Historically, the scope of practice of physiotherapy and other health professions in Australia was clearly defined and documented.

A list of techniques and approaches established exactly what a physiotherapist could provide and, in some cases, prevented other health professionals from dipping into our professional ‘box of tricks’.

However, while there were perceived advantages to this approach, it hindered professional development and growth in line with advances in research and patient care.

Today there is no prescribed list detailing the scope of practice of a physiotherapist.

The recently updated Code of Conduct that covers the Physiotherapy Board of Australia, along with 11 other National Boards, describes practice broadly as ‘any role, whether remunerated or not, in which the individual uses their skills and knowledge as a practitioner in their regulated health profession.

For the purposes of this code, practice is not restricted to the provision of direct clinical care.

It also includes using professional knowledge in a direct non-clinical relationship with patients, working in management, administration, education, research, advisory, regulatory or policy development roles and any other roles that have an impact on safe, effective delivery of health services in the health profession’ (click here for details).

This definition refers to ‘the individual’ and not the professional collective.

It’s a deliberate and important distinction—scope of practice for each physiotherapist is different.

Given the diverse nature of the work we do, it is imperative that all physiotherapists take personal stock to ensure that they are practising within their own personal and demonstrable scope of practice.

What falls under scope for a musculoskeletal physiotherapist working in private practice is quite different from the scope of a physiotherapist working in an intensive care unit.

All new graduates begin practice under the same scope umbrella.

Described as the ‘threshold’ level, their scope is entry-level physiotherapy.

However, this expands quickly in many directions as practitioners build up their knowledge and skills.

It’s worth noting that some of the skills and knowledge we had on graduation will be lost over time—while our scope may expand in some areas, it will also diminish in others.

Scope of practice is and should always be dynamic.

The past two decades have seen the growth of positions within the public health system requiring physiotherapists to work in ‘advanced scope’ roles.

These roles are created with clear job descriptions and applicants are required to formally satisfy specified selection criteria and often to undergo additional credentialing to demonstrate that they can undertake the required tasks.

This bureaucratic process, while at times cumbersome, does provide a clear description of the role and thus the scope of the job.

It also offers some objective evidence that the relevant physiotherapist is competent and working within their individual scope.

Physiotherapists working in the private sector may not have such formal processes in place.

The Australian Commission on Safety and Quality in Health Care encourages all health services (public and private) to define scope for their individual setting and to develop credentialing processes wherever ‘health practitioners are employed or provide unsupervised clinical care in an organisation under any contractual, honorary or formal relationship’ (tinyurl.com/TU480WQ).

This is relevant to all physiotherapy settings.

The APA has developed a scope of practice tool that includes a brief explanation and a self-test for members to take if they are unsure about whether they are practising within scope or not.

All members are encouraged to access this resource and, where necessary, complete the self-test to satisfy themselves that they are working within scope of practice.

As physiotherapists begin to move into specific areas of practice, either formally or informally, it is important to continually assess and reflect on levels of competence along the way.

If at any stage you find yourself operating out of your scope of practice, you may inadvertently place patients at risk and be in breach of both the APA’s and the National Boards’ Codes of Conduct.

Should an adverse event occur, you may not be covered by the APA’s professional indemnity insurance.

The importance of working within scope cannot be overemphasised and it goes hand in hand with our obligation to meet Ahpra’s continuing professional development requirements.

While employers can do a lot to assist their employees, ultimately it is you as an individual who needs to take responsibility to ensure that you are not placing yourself or your patients at risk.

A final point worth considering is the idea that other health professionals are ‘stepping on our toes’ by performing tasks that we have considered to be exclusively ours.

We can’t have our cake and eat it too.

If we are comfortable expanding our scope of practice into areas previously the domain of other health professionals, then we must also accept their expansion into our perceived domain.

However, if an adverse event occurs, the onus is on that health professional to demonstrate to Ahpra or their professional body that they have the skills and knowledge to have been practising in the way that they did.

No one can add ice like a physio. Just make sure you are competent to do so.

How can you assess your individual scope of practice? Click here to find out more and to take the self-test.

>> Ian Cooper APAM, Alison Smith APAM MACP, Tom Hindhaugh APAM and Khanh Tran APAM are members of the APA’s National Professional Standards Panel.