Certification Can't Change Your Scope of Practice
by Dr. Brent Brookbush DPT, PT, MS, CPT, HMS, IMT
"Scope" of this Article:
- This article is intended for movement professionals in the United States and Canada. Movement professionals include (but are not limited to) personal trainers, group fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, osteopaths, and acupuncturists.
Quick Summary:
A Technique is Likely Within Your Scope If:
- There is no legislation restricting your use of the technique
- Your liability insurance will cover injury during the responsible use of the technique
- The technique is reasonably similar to other techniques widely accepted as part of your scope
- You can develop competency in the technique (no legislation that would obstruct learning or practicing the technique)
- You document and can demonstrate that the technique improves patient or client outcomes based on reliable objective measures.
A Certification Cannot Change Your Scope of Practice:
- In the United States and Canada, certification cannot change the scope of practice of a movement professional. Scope of practice is dictated by the laws in your state or region; and generally, increasing your scope of practice requires the passing of a board exam to acquire a professional license. Most often, sitting for a board exam to attain a license requires graduating from an accredited institution.
If you want to become a manual therapist, certifications are not enough.
- If you want to be a manual therapist you need to research programs in your area, start working on meeting enrollment criteria, and prepare to go back to school. Generally speaking, scope and employment opportunities increase with the amount of schooling required to sit for the board exam and attain a professional license. The following professions include manual therapy in their scope of practice and are listed in order of the amount of schooling necessary to sit for the licensure exam:
- Massage Therapy: Trade School
- Occupational Therapy: Bachelor's and Master's Degree
- Athletic Training: Bachelor's and Master's Degree
- Doctor of Chiropractic Medicine: Associate's Degree and Clinical Doctorate
- Doctor of Physical Therapy: Bachelor's Degree and Clinical Doctorate
Can the Brookbush Institute's Integrated Manual Therapist (IMT) Certification Change Your Scope of Practice?
- By this point, you likely already know the answer. The IMT certification cannot increase the scope of practice of a professional. It was not developed with the intent to circumvent licensure. In fact, to print the IMT certificate or attend the live IMT workshop you have to provide proof of licensure. The IMT certification was intended to be an advanced credential for manual therapists. The intention of the IMT certification was to be the first manual therapy certification built from a comprehensively evidence-based, systematic, integrated, patient-centered, and outcome-driven approach. Further, we wanted to develop a manual therapy certification that included all of our innovations in the delivery of education. For more on our innovations and the intent of the certification, you may enjoy the following article.
- The "Real Cost" of Manual Therapy Certifications
Scope, Certification, and Licensure
Important Definitions:
- Certification: A certified statement; that is, an official document attesting to a level of achievement. In the movement professions, this is generally associated with the completion of a set of continuing education materials.
- License: Permission to act; permission granted by a competent authority to engage in a business or occupation or in an otherwise unlawful activity (Merriam-Webster ). In the movement professions, this is generally associated with access to the scope of practice associated with a profession, and permission to advertise, act and perform the duties of that profession.
- Scope: "Scope of practice refers to those activities that a person licensed to practice as a health professional (movement professional) is permitted to perform, which is increasingly determined by statutes enacted by state legislatures and by rules adopted by the appropriate licensing entity." (AMA )
- Practice: to be professionally engaged in (Merriam-Webster ). In the movement professions, your practice is the activities you engage in while representing yourself as a professional.
Is This Technique Within My Scope of Practice?
We frequently receive questions about whether certain techniques are within the scope of practice of the various movement professions. These questions range from personal trainers asking if they can manually stretch a client, to massage therapists asking about instrument-assisted soft tissue mobilization (IASTM), athletic trainers asking about pelvic floor therapy, to physical therapists asking about dry needling or blood flow restriction (BFR). Many of these questions are in legal "grey areas", with no specific reference to the situation published in regulations, legislation, or relevant court cases. This implies these techniques are likely permissible if done responsibly (indicated by assessment, performed using published protocols and guidelines, and documentation includes outcomes based on objective measures). The lack of regulation and legislation is likely ideal for practitioners, as lawyers and judges being involved in treatment decisions is not often positive. Although we do not recommend that any professional tests the boundaries of their scope, the law generally does not seek to restrict a professional's practice. It is likely "safe" to perform a technique if you cannot find specific legislation prohibiting the technique, your liability insurance will cover an injury that occurs during the responsible use of the technique, and the technique is similar to techniques already accepted as part of your scope of practice. Additionally, you should be able to develop competency in the technique, the technique should improve patient outcomes, and those outcomes should be documented. Here is an example of New York State legislation that defines "unprofessional conduct", and alludes to the above:
A technique is likely within your scope if:
- There is no legislation restricting your use of the technique
- Your liability insurance will cover injury during the responsible use of the technique
- The technique is reasonably similar to other techniques widely accepted as part of your scope
- You can develop competency in the technique (no legislation that would obstruct learning or practicing the technique)
- You document and can demonstrate that the technique improves patient or client outcomes based on reliable objective measures.
Sample Legislation - NYSED.gov § 29.1 General provisions (b.9) - Part 29, Unprofessional Conduct: practicing or offering to practice beyond the scope permitted by law, or accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform, or performing without adequate supervision professional services which the licensee is authorized to perform only under the supervision of a licensed professional, except in an emergency situation where a person's life or health is in danger.
- Myth #1: A movement professional's scope of practice is tightly controlled and regulated by legislation.
- Reality: Scope of practice is generally loosely defined by a "scope of practice document" from a representative organization (e.g. the AOTA, AMA, NATA, etc.), a few random laws and precedents set by court cases, and what is covered by your liability insurance provider. Most professionals that are practicing responsibly have little, is any reason to be concerned, even when integrating "new" techniques.
Misconceptions About Increasing Your Scope of Practice
Questions about increasing an individual's scope of practice are less grey, and have the potential to have serious repercussions. Many of these types of questions involve an individual attempting to cross into another scope of practice with a certification or an online course. It is important that all professionals have some empathy for the individuals asking these questions, as it can be very challenging to get a clear answer from online resources (and some education companies prey on misconceptions to sell more products). The majority of the confusion can be linked to the difference between the terms "licensure" (which dictates scope), and "certification" (which is a designation awarded for continuing education). But, before we get into details, the following point should be clearly stated: In the United States and Canada, certification cannot change the scope of practice of a movement professional. Scope of practice is dictated by the laws in your state or region; and generally, increasing your scope of practice requires the passing of a board exam to acquire a professional license. Most often, sitting for a board exam to attain a license requires graduating from an accredited institution.
Sample Legislation - NYSED.gov Office of the Professions: Practice Alert - Section 6732 of the Education Law limits the practice of physical therapy and use of the physical therapist title as follows: Only a person licensed or otherwise authorized under this article shall practice physical therapy or use the title "physical therapist", "physiotherapist" or "mechanotherapist" or the abbreviation of "P.T." in connection with his or her name or with any trade name in the conduct of his profession.
- Myth #2: With enough certifications, my scope will include diagnosis and treatment of pain and injury, and/or the use of manual techniques.
- Reality: Licensure dictates scope of practice, certifications do not.
Examples of Certification and Licensure:
To practice as a physical therapist in the United States you must pass a board exam - the National Physical Therapy Exam (NPTE). You can only sit for the NPTE after completing a doctorate of physical therapy (DPT) program accredited by the Federal State Board of Physical Therapy (FSBPT). To enter a DPT program, you must acquire a bachelor's degree from an accredited college or university, including about a dozen mandated "science prerequisites". Further, various programs have additional entry criteria related to grades, test scores (GRE), volunteer hours, etc. Passing the NPTE is the minimum standard required to be permitted by law to advertise, act, and perform the duties within a physical therapist's scope of practice. Completion requires many years of study. The scope of practice is at least partly dictated by state law. There is no such thing as a physical therapy certification. Any certification offered to physical therapists (for example, the Brookbush Institute's - Integrated Manual Therapist (IMT) certification ) is continuing education, and is offered to enhance skills and abilities, acquire advanced knowledge, enhance employment and career opportunities, and aid in fulfilling the necessary continuing education requirements for license renewal. Certifications are quite common in the movement professions, and many of them are wonderful programs. Our certification is roughly 80 hours of additional education and is the only program teaching an evidence-based, systematic, integrated, patient-centered, outcome-driven approach. It is not intended to match the breadth or scope of a doctorate program. The certification does not change what a physical therapist is permitted to do; however, it may show the physical therapist techniques they previously did not know how to do. While licensure gives permission, certification aids in life-long learning. Licensure and certification serve two different purposes.
Sample Legislation: CALIFORNIA LAWS AND REGULATIONS RELATED TO THE PRACTICE OF PHYSICAL THERAPY - (a) The physical therapist education requirements are as follows: (1) Except as otherwise provided in this chapter, each applicant for a license as a physical therapist shall be a graduate of a professional degree program of an accredited postsecondary institution or institutions approved by the board and shall have completed a professional education program including academic course work and clinical internship in physical therapy.
- Myth Busting #3: I have to get certified in a technique before I can perform a technique.
- Reality: If the technique is within your scope of practice you can perform the technique with or without the certification. If the technique was not within your scope the certification will not change your scope of practice. This does not imply that certifications are a waste of money. It may be advisable that certification is acquired to aid in developing competence.
The Weird World of Personal Training
Some of you reading this article may be asking whether a Certified Personal Trainer (CPT) Certification changes your scope of practice. You may be thinking to yourself, "Don't I need a CPT to work as a personal trainer?". The answer to this question is both yes and no. Technically, there is nothing preventing somebody from advertising, acting, and performing the duties associated with personal training. In the majority of states and regions in the USA and Canada, there is no legislation to specifically state that a "personal trainer" must be certified (or licensed). Unfortunately, this loophole has seemingly been exploited by every idiot on social media with a nice body, trying to sell supplements, coaching programs, etc. However, outside of this niche trend, the fitness industry has faired pretty well with "self-regulation". The two forces ensuring that certification is a quasi-minimum standard, are employment opportunities and liability insurance.
Starting Your Career as a Personal Trainer:
Before we discuss why employment opportunities successfully regulate the profession, we have to discuss how personal trainers should start their careers. Although it is possible to start your career as an independent personal trainer (solopreneur), anyone who has tried this can attest to how ridiculously hard it is, and how incredibly likely you are to fail. I am not trying to be negative, I just hate to see great professionals get burned by bad initial decisions. Think of it like this, starting a career this way is the equivalent of trying to learn how to be a personal trainer, write and coach programs, manage sessions times, learn how to work by appointment, etc... while trying to figure out how to acquire leads, perform orientations, sell services, manage payments, book and confirm appointments, maintain client records, re-sell to current clients, etc. In essence, you are trying to learn the profession, and learn how to build a business in that profession, at the same time. It is my humble recommendation following 25 years in the fitness industry, that every personal trainer shoulder start their career in a "big box" gym chain. Learn the profession with a company that has built systems that have consistently resulted in a profitable and sustainable personal training business/department. You may not love working for someone else, but learning in this environment will make it far more likely that your future attempts to build your own business will be successful. This is how most successful trainers start in the industry.
Back to Self-regulation and Scope of Practice:
Because the best opportunity to be successful as a personal trainer starts with employment at a gym chain (e.g. Lifetime, Orange Theory, Equinox, 24 Fitness, etc.), these companies become the "defacto-gatekeepers" of the profession. Every one of these chains requires that a personal trainer is certified before employment, or is hired with the expectation that they will attend training and development, and/or complete courses, that will result in certification shortly after being hired. So, although it is legally possible to act as a personal trainer without a CPT certification, the likelihood of success is not good. Without a CPT certification, your options are independent contracting or a few small boutique gyms with questionable quality standards. Alternatively, you certification immediately results in potential interviews with dozens of health clubs and fitness service providers in your area.
- Note, any individual completing the Brookbush Institute CPT Certification (included in membership) , is guaranteed an interview at Lifetime Fitness .
Liability Insurance
Another factor enforcing the quasi-minimum standard of certification for personal trainers is liability insurance. Although it is relatively rare that personal trainers are sued for injuring clients, it does happen. And, unfortunately, it often happens to great trainers for unforeseeable accidents. Liability insurance not only protects the personal trainer, but it may provide financial aid to a client who does not have appropriately robust medical coverage. Liability insurance is serious stuff, and commonly under-promoted. The good news is liability insurance is fairly inexpensive for CERTIFIED personal trainers (less than $200/year). That is to say, most liability insurance options for personal trainers mandate that a personal trainer is currently certified, and/or the most affordable liability coverage will only insure CERTIFIED personal trainers. In fact, often gyms will not hire personal trainers who are not certified, because the company's liability insurance stipulates they will only cover injuries that occur during personal training sessions if the personal trainer is certified.
Note, the Brookbush Institute has partnered with respected liability insurance providers in the USA and Canada to aid in reducing the cost of liability insurance:
- Canada - www.ineedapolicy.com
- United States - insurefitness.com/partners/brookbush
- Myth Busting #4: You must be certified to be a personal trainer.
- Reality: Technically, this a myth; however, practically, without certification it is unlikely you will have the skills necessary to provide high-quality service, and your employment options will be very limited.
Athletic Trainer Certified (ATC) is actually a License
It is a little strange that the athletic training profession named their credential - "Athletic Trainer Certified (ATC)" and not "Licensed Athletic Trainer (LAT)". In the domain of sports medicine, and outpatient orthopedics, ATCs have a scope that is similar to physical therapists or chiropractors, their education is comparable to other licensed professions, and their own guidelines discuss "getting certified to be licensed". In short, although athletic trainers use the term "certification" as part of their credentials, ATCs are licensed professionals. For the sake of clarity, the National Athletic Trainer Association (NATA) should consider renaming the credential, which would also aid in ATCs being differentiated from personal trainers and strength coaches.
From National Athletic Trainers' Association (NATA) - Becoming Certified
To become a certified athletic trainer, a student must graduate with bachelor's or master’s degree from an accredited professional athletic training education program and pass a comprehensive test administered by the Board of Certification (BOC). Once certified, he or she must meet ongoing continuing education requirements in order to remain certified. Athletic trainers must also work in collaboration with a physician and within their state practice act.
Eligibility for the BOC exam is contingent upon completion of a program accredited by the Commission on Accreditation of Athletic Training Education (CAATE) that must instruct the Competencies within the curriculum. Passage of the certifying examination is a requirement for licensure in most states.
- Myth Busting #5: Athletic Trainer Certified (ATC) and Certified Personal Trainer (CPT) are similar credentials, with a similar scope.
- Reality: Not even close to true. While a personal training certification can be acquired with no previous knowledge, becoming a Certified Athletic Trainer requires that an individual complete a Bachelor's Degree, a Masters Degree from an institution accredited to offer an ATC program, and passing of the Board of Certification Exam. (Further, personal trainers are fitness professionals, while ATCs are primarily physical rehabilitation professionals and considered "clinical or medical professionals")
How Do I Become a Manual Therapist?
In many states and regions, manual therapy is prohibited without a professional license that includes manual therapy within the profession's scope of practice. This implies that in most states and regions, certified personal trainers, without an additional license, cannot legally perform manual therapy. There are several professions that include manual therapy within their scope. Generally speaking, scope and employment opportunities increase with the amount of schooling required to sit for the board exam and attain a professional license. The following professions include manual therapy in their scope of practice and are listed in order of the amount of schooling necessary to sit for the licensure exam. In short, if you want to become a manual therapist, certifications are not enough. You need to research programs in your area, start working on meeting enrollment criteria, and prepare to go back to school. We hope this does not discourage professionals who are genuinely interested in physical medicine, rehabilitation, and manual therapy. The truth is, the sacrifice to return to school and finish degrees and licenses is well worth decades of a career that you enjoy. And, most manual therapy professions provide a variety of stable, well paying, employment opportunities. Although you may hear manual therapists complain about their profession, their jobs favor quite well against national average wages, benefits, and even job satisfaction.
- Massage Therapy: Trade School
- Occupational Therapy: Bachelor's and Master's Degree
- Athletic Training: Bachelor's and Master's Degree
- Doctor of Chiropractic Medicine: Associate's Degree and Clinical Doctorate
- Doctor of Physical Therapy: Bachelor's Degree and Clinical Doctorate
Pro Tip: The Brookbush Institute also advidly recommends internships. Internships are not "free labor". They are your chance to invest weeks in determining whether a job is something you would enjoy for a lifetime. Often young students forget that enjoying a topic is only part of the job, the other half is the day-to-day grind. I love the science of surgery, but hate hospitals, and cadaver work even more; chances are surgery would be a very poor career choice for me. Manual therapy professions may be the same for you. Maybe you love human movement science, but hate being in a clinic. Better to find out in a 10 week internship, than 10 years into your career as a physical therapist.
P.S. In most cases internships cost employers more than they gain. The training and development that goes into an individual with limited availability and only short-term intentions, is usually a net negative for a company. This is time and money that could have been spent on a potential employee with long-term intentions. Internships are most often a charitable act by a clinic, or means of building an applicant pool for future employment opportunities. If you find an internship, respect the employer for creating the opportunity. They are not usually farming for free labor, they are most often giving back to the profession.
- Myth Busting #6: There is a certification out there that will permit me to do manual therapy without a license.
- Reality: Only licensure can increase your scope of practice, attaining a license requires that you pass a board exam, and most often sitting for a board exam requires graduation from an accredited institution.
Can the Brookbush Institute's Integrated Manual Therapist (IMT) Certification change my scope of practice?
By this point, you likely already know the answer. The IMT certification cannot increase the scope of practice of a professional. It was not developed with the intent to circumvent licensure. In fact, to print the IMT certificate or attend the live IMT workshop you have to provide proof of licensure. The IMT certication was intended to be an advanced credential for manual therapists.
Certifications are quite common in the movement professions, and many of them are wonderful programs. The IMT certification could be viewed as a product that competes with other popular manual therapy certifications (e.g... IPA, COMT, ART, etc). These certifications are continuing education, with the intent of enhancing skills and abilities, acquire advanced knowledge, enhance employment and career opportunities, and aid in fulfilling the necessary continuing education requirements for license renewal. You can read more about how our certification compares in the article:
The intention of the IMT certification was to be the first manual therapy certification built from a comprehensively evidence-based, systematic, integrated, patient-centered, and outcome driven approach. Further, we wanted to develop a certification that includes all of our innovations in education delivery.
- Myth Busting #7: The IMT certification was designed to circumvent licensure.
- Reality: The IMT certification was designed as continuing education for manual therapists; licensure is required to attain the certification.
For Additional Resources on Certification and Accreditation:
- The Best Personal Training Certification?
- How Much Does a Personal Training Certification Cost (Including Hidden Fees)?
- Building a Better Corrective Exercise Certification
- The "Real Cost" of Manual Therapy Certification
- Certification Cannot Change the Scope of Practice of a Movement Professional
- What is a Fully Accredited Personal Trainer Certification?
- What is NCCA accreditation?
- We Think About Continuing Education Credit Approval (So you don't have to)
- State-by-State Course Approval and Credit Requirements for PTs and PTAs
- Approval and Accreditation of Courses and Certifications Could Be MUCH Better!
Help Us Help You!
We would love for this article to grow into a reference for movement professionals that includes a listing of various laws and statutes. If you want us to add links to laws or practice guidelines you have found, or you have additional questions please leave them in the comments below.
© 2022 Brent Brookbush (B2C Fitness, LLC d.b.a. Brookbush Institute )
Comments, critiques, and questions are welcome!