The Case  

The College became aware of a physiotherapist who was providing services outside the physiotherapy scope of practice, including giving diet advice and billing for supplements, and launched an investigation.  
 
A review of patient files indicated the PT was telling patients that taking probiotics could help with weight loss, inflammation and gut health. The physiotherapist also sold probiotic capsules to the patient and included their name and registration number on the invoices.  
 
Additionally, the PT provided patients with handouts recommending the use of the Calcarea Carbonica (weight loss supplement), Genacol (anti-inflammation supplement) and provided dietary advice on sugary or starchy foods and gluten.  
 
The investigator noted the PT’s practice location was not listed on the Public Register. The physiotherapist updated the practice location after being informed of the investigation, but it appeared they had already been working at the clinic for approximately six years.  
 
The physiotherapist maintained they had difficulty navigating the PT Portal and had tried unsuccessfully to change their practice location. However, they never followed up with the College to update the information. They also said they had taken courses on nutrition and supplements and noted they billed for supplements separately from physiotherapy services, putting each on separate invoices. The PT believed the services they provided were within the scope of practice for physiotherapists.  

The Standards 

The Physiotherapy Act defines the practice of physiotherapy as the assessment of neuromuscular, musculoskeletal and cardiorespiratory systems, the diagnosis of diseases or disorders associated with physical dysfunction, injury or pain and the treatment, rehabilitation and prevention or relief of physical dysfunction, injury or pain to develop, maintain, rehabilitate or augment function and promote mobility. 
 
Physiotherapists are advised to avoid providing recommendations about medications (including supplements) because of a lack of pharmaceutical knowledge, the risk of adverse events including side effects of the medication interacting with other medications, and the significance that such recommendations carry for patients.  

Physiotherapists should direct patients to seek advice from a pharmacist, physician, or another health professional authorized to prescribe medications.  

Physiotherapists can’t advise patients on specific diets. Physiotherapists don’t have the training or skills to diagnose deficiencies in things like minerals, vitamins, hormone levels, cholesterol levels or anything that would require blood analysis.  
 
Patients should be able to trust regulated health professionals. For that reason, patients are likely to believe a healthcare provider’s advice – regardless of whether they’re qualified to give it.  
 
The Fees, Billing and Accounts Standard requires physiotherapists ensure any fee, billing or account that uses their name and registration number is an accurate reflection of the services and/or products provided. Physiotherapists must never charge fees or create billings that are inaccurate, false or misleading. In this case, the physiotherapist was billing for products that are outside the scope of physiotherapy while including their PT registration number on the invoices. Doing so falsely creates the impression the services were part of physiotherapy treatment.   

Additionally, physiotherapists are required to inform the College of any changes to their employment information within 30 days. While the PT updated their practice location after they were informed of the investigation, they should have done so earlier. If the physiotherapist had difficulty navigating the PT Portal, they should have contacted the College to troubleshoot the issue.  

The Outcome  

The physiotherapist received a caution and was required to complete a Specified Continuing Education or Remediation Program (SCERP) focused on scope of practice, fees and billing and regulatory obligations. The costs of the SCERP are paid by the PT. Notice of the SCERP and caution will appear on the Public Register.

Fees, Billing and Accounts Standard

Physiotherapy Scope of Practice