Scope of practice has been coming up a lot lately as massage therapists consider telehealth and other practice adaptations, so it’s important to understand what scope is and why it matters. Working within our scope is not only key to professional practice, it’s essential to the health of the profession as we continue to work toward recognition as health-care providers.
Scope lives at a strange intersection of competency, law, and ethics. At a most basic level, scope defines the services that a professional is deemed competent to perform and permitted to provide. This leaves a lot of room for interpretation. There are many things we may be sanctioned to provide, but it’s up to us to decide whether we, as providers under this umbrella of scope, are competent to do so.
Scope isn’t about punitive action. Scope is like a guardrail to help us uphold a high standard of professionalism and competency. The only real ways a regulator will even know you’ve violated scope provisions is if a client (or competitor) files a complaint against you or if you practice in a jurisdiction where regulators pose as clients, and you work outside your scope with one of these regulators.
Our Scope Is Broad, But It Has Borders
Working within our scope requires thoughtfulness. We need to continually assess our competency with open eyes. On a basic level, this comes down to bias, which can be and is largely unconscious. Without noticing, we can assume we are competent to treat conditions about which we’ve read extensively, about which we feel passionately, or with which our spouse or neighbor lives on a daily basis. This leads us outside our scope every day.
Staying within our scope requires us to know where the line is. In a recent informal poll of massage therapists, I discovered that many don’t know if they are what’s called “mandated reporters.” Being a mandated reporter can mean different things, but at a basic level it means you are required by law to report it if you have reason to believe a client is involved (as a victim or as a perpetrator) in child (or elder) abuse or neglect. (You can learn more at https://apps.rainn.org/policy/compare/children.cfm.) One question that came up multiple times was, “Isn’t this outside my scope?”
No. It’s not. Attempting to provide counseling or advice is definitely outside your scope, but listening and then sharing with appropriate agencies is not. This goes for lots of things. If a client goes into great detail about their recent divorce, about their new diet, or how they struggle to handle their teenager’s mood swings, you’re well inside your scope . . . until you decide you have something to say. You can even ask about these things if they are concerns your client previously expressed. Listening is never outside your scope. Solving and advising often are.
Why Is It So Hard to Understand?
Our professional associations (and National Certification Board) have their own scope documents. Each (rightfully) recommends that you adhere to the requirements of your state regulatory agency, but at the end of the day, scope is about competency. I have taught oncology massage for years. It’s the very rare student who can leave a three-day oncology massage course with the necessary competency to safely meet the needs of a client with advanced cancer. When your client needs something you’re not competent to provide, even if that thing falls within the broad scope of your discipline and you provide treatment anyway, you are providing treatment outside your scope.
We are experts at chasing specialty training and information to treat populations that are beyond our skills and capabilities. In our pursuit, we miss the value that lies in going deep instead of wide. Our habits of making it about scarcity and “diversifying revenue” compromise our professionalism and scope.
The limits of our scope, however, are an opportunity for interdisciplinary collaboration. A broad and informed understanding of what other disciplines have to offer can meaningfully widen the scope of support you can provide for your clients. Intelligent, thoughtful, well-vetted referrals are always within your scope, whether they be to another bodyworker, to a psychotherapist, or a pelvic floor specialist. Informed referrals strengthen your professional integrity.
Communication is critical. Preparation, education, and honesty are essential. Know when you don’t know. Remember the richness of what’s clearly inside the lines and remember that you’re not alone.
Cal Cates is an educator, writer, and speaker on topics ranging from massage therapy in the hospital setting to end-of-life care and massage therapy policy and regulation. A founding director of the Society for Oncology Massage from 2007–2014 and current executive director and founder of Healwell, Cates works within and beyond the massage therapy community to elevate the level of practice and integration of massage overall and in health care specifically. Cates also is the co-creator of the podcast Massage Therapy Without Borders.