The College’s Practice Advice Team sometimes gets calls from physiotherapists who have been offered jobs that sound too good to be true.  

The offer might look like this – $300 to assess a patient virtually and then assign all further care to a personal trainer who would be working as a physiotherapist assistant (PTA).  

Subsequent sessions with the personal trainer would then be billed to insurers as physiotherapy using the physiotherapist’s name and registration number.  

In some cases, the physiotherapist might be expected to work with multiple personal trainers at various gyms. 

Arrangements like this make it very difficult for physiotherapists to meet their professional obligations. Let’s talk through why.  

The Standards 

As a physiotherapist, when you practice virtually – for example, conduct a virtual assessment or supervise a PTA remotely – you are still responsible for meeting the same standards as if you were seeing a patient in-person at a clinic or hospital.  

Virtual practice will not be right for every patient and it’s up to the physiotherapist to determine the best method of service delivery, taking the patient’s unique needs into consideration.  

As outlined in the Working with Physiotherapist Assistants Standard, a physiotherapist who assigns care to a PTA remains responsible for that care.  

The physiotherapist must determine the right level of supervision using their clinical reasoning skills and assess the PTA’s knowledge, skill and judgement to make sure they can deliver the assigned care safely and competently.

Independently-employed physiotherapists should keep a record of how they determined that a PTA is competent, in case they ever need to demonstrate this to the College. 

The physiotherapist must have a written communication protocol for how they will discuss patient care with the PTA. Communication should be ongoing.  

Additionally, a physiotherapist can only assign care they themselves are qualified to deliver.  

For example, a personal trainer might have a specialization in hypertrophy (increasing the size of muscles). But, if the physiotherapist does not have the same qualification, they can’t assign hypertrophy training for the PTA to deliver to a patient.  

All requirements of the Infection Control and Equipment Maintenance Standard must also be met – something that could be very difficult if you’re working remotely across multiple sites.  

As a reminder, physiotherapists must have a written process for routinely reviewing the maintenance and safety of the equipment they use and be able to demonstrate that they did the review. 

Finally, it’s important to understand that personal training is not physiotherapy. By definition, physiotherapy should include a discharge plan, as outlined in the Assessment, Diagnosis, Treatment Standard. Unlike in personal training, where fitness goals change over time, physiotherapy care focuses on the treatment of a patient’s specific condition or problem based on a physiotherapy diagnosis.  

Risk for PTs and Patients  

Cases where frequent sessions with a personal trainer are billed as physiotherapy are often flagged by insurers as excessive treatment. When this happens, the insurer may delist the physiotherapist (stop covering any care provided by them) and cut off a patient’s extended health benefits.  

Failing to meet the standards, particularly if a patient is injured as a result, can also have serious professional consequences. This could potentially include the suspension of your certificate of registration or notice posted to the Public Register.  

Before accepting a new position, ask questions to make sure the employer will allow you to meet your professional obligations and if you have any concerns, call the College’s Practice Advice Team. They’ll be happy to talk it through with you.