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What Is Scope Of Practice?

The concept of scope of practice is an important part of the current health legislation in Ontario,
the Regulated Health Professions Act, 1991 (the “RHPA”). The Health Professions Regulatory Advisory Council (HPRAC) is an “arms length” agency of the Ontario Ministry of Health and Long-Term Care.


September 29, 2009
By Corinne Flitton

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The concept of scope of practice is an important part of the current health legislation in Ontario,
the Regulated Health Professions Act, 1991 (the “RHPA”). The Health Professions Regulatory Advisory Council (HPRAC) is an “arms length” agency of the Ontario Ministry of Health and Long-Term Care. The Council is responsible for giving the Ministry advice. HPRAC has a very informative website (www.hprac.org) that states in detail the details about scope of practice.

“The Regulated Health Professions Act (RHPA) introduced a new way to regulate health professionals through the mechanism of “scope of practice.” The scope of practice mechanism is comprised of the following elements: 1. Scope of Practice Statement; 2. Controlled/Authorized Acts; 3. Harm Clause; 4. Title Protection.

scope1.jpg1. Scope of Practice Statement: a brief description which generally provides three types of information about a given profession: what the profession does; the methods it uses; and the purpose for which it does it.

2. Controlled/Authorized Acts:
under the RHPA, there are 13 controlled acts which only members of a regulated health profession may perform under the authority of their respective profession-specific Acts.

These controlled acts are potentially hazardous health care activities, which ought to be performed only by health professionals who are properly trained and accountable for their performance.

Not all controlled acts are assigned to each profession. For example, some regulated health professions do not have authority to do any controlled acts, while others, such as medicine, have authority to do many of the 13 controlled acts. “Controlled acts” include such things as communicating a diagnosis, giving injections, prescribing hearing aids, delivering babies and using electricity or certain forms of “energy” to treat a patient/client or diagnose a condition.

3. Harm Clause: aims to protect individuals from unqualified practitioners or non-regulated individuals who cause serious harm without actually performing any of the controlled acts.

4. Title Protection:
ensures that professional titles are protected from unauthorized use by individuals who are not members of a regulated health profession.

Each profession therefore has a unique scope of practice which regulates its members’ conduct in the delivery of health care services. The scope of practice mechanism seeks to provide protection from harm in the provision of health care activities where needed.

scope2.jpgIn Ontario, the Scope of Practice statement of Massage Therapists as defined by the Massage Therapy Act, 1991 is:

‘The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissues and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain.’

If a profession has no controlled acts, like massage therapy in Ontario, all of its services are in what as known as the “public domain”, meaning that another regulated health professional, un-regulated professional or non-professional could also provide massage therapy services. Unfortunately, the public often assumes that it will receive the same safe and ethical care from the other providers as it will from massage therapists.

This is not the case. It is important therefore that massage therapists explain scope of practice to their clients to avoid confusion and erosion of trust.

To further clarify the scope of practice statement and to provide guidance to massage therapists and the public, the College adopted two policies: 1) The “Policy on Modalities Considered Outside Scope” where massage
therapists cannot provide any of the modalities on this list; and 2) the “Policy on Complementary Modalities,” where certain modalities combined and regulated by the ethics and standards of the practice of massage therapy, with proof of competency, can be performed. An example of a complementary modality is described in the College’s policy on Acupuncture. It indicates that the College believes that acupuncture constitutes a “manipulation” within the meaning of the Massage Therapy Act, 1991 and therefore massage therapists who have obtained certain specified training may provide acupuncture within the scope of practice of the massage therapy profession.

If using a complementary modality, massage therapists must recognize that they are accountable to ensure that
the modality is integrated into a treatment plan that largely consists of modalities that are within the scope of practice.

The Scope of Practice Statement provides important information to the public to assist them in choosing the appropriate health care provider for their needs.

As a result massage therapists need to fully understand the scope of practice of their profession, practice according to College policy and assist the public in understanding what scope of practice means so that they can make informed choices about who to receive massage therapy as well as other health services from.

Massage Therapists must also be fully aware of and takes steps to educate the public about the other elements of the scope of practice mechanism; the Controlled Acts Scheme, the Harm Clause and the Protected Titles of each profession regulated by the RHPA. 


For more about the Regulated Health Professions Act, 1991 and how it protects the public of Ontario, contact the College of Massage Therapists of Ontario at: 810-1867 Yonge St., Toronto, ON M4S 1Y5, (800) 465-1933, (416) 489-2626, cmto@cmto.com, www.cmto.com


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