider what services are appropriate for delivery in a less-formal environment, or one where no other staff are present. For example, is it appropriate to provide pelvic health interventions in a home environment?
What sorts of potential misunderstandings could a less-formal environment give rise to? How will you manage a critical event if there is no one present that you can call on for help? Do you have a crisis management plan that is feasible for your environment?
Infection Prevention and Control (IPC)
No matter which practice setting you are working out of, IPC matters. You are required to maintain a work environment that meets the standards, legislative requirements, IPC best practices and manufacturer recommendations.
Other Important Questions:
The College of Physiotherapists of Alberta cannot provide legal, insurance or accounting advice. Our recommendations to registrants considering starting a business are:
- While your malpractice insurance covers your personal professional liability, it’s important to talk to an insurance advisor about other insurance instruments that you may need.
- Seek the advice of a lawyer regarding how to structure your business. For example, do you need to incorporate of should you form a sole proprietorship? These are questions for your lawyer.
- Do you need a GST number? How should you best manage your bookkeeping? Speak to an accountant about this early on, to avoid a tax headache later.
Each setting has its own unique challenges, but we can go back to one of the initial phrases at the start of all of this.
No matter where you practice, or what type of practice you engage in, as a regulated member the Standards of Practice apply to your practice at all times.
Regardless of whether you are contemplating a change or are in the midst of planning a move to self-employment; whether you plan to see one patient in the next month, or one hundred; whether this is your primary employment or not, the bottom line is that business is business and should only be entered into after careful consideration of the legal, financial and professional implications and requirements of doing so.
- Physiotherapy Alberta – College + Association. Code of Ethics. (n.d.) Available at: https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/code_of_ethics. Accessed on November 16, 2015.
- Physiotherapy Alberta – College + Association. Practice Standard: Legislative Compliance. 2012. Available at: http://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/legislative_compliance. Accessed on November 16, 2015.
- Province of Alberta. Health Professions Act. 2015. Available at: http://www.qp.alberta.ca/documents/Acts/h07.pdf. Accessed on November 16, 2015.
- Physiotherapy Alberta – College + Association. Practice Standard: Record Keeping and Management. 2012. Available at: https://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/record_keeping_and_management. Accessed on November 16, 2015.
- Physiotherapy Alberta – College + Association. Practice Standard: Safety. 2012. Available at: http://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/standards_of_practice/safety. Accessed on November 16, 2015.
