Features Collaboration Practice
Breakthrough: Tangible opportunities for massage therapy practice

In the article, Boom, Bust, Bane & Breakthrough (MTC Spring 2015), I described the economic drivers nurturing the growth of the massage therapy profession, as well as threats (some self-imposed) stalling it’s evolution during this economy shift. In this article, I’ll outline several marketplace developments that are changing the way massage therapists deliver service, and some tangible markets the profession can explore.

Massage on demand
In his book, The Patient Will See You Now, Dr. Eric Topol outlines how patients – not physicians – will direct health care. Patients will adopt monitoring devices that give real-time feedback on one’s physiological functions via their smart phone, while relaying bio-metrics to their health-care team.  Smart phones will be used for symptom analysis by the patient – for example a suspicious skin lesion – and, via the built-in camera and medical algorithms, can provide direction on when to seek medical attention.

Technology and the development of new markets provide massage on demand. Zeel – currently operating in New York, Miami, San Francisco and Los Angeles – has made massage more convenient. With the Zeel app on your smart phone you can book a same-day, in-home massage, designate the type and duration (60- or 90-minute), and the practitioner comes to you. Zeel is membership-based, and for $99 a month (more in some upscale areas) plus built-in tip and taxes, you receive a monthly massage plus a massage table you own and retain in your home. You can purchase more massage sessions at the same $99 price if you choose. Zeel also offers a corporate chair massage service.

Zeel counters the greatest obstacle to in-home massage: the practitioner having to lug in the table every session. In using smart phone technology to select, book and pay for your massage, Zeel has maximized convenience and time savings for the user while appealing to our ego’s need for convenience and to be nurtured in our own space. How much more often will users book a massage when they’re regularly reminded of the massage table in their home? I predict this will be very, very big.

Do-it-yourself massage
People will be looking for inexpensive ways to apply their own massage. As I wrote in Do-it-Yourself Massage, (MTC Autumn 2010), “Foam rollers, inflatable balls and percussive/vibratory devices are already being incorporated into self-massage. In fact, massage therapists often prescribe and supply these devices to provide relief between office visits. Small, self-applying TENS (muscle stimulators) and ultrasound machines are available, and hot tubs and saunas are finding their way into more homes as pricing for these becomes more affordable.

Massage therapy is a time and labour intensive service and relies heavily on the availability of employee benefits plans and discretionary income available in strong economies to finance supply. But with the advent of cheaper surplus goods in the marketplace, more people will seek relief on their own. For instance, videos can be found on YouTube that compare the cost of a foam roller to massage care, arguing the roller as a more economical and equally practical alternative to actual massage therapy. Mechanical massage chairs claim to be “your personal masseuse” and you can easily find self-application technology for muscle stimulation or ultrasound that is, in addition to being inexpensive, easy for patients to access and use.”

With the disruptive technologies of artificial intelligence and robotics, we will see even more technology replacing hands-on care, and massage therapists must identify and develop the professional sophistication than can’t be replaced by machines.

From self-employed to employee
While massage training colleges largely promote and presume a self-employed model for their students, massage therapists generally struggle to build and maintain a sole practice. Many fail due to insufficient business training, real business experience and capital. Some rely heavily on referrals from feeder-gatekeeper professions, while others prefer someone else to handle marketing, maintenance and business operations – skillsets typically outside a practitioner’s training.

Many practitioners fear emerging spa and rehab franchises are disrupting the possibilities for sole-practitioners. However these companies may have a solution for the common and chronic practice problems facing self-employed, sole practitioners. These well-capitalized businesses offer highly-visible commercial locations, rigorous marketing campaigns, high quality equipment with supplies and leasehold improvements in place, and operating and administrative systems built in. The practitioner has the opportunity to work with a team while enjoying a market-tested model and delivering a price-point and convenience to customers that are hard to beat.

As employees, practitioners may access workplace benefits such as pension plans, employment insurance and maternity/paternity leave, workplace health and dental plans and holiday/vacation pay. Companies can offer profit sharing or the opportunity to buy into the business as a partner/investor. There is room for organizational growth as a lead therapist/assistant manager – an option that reduces wear-and-tear on the practitioner’s body.

With the capital investment and marketplace expertise they bring, corporations may possess the might to positively influence public/media relations and access to massage therapy services unavailable currently. Professional associations, regulatory bodies and training schools can play a major role in representing practitioners and ensuring fair and equitable working conditions in spas and rehab centres.

Underexplored opportunities
It’s time for the massage therapy profession to get more ambitious. Currently, the profession sets its sites on the low-hanging fruit – a nationwide accreditation of schools, promoting research literacy and the adoption of evidence-based practice, and regulation in all provinces.  While all worthwhile pursuits, alone they are insufficient to improve the viability of practice or opportunity in the marketplace. We need to pool talent and resources, advocacy and relationship building, and explore new markets.

For example, it was focused political lobbying and a concerted march toward regulation that saw naturopathy and acupuncture services – two professions both small and considerably more alternative than massage therapy – exempt from the goods and services tax (HST) in 2014. Regulation did not help British Columbia RMTs preserve coverage for massage therapy under the provincial health plan, nor did available research gain massage therapists access to the Ministry of Health Low Back Pain Pilot program in Ontario (Ontario’s Ministry of Health Low Back Pain pilot was revised to allow massage therapy students to provide care once/week at one of the seven sites).

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While we steadily hope for favour in the health-care system, there are attractive opportunities that a focused massage therapy profession can pursue in the marketplace. Following are three such opportunities.

CAM and fitness/wellness collaboration
During the “Role of Massage Therapy in Public Health” roundtable at the Highlighting Massage Therapy in Complementary and Integrated Medicine (CIM) Research conference 2010, panel moderator William Meeker asked the salient question, “Why are we trying to do this by ourselves?” Meeker described how all CAM professions pursue similar goals: generating research and evidence-based practice, lobbying government for policy change and inclusion in health-care funding, negotiating claim reimbursement with an often adversarial insurance industry, promoting positive public and media relations, and raising the standards of education and training of their practitioners.

Because each profession pursues these objectives separately, they are limited by resources and ergo slow and ineffective. Meeker suggests these professions collaborate on resources, share knowledge and coordinate lobbying and education initiatives.

The collaboration of CAM providers would benefit both practitioners and patients. Progressive physicians and nurse practitioners eager to provide comprehensive and less-invasive care may embrace complementary and integrated medicine (CIM) practice – offering both Western medicine and CAM – that are competitive in the marketplace and profitable for the gatekeeper disciplines and investors.

There is also opportunity to align with fitness and wellness industries. Dr. Jayne Alleyne, MD, in an article titled, “Welcome to Wellness,” published in the July/August 2005 issue of Fitness Business Canada, wrote: “Perhaps the time has come to connect the fitness and health care industry together in a joint action plan of education, service delivery and preventative medicine. I would like to see a Wellness Package that includes a monthly fee for health services that would be used over the year for prevention, performance or treatment. A wellness coordinator would meet with all clients and set out a plan for achieving an improved state of health and wellness over the year. Services such as massage therapy, dietary consultations, injury prevention assessments, stress management strategies and ergonomic assessments are a few of the gems that would be included in the package… a seamless transition from fitness to health and back again.

While regulation, evidence-based practice and school accreditation are laudable objectives, by themselves they will not advance the profession in improving funding or access. There are myriad political and resource issues with trying to scale the government-sanctioned health-care hegemony. However, real advancements can be made in the marketplace by collaborating with partners in CAM and fitness/wellness toward common objectives, providing attractive products/services in the marketplace and becoming more attractive to government regulators, insurance funders, gatekeeper disciplines, public/media, and employers who purchase employee benefit plans for their workers.

Workplace wellness
People spend a great deal of their waking hours at work. It makes sense to incorporate methods to enhance their health and well-being while off-setting the negative effects of associated strain and job-related stress. Corporations can take an active role in promoting healthy eating, walk-to-work programs, and incorporate on-site services in exercise and wellness, including massage therapy.

In the era of downsizing, Canadian workers have increased their workloads to keep up with diminishing budgets and fierce competition in all industries. There are physical, mental and social costs to these workers, with resultant financial and human resource costs on employers’ bottom line.

According to data from the 2003 Canadian Community Health Survey (CCHS), nearly one in three employed Canadians, about 5.1 million, reported that most days at work were “quite” or “extremely” stressful. Work-related stress costs Canadian taxpayers an estimated $2.8 billion annually in physician visits, hospital stays and emergency room visits.

A 1992 United Nations report called job-related stress “the 20th century disease.” Job-related stress syndromes cost $16 billion a year in Canada – the equivalent of 14 per cent of all net profits. A conservative estimate figures job-related stress is responsible for:
•    19% absenteeism
•    40% turnover (employee replacement costs 150-250% of their yearly salary)
•    55% Employee Assistance Programs (EAP)
•    30% short term and long term disability costs
•    60% of the total costs related to workplace accidents
•    10% drug plan costs are for psychotherapeutic prescriptions

In his book, Stress Costs Stress-Cures, published in 2003, author Ravi Tangri stated (page 24), “Stress generally has more of an impact on white-collar workers, on employees lower in the organizational ranks, in the services sector, and on women. Everyday small stressors are generally the most damaging. Each one of these stressors catalyzes 1,400 chemical reactions in your body, some of which continue for hours after the stressor that caused it has passed.

Individuals affected by stress smoke more, eat more, have more alcohol and drug-related problems, are less motivated, have more trouble with co-workers, and have more illness.  Stress impairs the immune system and can result in more infectious diseases, chronic respiratory illnesses, high blood pressure, obesity, cardiovascular diseases, gastrointestinal disorders, depression and cancer.”

Workplace wellness programs are instituted by progressive employers to boost morale and productivity, stem absenteeism, “presenteeism” and turnover, and yield the benefits of a loyal, healthy workforce. Workplace wellness initiatives include: health screenings and biometrics, health fairs and information, occupational safety improvements, on-site paramedical interventions/therapies, exercise, walk-to-work and quit smoking/curb obesity programs.

These programs are paid for directly by the employer or indirectly via employees utilizing their employee health benefit plans. Sixty-five percent of employees polled in a 2011 Safoni Canada Health Care Survey state a health benefits plan is a strong incentive to stay with their current employer.

In her 2008 article, “The Business Case for a Healthy Workplace,” Joan Burton, senior strategy advisor for Healthy Workplaces with the Industrial Accident Prevention Association (now Workplace Safety and Preventions Services), the components of a healthy workplace include the organizational culture, physical work environment and the personal health resources an employee brings to the workplace. She states the cost of “doing nothing” puts an organization’s employees at risk for doubling or tripling the incidence of injuries, mental health problems, conflicts, substance abuse and other undesired outcomes.

According to Burton’s report, companies that incorporate workplace wellness programs experience strong benefits-to-cost ratio.  Here are a few examples:

BC Hydro: For every $1 spent on the organization’s wellness program, the company saved an estimated $3 (after running 10 years)
Canada Life Insurance: The company saved $3.43 for every $1 spent on its fitness program.
University of Michigan: For every US$1 spent on workplace health programs, savings were estimated at $1.50 to $2.50
Dupont (USA): For every US$1 spent on a company health promotion program, the company saved $2.05 on disability after two years
Citibank: For every US$1 the company spent on its comprehensive health program, there was a savings of US$4.56

As an alternative to seeking funding and administration under the health-care system, massage therapists can work directly with employers to improve profits by off-setting the negative costs of job-related stress and repetitive-strain injuries. Workplace wellness programs can become one of the most important assets on a company’s balance sheet.

Human potential, baby boomers and the open marketplace
The open marketplace is larger than the massage therapy profession, health-care systems and government combined. Big business bends to consumer demand and the baby boomer generation has power to wield. Technology and generous discretionary income position Baby Boomers and their kin to seek sophisticated, effective bodywork. Many boomers are affluent, information-savvy and looking far and wide for sophisticated solutions to their somatic problems.

Many boomers suffer the effects of aging and the wear-and-tear from their tenure in the industrial/manufacturing work era, while their Gen X and Y kin seek care of injuries for extreme sport pursuits and illnesses from chronic stress syndromes related to technology and capitalist culture-overload. Gen X and Y don’t have the resources of the boomers, but their parents/grandparents will support them in their family ties.

Like the human potential movement of the 1960s and 1970s, we’re heading for a renaissance and in this technology-saturated, touch-starved world. Massage therapy could play a more important role than ever.

Looking forward
In this series of articles we’ve been presented with the economic drivers that helped fuel interest in massage therapy, the threats to practice of the current economy, and the problems practitioners and their culture have generated themselves in holding on to antiquated delivery-of-service and practice management notions. In this latter part we’ve explored marketplace trends sure to affect every massage therapist’s practice going forward, and real opportunities for an enlightened, organized and self-determining profession to explore.

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Donald Q. Dillon is a practitioner, author and adviser to massage therapists. Find him at DonDillon-RMT.com