Introduction
The topics of freedom of expression and off-duty conduct within the regulated health professions have received increased attention in recent months. There are several reasons for this attention:
- Amendments to the Alberta Bill of Rights, effective December 5, 2024, enshrined freedom of speech and expression, expanding on the pre-existing freedom of speech provisions.
- The COVID-19 Pandemic Response Task Force Report (January 2025) and the Manning Report (2023) comments related to the freedom of expression rights of regulated health professionals.
- Societal interest in, and discussion of freedom of expression which has emerged during and following the COVID-19 pandemic.
Given these discussions, you may have questions about performance expectations that relate to your use of social media, the College’s role in regulating social media communication, and the boundaries of the College’s authority.
Key Messages
- The College regulates your conduct when you are engaged in the practice of physiotherapy.
- The performance expectations in the Standards of Practice and Code of Ethical Conduct apply to your social media use, communication and expression, and off-duty conduct when you are using your professional title, or when another person can identify you as a physiotherapist.
- If you do not identify yourself as a physiotherapist by using your professional title or by referring to your professional status, the College’s view is that you are acting as a private citizen.
- Conduct or remarks that constitute sexual abuse or sexual misconduct are an exception. These performance expectations are in effect 24 hours a day, 7 days a week, for 365 days from the last date of physiotherapy service to the patient.
Which Performance Expectations Do We Mean?
The Standards of Practice and Code of Ethical conduct include performance expectations that apply to physiotherapists’ social medica activities, including that the physiotherapist:
- Act in a respectful manner... (Code of Ethical Conduct)
- Practice the profession of physiotherapy according to their own competence and limitations... (Code of Ethical Conduct)
- Communicate openly, honestly and respectfully with clients at all times. (Code of Ethical Conduct)
- Does not engage in communication that is disrespectful, dishonest, misleading, or lacking in transparency. (Communication Standard of Practice)
- When using social media platforms, communicates with clients, potential clients, members of the public, and others honestly, transparently, and professionally:
- Conveys scientifically sound, evidence-based information. (Communication Standard of Practice)
- Clearly communicates with clients and others when the services proposed are emerging or complementary therapies. (Evidence-Informed Practice Standard of Practice)
- Shares information related to evidence and best practices and does not promote information, treatment options, or products that are not grounded in scientific, peer reviewed, and physiologically plausible evidence. (Evidence-Informed Practice Standard of Practice).
The College’s Role
The College of Physiotherapists of Alberta’s role is to regulate physiotherapy practice.
The College establishes and enforces the Code of Ethical Conduct and Standards of Practice. The documents address topics including professionalism, communication, evidence-informed practice, and sexual abuse and sexual misconduct, which all can be relevant to your use of social media, freedom of expression, and actions while at work or identified as a physiotherapist.
The College’s role is to regulate physiotherapists when they are engaged in the practice of physiotherapy.
The College does not regulate the activities of physiotherapists when they are acting as private citizens, nor does it wish to have a role regulating the activities of physiotherapists when they are acting as private citizens.
Where is the Boundary Between Physiotherapist and Private Citizen?
This is an important distinction, especially when it comes to social media use which can blur the line between when you are engaged in the practice of the profession and when you are not.
How do you know if you are acting as a physiotherapist or as a private citizen?
The College’s perspective is that if you are communicating with others and do not identify yourself as a physiotherapist by using your professional title or by referring or alluding to your professional status, you are acting as a private citizen. This includes both online and in-person interactions.
In contrast, when you identify yourself as a physiotherapist, the College has a role in regulating your conduct and communication. If your conduct or communication effects your professional responsibilities and ability to fulfill the expectations established in the Code of Ethical Conduct and Standards of Practice, the College will enforce those expectations.
What does this mean for you?
The requirements in the Standards apply to your social media communications and other activities when you are using your professional title, or when another person can identify that you are a physiotherapist.
Social media communications are often a focus of discussions about freedom of expression and off-duty conduct, due to the ease of posting comments and the broad reach of social media posts.
The College has long encouraged physiotherapists to be active on social media, using their knowledge and expertise to promote accurate, trustworthy physiotherapy-related health information.
The College has also long encouraged physiotherapists to take steps to create a distinction between their personal social media use and their professional social media activities, to avoid unintended consequences and professionalism or privacy concerns. The Social Media Guide for Alberta Physiotherapists provides tips to help physiotherapists navigate the professional use of social media platforms.
The performance expectations of the Standards do not prevent you from sharing your opinions on professional or other matters while identified as a physiotherapist. They do establish expectations for doing so in a professional, honest, and respectful manner.
The expectations also establish requirements for honesty, transparency, and accuracy when communicating about physiotherapy treatments and the evidence related to the effectiveness of those treatments.
The expectations from the Communication and Evidence-Informed Standards of Practice include expectations that you avoid commenting on matters that are outside of your area of competence and expertise and require that you do not share misinformation. If a topic is outside of your area of professional expertise, you may not have the knowledge to be able to accurately identify if the information is credible or is in fact misinformation. The College advises that you avoid commenting on these topics within the context of your physiotherapy practice or when identified as a physiotherapist.
Special Consideration: Sexual Abuse and Sexual Misconduct
There is no such thing as being “off-duty” when it comes to sexual abuse or sexual misconduct of a patient by a physiotherapist.
The requirements established by the Health Professions Act (HPA) include mandatory penalties if Sexual Abuse or Sexual Misconduct occurs at any time during the therapeutic relationship. The therapeutic relationship with your patient continues for 365 days from the last date of physiotherapy service and is in effect both within the practice setting and outside of it.
Due to the HPA’s definition of sexual misconduct, the legislation places a clear limit on your freedom of expression by prohibiting comments towards a patient that constitute sexual misconduct.
The sexual abuse and sexual misconduct definition may not apply to non-patients. However, sexual harassment or sexual abuse of non-patients may still be considered unprofessional conduct under the HPA.
Conclusion
Physiotherapists hold a position of trust in society and that trust must be maintained to ensure all physiotherapists can practice effectively, for the benefit of Albertans. Conversations about freedom of speech and off-duty conduct are important. Understanding expectations for social media use when you are identified as a physiotherapist is essential. Clarity regarding the regulator’s role and authority to regulate this conduct is a good thing, benefiting registrants, the public and the regulator alike.
The College believes there must be a balance between the need for discourse and at times even dissent (whether in person or online), and a need to maintain the professionalism and respect that enables Albertans to trust physiotherapists and the broader health system.
The College does not wish to be in the business of investigating a physiotherapist’s social media activities, general communication, or off-duty conduct. The College becomes involved when a physiotherapist’s off-duty conduct, communications, and social media activities pertain to their professional practice and the College’s legislated responsibilities, and the conduct or communication contravened the requirements set out in the Code of Ethical Conduct or Standards of Practice.
Sean FitzGerald, PT, Practice Advisor
