Features Leadership Op-Ed
Boom, bust, bane and breakthrough

The popularity of massage therapy has waxed and waned in North American culture, but its greatest push came with the massive economic boom in post-World War industrial and information eras. Massage practitioners deserve some credit for the growth of the industry, but popularity alone did not generate the growth and interest enjoyed by the profession today. Primarily, socio-economic influences provided fertile ground for the growth and development of massage therapy in North America.

Boom: Ripe for growth
In a World War economy, North America established large manufacturing sectors to produce machines of war. Unlike Europe, North America was largely unaffected by bombings and destruction. In the period following the end of the wars, it was able to invest in manufacturing consumer goods, construction of houses, development of roads and in building businesses that generate employment. There was a surplus of jobs and a great demand for skilled workers. Employers offered high wages and employee health and dental benefits to retain these workers. Trade unions succeeded in negotiating favourable working conditions to provide workers with more money and leisure time.

These economic drivers led to demand for massage therapy in five areas:
Rehabilitation – Massage was provided among other methods and modalities by physiotherapists and nurses in the treatment of war wounds and conditions affecting skeletal muscles and joints, like polio. After the war years, massage therapy was applied in the rehabilitation of work-related injuries and automobile crash claims covered by insurance programs.

Athletics and fitness – With surplus time and increased appreciation for health and vitality, people began exercising. They invested in fitness and health practices, including equipment and supplements. These citizens-turned-fitness-enthusiasts required massage and chiropractic for their aches and pains. High-level athletes (or those who want to be) see massage and chiropractic as must-haves in their athletic and fitness regimen.

Human potential movement – With post-war reflections on human values, self-cultivation and liberalism, the concept of purposeful life and self-actualization appealed to many North Americans. People who were well-educated and earning higher income invested in psychotherapies, novel philosophical and religious teachings and various forms of bodywork in aspiring for a richer human experience.

Hedonism and well-being – With more time and money on their hands, North Americans swarmed the European-style spas as refuge from demanding work schedules and increasing impersonality of the work culture. The European spa provided a mecca to nurture oneself beyond the athlete’s or injured person’s objective of injury resolution and pain relief.  Massage is a primary application in spas and includes various forms of hydrotherapies to enhance relaxation and wellness.

Worker performance and productivity – Employers need to maximize worker productivity and job satisfaction, while lowering absenteeism and employee turnover in an increasingly competitive marketplace. To retain skilled workers, employers provided benefit plans for the workers and their families. These prime drivers have caused massage, chiropractic and other wellness-focused industries to thrive and, as a result, representation, regulation and education for these professions and their practitioners have flourished.

Bust: Threats to practice
No growth cycle can continue in perpetuity. Society and economy shift, technologies develop and markets must adapt. Boom has turned to economic bust in North America and many parts of the world, imposing change in the employment landscape and options for massage practitioners.

Workplace benefits claw back – Disappearance or decline of manufacturing and other sector jobs in economically-recessive North America negatively affects discretionary income, employee benefit plans and, as a result, workers’ utilization of massage therapy.

Oppressive taxation – Massage therapy is subject to a goods and services tax (HST) in many Canadian provinces, while other services like chiropractic and physiotherapy are not. This higher service cost of massage therapy creates a clear competitive disadvantage.

Growing competition – The provision of some health services is shifting from physicians and nurses to physiotherapists, pharmacists and nurse practitioners, at lower cost-per-service rates. These professions employ assistants to deliver health care at an even lower cost to a larger number of people. Physiotherapy/occupational therapy assistants, kinesiologists and other assisting providers may potentially displace independent massage therapists in providing massage services.

Employment upgrade – Large, business-savvy, well-financed spas and rehab facilities draw more practitioners to employment. Self-employed, small-scale massage therapists find it tough to compete against well-capitalized, effectively-marketed and experienced larger businesses.

Incredulity – Insurers and governments are sceptical of massage therapist claims without degree-level education or evidence-based practices. These criteria are standard for other health disciplines. No credibility means no funding.

Threat to primary funding – Insurance fraud, association with prostitution and illegitimate business practices taint public and media perception of massage therapy. This negatively affects employer perception and procurement of massage therapy services for employee benefit plans.

Bane: When we become our own enemy
The current challenges of massage therapists’ practice can’t be attributed to external threats alone. Indeed, our greatest challenges may be self-inflicted by our distorted perspectives and our collectively designed professional culture.

Practitioner-centric models – The massage therapy profession hails from spa and rehab, athletics and human potential, workplace wellness and well-being. The sectors served are vastly different in the desired service, pricing structure, promotional messages and distribution – and a sole definition or identity for massage therapy cannot serve the marketplace on all fronts. To serve the needs of each market, practitioners must learn and adapt to the market they serve.

Unsustainable work model – In surveys of Canadian and American massage practitioners, the time and labor-intensity of providing massage limits practitioners to 14 to 19 hours of direct hands-on care a day. Since that’s equivalent to part-time work, practitioners struggle to earn a full-time living. For practitioners to earn a viable living, they must: work within a market niche that supports high service pricing – therefore increasing take-home pay – and contain expenses within the limits of existing income; increase work capacity with the use of therapy-tools, hydro or electro-therapies or remedial exercise, increasing the number of services provided in a workday; or relegate providing massage therapy to part-time, seeking secondary work.

Unviable working agreements – Successful massage practitioners frequently address their work overflow by brokering established reputation, location and operations for a colleague. However, there remains an insidious ignorance of accounting and profit/loss concepts that threaten these practitioners-turned-practice brokers from earning a profit or even meeting operating expenses. I suspect this ignorance is perpetuated in part by a maternally protective massage culture that denies accounting principles or the rigorous examination of time- and labour-intensive work models.

Isolation and little support for innovation – The massage culture blind spot is made worse by the irregularity with which massage practitioners come together to dialogue and debate theoretical and political issues in the profession. Working one-on-one with client or patient negates intercollegiality, even in a multipractitioner office. There is a paucity of symposiums, think tanks and “town hall meetings” that should be provided by the professional associations and training schools. Entrepreneurial practitioners are left without support for innovation, research or collaboration.

Ineffective or under-resourced professional associations – Massage professional associations are in the business of advocating for practitioner interests and advancing opportunities for employment, learning and collaboration for their members. Board members untrained in organizational operations must be careful not to waste precious resources on chronic deliberations over minutiae. Nothing gains more members like tangible results, and associations should focus on results to draw members – and essential operating dollars – to the association.

Low entry-to-education requirements – The popularity, relative autonomy and low entry-to-education requirements for massage therapy training has contributed to an influx of candidates. It can be argued whether quality standards can be maintained without sufficient safeguards: competency indicators, training school accreditation and stakeholder involvement (including apprenticeship/mentoring models).

Breakthrough: Tangible opportunities for the practice
While we steadily hope for favour in the health-care system, there are attractive opportunities that a focused massage therapy profession can pursue right now.

For the remainder of this article and to explore these opportunities, visit this link. There’s opportunity for you to comment and join the movement in shaping our collective future.

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