Good Practice: Ethical Advertising
By: Leanne Loranger, PT, Practice Advisor
There are specific advertising requirements that apply to all Alberta physiotherapists. You can find these in the Advertising and Promotional Activities Standards of Practice3. Unfortunately, a quick survey of Alberta’s physiotherapy advertising world proves that these standards are not often followed.
To clarify, Physiotherapy Alberta believes 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 it is doing so at a loss. We are also not anti-profit, so long as profits are made ethically. That’s where this discussion on advertising comes in.
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 Standards of Practice2 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 commonly encountered advertising issues include: promotion of unnecessary services,3 pricing issues,3,4 free services,3 and giving away prizes.3
1. Promotion of unnecessary services
Promotion of unnecessary services includes such things as package deals. While clinical experience may tell you that a patient with a specific diagnosis will typically require a certain number of treatments to improve, selling a package for that number of visits does not allow individualized treatment, nor does it reflect client-centered service. What about the patient who improves faster than average? What if they have an adverse event and don’t return? Selling a package deal ensures the business’ income at the expense of the client’s interests, thereby breaching the physiotherapist’s fiduciary duty to put the client’s interests first.
Other inappropriate ways that unnecessary services are promoted include 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 following requirements apply:
- The physiotherapist must have a fee schedule.4
- The fee schedule must be posted in a visible place for all patients and available for review before the patient starts treatment4 so they know all of the fees that may apply to their care.
- It is the responsibility of each physiotherapist to ensure there is a fee schedule in place, and that their patients are informed of the fee schedule. In a group practice environment, the practice may have a fee schedule that applies to all physiotherapists.
- If a clinic chooses to offer a discount (for example a senior or student discount) it is documented on the fee schedule so that all patients are aware of the discounts that the clinic offers.3
- If the clinic chooses to offer a discount, it is available for all that meet the criteria (if you offer a senior’s discount, all seniors get the discount, not just favorite clients or ones who ask about it, and not just when business is good).3
Time-limited pricing is prohibited because it is a deviation from the 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
Marketing through the use of free consultation is only to be used for the purpose of informing the public about physiotherapy services offered and rendering an opinion about the propriety of physiotherapy services to that patient.3 No paid services can occur on the same day as a free consultation. It is misleading to offer free initial appointments. 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 do you expect to provide an opinion to a potential patient 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.5 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!
Prizes and gifts are also expressly prohibited, because they serve as an inducement for unnecessary services.3 “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 Ethics1 comes in.
In addition to the Standards of Practice, the Code of Ethics 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 on Professionalism and Trustworthiness. In it, physiotherapists are called upon to:
- “Conduct themselves so as to maintain public confidence in the integrity and dignity of the profession.”1
- Be “honest and truthful, so clients and the public have confidence in them as professionals and in the services they provide.”1
- “Conduct themselves in such a manner as to reflect the highest standard of professional integrity and responsibility.”1
The next time you’re looking at an advertisement for your physiotherapy services, ask yourself if you can honestly say to your peers that you’ve met these requirements.
If not, you’re not engaging in Good Practice.
- Physiotherapy Alberta – College + Association. Code of Ethics. (n.d.). Available at: http://www.physiotherapyalberta.ca/files/code_of_ethics.pdf. Accessed on July 15, 2015.
- Physiotherapy Alberta – College + Association. Standards of Practice for Alberta Physiotherapists. 2012. Available at: http://www.physiotherapyalberta.ca/files/practice_standards_all_2012_revised.pdf. Accessed on July 15, 2015.
- Physiotherapy Alberta – College + Association. Practice Standard: Advertising and promotional activities. 2012. Available at: http://www.physiotherapyalberta.ca/files/practice_standard_advertising.pdf. Accessed on July 15, 2015.
- Physiotherapy Alberta – College + Association. Practice Standard: Fees and billing. 2012. Available at: http://www.physiotherapyalberta.ca/files/practice_standard_fees_and_billing.pdf. Accessed on July 15, 2015.
- Government of Canada, Competition Bureau. False or misleading representations and deceptive marketing practices under the Competition Act. 2011. Available at: http://www.competitionbureau.gc.ca/eic/site/cb-bc.nsf/eng/03133.html. Accessed on July 15, 2015.