Climate is changing, culture is changing, the economy is changing, and with it, the massage therapist’s workplace is changing! Varying considerably from the previous era, the current era is tinged with economic and job insecurity, an aging population and rising health-care costs, and increased reliance on government, technology and credit. Home-based or small facility self-employed practitioners are subject to increasing competition by well-financed and sophisticated rehab centres and spas, family medical practices (with in-house physiotherapy assistants) and various low-cost modalities purporting the reduction of stress, strain and pain.
Given this environment, massage therapists need to observe, respect and respond to the following trends:
Shift from self-employed practitioners to employees in large, commercially viable enterprises
Through social networks and collective conversations, a primary problem is apparent – therapists worldwide struggle to maintain their practices. Most practitioners lack business experience or time, energy and the required capital. They prefer someone else handle marketing, maintenance and business operations while the practitioner focuses on his or her first love – providing care.
Rehab centres, spas and massage franchises offer solutions to the common problems of self-employed practitioners: highly visible commercial real estate, rigorous marketing campaigns, equipment, supplies, financed leasehold improvements, the opportunity to work as a team/staff within available hours, time-tested operation and administration procedures, and a cost-point and service convenience that is hard to beat. Michael Gerber, author of The E Myth, reports franchises have a 75 per cent success rate compared to small businesses where four in five fail within five years of startup. Many self-employed practitioners recognize the clear time- and money-saving advantages of working in an established business and will jump their own ship to join one.
Employed practitioners have opportunity for workplace benefits such as pension plan, employment insurance and maternity/paternity leave, extended health-care and dental plans, and holiday/vacation pay. Some companies 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,” which moves the practitioner into a management position – hence, less physical wear and tear on her/his body.
Despite this shift, there is still room for the self-employed specialist who provides sophisticated massage/manual therapy and has built a loyal following. New massage practitioners, however, face greater competition to grow alongside streamlined and sophisticated rehab and spa facilities.
Massage therapists as assistive/adjunctive care
Massage therapy may approach mainstream health care in public perception, but it remains adjunctive in health-care policy and funding. In Ontario, massage therapists are regulated health professionals, yet face barriers to funding from provincial health care, auto insurance and worker’s compensation.
The reasons stated by the powers that be are i) lack of degree-level education, and ii) insufficient research. A third reason, I suspect, is a largely unsupported professional association. It’s the job of the professional association in your province to advocate and lobby on behalf of the massage profession to government, the insurance industry, other health-care providers, the media and public. Massage therapy is viewed as mostly harmless, but hardly curative, and thus it lacks credibility to receive full health-care funding. RMTs are reliant on gatekeeper health professions to access to health-care dollars.
Government policy continues to download duties and responsibilities to lesser-trained, lower-salaried health-care positions. Physicians defer to nurse practitioners or physician assistants, dentists to dental hygienists, nurses to practical nurses, and so forth. In 2009, physiotherapy and pharmacy received more powerful scopes of practice – in part to supplement shortage of physician, nurse and hospital resources. An insidious possibility is that physiotherapy/occupational therapy assistants employed by gatekeepers may usurp massage therapists, providing massage therapy at lower cost and greater accessibility to patients. However, it’s also possible RMTs could be retrained to work in family practice and provide supportive care to patients alongside physicians, nurse practitioners and physiotherapists.
At the Highlighting Massage Therapy in CIM Research conference of May 2010, William Meeker, DC, MPH, asked the salient question “Why are we trying to do this by ourselves?” Moderating the panel “Role of Massage Therapy in Public Health,” Meeker described that complementary and alternative medicine (CAM) professions are pursuing the same goals: generating research and evidence-based practice, lobbying government for policy change and inclusion in health care, negotiating with the insurance industry, and raising the standards of education and training in their respective practitioners. Working alone, each profession is limited by resources and is ultimately slow and ineffective. Meeker suggested CAM professions collaborate on resources, share knowledge and co-ordinate lobbying and education initiatives.
There is also opportunity to align with the fitness and wellness industries. Dr. Jayne Alleyne, MD, 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.”
It is this author’s strong suggestion to press your training institutions, regulatory bodies and professional associations to collaborate within the profession and make inroads for collaboration with other CAM professions . . . there’s no time to lose!
‘Heal yourself’ health care
With the advent of the Internet and a “me” culture focused on consumption and choice, boomers and their children and grandchildren will be looking for sophisticated, effective bodywork. Boomers and generations X and Y are information-savvy and will look far and wide for solutions to their somatic problems. Many boomers suffer the body-breaking effects of the second industrial – then information – era, while generations X and Y require care for extreme sport pursuits and chronic stress syndromes. Boomers exercise their buying power and demand exclusive, sophisticated results-oriented care.
Like all things popular, massage therapy has attracted profiteers that commoditize product or service to yield higher profits.
Beyond the concern of diffusing the original potential of bodywork, there is definite value in making it available to the masses. I suspect people will continue to seek ever-sophisticated forms of its healing properties. The human potential movement began with the boomers in the 1960s, and I believe we’ll see a renaissance. More people seek embodiment in a culture that continuously disembodies. In a technology-saturated world, massage therapy will become more important than ever.
Don Dillon, RMT, is the author of Better Business Agreements: A Guide for Massage Therapists and the self-study workbook Charting Skills for Massage Therapists. Don has lectured in seven provinces and many of his articles have appeared in industry publications. Visit his website, www.MTCoach.com .
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