Massage Therapy Canada

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Practice Management: Winter 2003

When a therapist becomes successful, they often find they cannot provide service to all the potential patients knocking at their door. This “arrival” at success can be very stressful, oddly enough. The therapist can burn out trying to accommodate existing and new patients, and lose potential business.

September 23, 2009  By Donald Dillon

This is the first in a three-part series on the financial management of a massage therapy practice. This article focuses on the financial relationship of the business owner/clinic manager and an associate therapist.

When a therapist becomes successful, they often find they cannot provide service to all the potential patients knocking at their door. This “arrival” at success can be very stressful, oddly enough. The therapist can burn out trying to accommodate existing and new patients, and lose potential business.

The axiom “be careful for what you wish for … you just might get it” is true of success. If you don’t have a plan to accept and manage that success, you might chase away the very thing you hoped for. I’ve seen therapists become full in their practice, only to wish for free time. They soon have more free time than they wanted.

One way to experience success in an expansive and worthwhile way is to become a clinic manager – offering clinic space, mentorship and associated business services to an associate. There are several great reasons for both clinic managers and associates to do this.

Share Resources And Offset Expenses

It can be expensive to run a therapy business, costing several thousand dollars a month in lease, phone, utilities, reception, credit card/interac services, marketing and promotional materials, linen service, website maintenance, and business association dues/meetings.


A single therapist incurs all of these costs, lowering the amount of income for personal use and
re-investment into the business.

For the clinic manager, bringing in an associate offsets these expenses, and provides opportunity to create another source of income. This is the clinic manager’s reward for establishing the systems, location and reputation of a successful business.

Start-up costs for a therapist opening a new clinic from scratch can be prohibitive, so an associate enjoys the opportunity of coming into an existing business with existing tried-and-true business systems in place.

In addition, the associate benefits greatly from observing the management of a successful therapy business, and the mentorship of the clinic manager as an established therapist.

Collective Marketing

Marketing can be a time-intensive and costly venture. Marketing involves gathering information, reviewing various marketing opportunities, designing consistent imaging and messages, approving copy of marketing materials, and more. When therapists join forces to produce newsletters, build business relationships, finance marketing materials and advertising, and assess marketing venues, the work becomes less than half. This means marketing can be done strongly, consistently and effectively because several people are co-ordinating the effort, and sharing the costs.

Clinic managers who have been too busy to market regularly run the risk of a diminishing contact with their patient-base. An associate can breathe life and enthusiasm to tired and inconsistent marketing efforts. The associate benefits from the experience of the clinical manager in deciding the best messages and images to use in a marketing campaign.

Increase Diversity Of Service
I believe a clinic manager gains greatly from taking on an associate with interests different from her own. If the clinic manager focuses on rehabilitative patients, for example, bringing on a associate with a focus on relaxation/spa treatments immediately expands the breadth and depth of services provided.

The clinic manager should encourage each associate to be an SME (subject matter expert), so that the clinic strongly attracts patients/ clients looking for excellent care in that area.

Each associate’s expertise would come out in brochures, newsletters, and other opportunities where the therapist could carve a clear niche and differentiate themselves from other associates in the clinic. Some areas to develop expertise include spa/relaxation, neurological conditions, palliative care, pregnancy and infant care, rehabilitation, sports therapy, workplace injuries, and movement therapies or remedial exercise.

There are a number of pitfalls to address in forming a successful mentor/associate relationship. Here are some of the issues:

Assumed Expectations

Meet several times before initiating any work arrangement to understand the interests, skills and aspirations of both the associate and the clinic manager.

Put these interests and expectations in a letter of agreement/contract and seek legal counsel for ratification, if necessary. If roles and goals are clearly defined at the outset, you are much better positioned to meet the challenges that will arise in the future. Trying to change the agreement mid-stream creates great distress and immobilizes growth for business owners and associates.

A Lack Of Commitment To The Growth Process
When an associate comes into the existing business with his own set of ideas, the clinic manager may not be fully open to the new changes and challenges of a multi-therapist practice. As well, if the associate is not open to the “wisdom” of existing systems, he may sabotage his practice and his own learning process.

Building relationships takes time, and you will spend much time initially getting comfortable in each other’s space, and understanding each other’s roles and responsibilities.

Recognize that change, and resistance to change, are normal. Keep communication frequent and open, and commit to work on the same side of the table to meet challenges head-on and resolve them together.

Financial Ignorance
Sometimes the clinic manager/owner can be successful despite themselves … but not for too long. The owner  should have accounting skills and know from week to week what income and expenses are (the income statement) and what assets and liabilities they hold (the balance sheet). Without this information, she cannot make sound financial decisions, or determine a fair and equitable relationship with her associate. The clinic manager may face stress down the line when she sees rising clinic costs associated with bringing on new therapists or investing in a poorly planned marketing campaign.

Associates are guilty of financial ignorance too. There are certainly stories of therapists who’ve been in
a massage therapy or other health practitioner clinic and faced restrictive contracts. There are less-told
stories of associates that never became accountable for their financial responsibilities in the business, costing the clinic manager a great amount of resources because the associate never developed.

Your best tool as an associate is to continually build your relationship with the clinic owner/manager, and hold her or him to the expectations outlined in your letter of agreement.

Lack Of Accountability
Clinic managers sign the leases and otherwise take the financial risk of the business. These risks should be shared with associates, expecting them to be accountable for a base-amount of expenses in a percentage agreement, or at a fair and reasonable lease. I personally don’t recommend percentage agreements, because the associate can become dependent on the clinic and passive in their accountability to meet the financial expenses of the clinic. When the bar is set at a certain level, associates find resources and skills within themselves they never knew they had. A clinic manager does a great disservice in shielding associates from learning to become independent. I highly recommend the clinic manager share her accounting books with the associate – be completely transparent – so the associate can see the true cost of running a therapy business. It also causes the clinic manager to be more accountable with resources, identifying areas of the business that are wasteful and need work. When both parties know the financial expectations, they rise to the occasion and work together to support both common and distinct financial goals.

Ignorance Of The Laws
The Government of Canada has some distinctions regarding self-employed versus employed individuals. Get a copy of RC4110: Employee or Self-Employed? at www.ccra- Ensure you are not liable for a relationship that, down the road was deemed to be taxable in a different manner.

In addition, be clear and familiar with all the policies your regulatory body. In Ontario, the College of Massage Therapists of Ontario outlines the Standards of Practice and Code of Ethics expected of all massage therapists. An associate is responsible for maintaining these standards, even if the clinic manager (who may not be a massage therapist) is not. As an associate, understand there are many costs associated with running a business, whether your appointment book is full or less than so. Weigh the various considerations of opening your own business or serving as an associate to develop your technical and business skills. Not everyone has the inherent drive or abilities to be a clinic manager, and some therapists are better off staying as self-employed service providers than entrepreneurial business owners. Only you can decide, with some assessment, where your destiny will lie.

• In our next article, we’ll look at tracking business and personal expenses, creating income statements and balance sheets and building your financial intelligence.

Donald Quinn Dillon, M.T. has practiced in the Niagara region for over 12 years. He is a regular columnist in Massage Therapy Canada magazine and the Body Politic, and a three-time presenter at the OMTA Hands Together conference. Don has received the OMTA’s President’s Award of Merit, and served on the OMTA board from 1993 to 1997. During this time, he represented the OMTA at the auto insurance fee negotiations, as well as drafted the original OMTA brochures targeted to auto insurance adjusters and health care professionals. Don has worked in medical, naturopathic, spa, chiropractic and fitness club environments and has taught practice management workshops to massage therapists since 1995. He can be reached at .

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