Features Education Regulations
Open Forum: Sprng 2004

Massage Therapists Are Not An Inconsequential Part Of Ontario’s Medical Services … But We Do Have An Inferiority complex

Toronto police officer Barbara Cabot was providing motorcycle escort for a southbound funeral when an impatient eastbound driver gave gas and attempted to run the brigade. He misjudged her speed and his clearance and as he made contact with her right leg succeeded in separating rider from bike. Through her boot he had also separated her foot from the rest of her leg.

In her seventies, Linda Danson is the mother of one of Canada’s most respected and successful business women. A slip and fall caused her right tibia to break in three places. She received immediate attention and the best possible post-op care.

For more than seven months she wore a metal brace bolted to her shin. In both instances my services were sought long after the precipitating incident, nine and six months, respectively, and in both of these patients a severe inflammation of the affected area was still present.

For six months and three times a week, Officer Cabot’s physiotherapist had been applying deep moist heat to her re-attached foot and had prescribed the same as home-care. Although Linda Danson had frequent follow-up visits with her specialists, her painful and excessively swollen lower limb went undiagnosed.

These women were in a state of emergency and I recommended the application of ice and an immediate visit to their physicians.

Being 45 years younger, Officer Cabot recovered from her condition with the help of a modified care regimen. Mrs. Danson underwent a biopsy to determine if the infection had spread to the bone. The lab results showed amputation would not be necessary and she was placed on a double course of antibiotics.

While my role in the care of these women may have been fortuitous, my observations and recommendations were wholly generic and I’d like to believe that any half-sentient medical practitioner would have done the same. Where I will express no small measure of delight is in the fact that these women are enjoying a quality of life in their entirety.

Most massage therapists are familiar with such stories: the therapist who detected and warned of a suspicious mole or the therapist who eased a patients mind by explaining that the disconcerting lump was in all likelihood a lipoma and could better be assessed by a doctor.

Massage therapists have so long now been a part of Ontario’s medical landscape, that we understand our role as going well beyond that of relaxation provider. Slowly the public has come to realize that they may turn to us for more than just stress reduction. Yet the challenges to our profession persist. Largely these challenges have their roots in economics.

The other challenges, which I will speak to later, are ones of perception both on the part of the public and other medical professionals. Over my 10 years in the profession I have met or heard of, too many other practitioners who hold part-time jobs working in bookshops or grocery stores often simply to hold onto benefits.

While it might be tempting to argue that some of these therapists enjoy the change from the routine of providing massage, the truth is you will not find Chiropractors sharing the same peripatetic view of their careers. They are too concerned with the daily details of their chosen profession. What makes massage therapy different is that it’s bloody hard to earn a living and the reasons for this are as varied as they are many.

That massage is the most physically demanding of the health care professions should come as a surprise to no one and this accounts, in no small degree, for the well-known “burnout” experienced by therapists. Couple these physical demands with little financial return and you have a good percentage of therapists waking up to the reality of their lives within five years. As much as we’d like to believe that people enter the health professions for purely altruistic reasons, such life choices are seldom entirely self-less. Nor should they be.

Call us slow learners but if someone at my college had been honest about the financial prospects of massage therapy, there would have been a higher dropout rate after first year.
 
We might continue to hope for such disclosure but that would be counter-productive to a school’s goals. In what ways then do we find ourselves as therapists undervalued, and more on the margins of the medical community?

Let us look first at our own complicity in the state of things. There is a well-known and long established group of massage clinics operating in downtown Toronto that offers the services of its practitioners to a business-type crowd.

The therapists that I have treated, and who are or were employed there, have described it alternately as an “assembly line.” Certainly there’s no shortage of work and that is its primary appeal for those therapists seeking a steadier source of income.

A steadier but not an improved income, for this company takes a whopping 45 per cent of a therapist’s earnings. This kind of financial fleecing of our own is by no means the exception but rather the rule. 

While our colleagues are, in fact, earning a living, they’re often doing so under conditions that breed resentment and in which they risk burnout. This does not translate to the very best in patient care.

Those of us in larger centres such as Ottawa and Toronto will know that the 60/40 split is common practice and it is common because our profession has been conditioned to expect that it is not entitled to better.

Other variations on this financial arrangement include: 1) The flat monthly rent (commonly the most sound option); 2) Flat monthly rent plus percentage; 3) Percentage without a cap; 4) In the case of many spas, a low hourly wage (as low as seven dollars) plus gratuity.

There are better arrangements out there but they’re few and far between and when they do become available they’re often bequeathed rather than open to competition. What this leads to is packs of well-trained professionals roaming the landscape foraging for a better deal.

And why not? It’s the free market after all. The same free market that says it’s legitimate to take 45 per cent of a therapist’s earnings.

And here we touch on the perception problem I spoke of earlier: we are seen, by the public and especially by others in the medical community, as being transient. Translation: unreliable and not serious enough.

And rather than just laying the blame at the feet of market forces or unscrupulous business owners, let’s be honest about one other thing; our profession attracts too many unreliable and not serious enough people.

We know it, and business owners know it, and as long as we’re content to maintain the status quo, things will not improve. All trades and professions draw to them certain “types” of individuals and it seems to me that the massage profession has more than its share of people who are transient by nature. It is who they were before they became therapists.

Indeed it is the freedom of movement (“My hands are my tools”) inherent to massage therapy that is the chief appeal for those people. For many, it’s better to pay an unfair “split” than spend years building a practice and investing in one community. A percentage-based arrangement has inherent to it the danger that a therapist may leave the clinic in which they work.

And so the term “split” assumes a double meaning. “You take advantage of 40 per cent of my income and there’s a 60 per cent chance that I’ll leave.” It’s a cycle in which both parties participate equally.

Clinic and fitness club owners too, seem to lack sufficient imagination to comprehend the problem in such a system. Rather than charge the therapist an honest amount to cover room and any administrative costs, they’re more intent on generating revenue, which can lead to higher therapist turnover.

For the patient-base, the optics of this are not good. If I sub-let my $1000.00 apartment for $1500.00 a month that would be against the law, but because we have all learned to unquestioningly, and to varying degrees, pray to the God of Mammon, we allow the rules for commercial property to be different.

And so we factor in the “good will” of patient referral to allow for the surplus a clinic generates off a therapist’s labours, not acknowledging that patient referral swings both ways.

It took five years, but I eventually found myself working with a team of highly qualified, intelligent and ethical chiropractors and therapists. It pleases me that on some level we interact like a not-too-dysfunctional family and I’m fairly certain that we all do genuinely like each other.

My flat monthly arrangement is fair and is such that it encourages a generosity of spirit, out of which and in different ways, both my patients and the chiropractors benefit. A few of my friends find themselves working in similar happy circumstances and it’s encouraging to believe that this is a slowly building trend.

Somewhere in the first few months of 2001, I was contacted by a large Spa, asking me if I would meet with them to discuss possible employment. The spa was a triumph of million-dollar design; an atmospherically lit melding of the elemental, high-tech and oriental minimalism.

Following the tour I sat down with the human resources director and she laid out the terms of employment. I would be paid $7.00 for every hour of every shift (whether I was working or not) plus a maximum gratuity of $18.00 per treatment because I was a “senior” therapist. Therapists who were not “senior” could expect a sufficiently smaller gratuity even if their clients left behind a $20.00 bill. I wasn’t able to guess what happened to the rest.

Because the money was this bad, I inquired after the massage department manager’s position. I was told that it had already been filled by a 23-year-old recent graduate with seven months experience.

As a matter of interest, the cost of a one-hour massage at this Spa is over $120. It is painfully obvious the esthetic presentation of this facility, and others like it, is a higher priority than the appropriate compensation of its staffed “therapeutic professionals.”

Such attitudes towards our profession are commonplace within the spa and hotel industries, with therapists, in the absence of a common lounge, often relegated to the treatment rooms when not working. There they are required to wait like workers in Amsterdam’s Red Light district for the next client; the receptionist wielding all the power of a bawdy house Madame. The comparison is an odious one and that’s precisely the point.

Our profession needs to become far more outraged about a host of inequities that continue to undermine our credibility. The expectations and treatment of therapists is at odds with our qualifications and professionalism as health care providers. After all, we are a part of the Regulated Health Professions Act (RHPA) and not the Regulated Health Trades Act.

Yet if we continue to believe that we are nothing more than “massage workers,” then perhaps we do not need to be represented by the Ontario Massage Therapist Association (OMTA) but rather the Ontario Massage Therapist Union.

Unfortunately, neither the OMTA nor the College of Massage Therapists of Ontario (CMTO) seems to be in a position empowering them to curb these abuses of its membership.

I think it would be a bold and appropriate stance if the CMTO required that its members, as a condition of licensing, sign a declaration stating that they will not work in spa environments. There are too many registered therapists working alongside untrained massage “providers” in spas throughout Ontario. I feel our services must be withheld from the spa industry with the municipal licensing body requiring that these businesses inform their customers that registered massage therapists, by law, are not available.

Those who use spas will soon understand that they are not receiving the best possible care. I have seen enough to know that spa customers seek a lifestyle experience and not corrective therapy. Hotel spas are a particular case-in-point where the client-base is so transient that a treatment protocol is impossible and record keeping virtually non-existent.

Unavoidably we must continue to challenge the public’s perception and perceived notions around massage therapy. If you look on the Statistics Canada website you will find that massage therapy is described as
an “alternative therapy.”

As a matter of fact, you will find it described as an “alternative therapy” almost everywhere.

An “alternative” to what? Liver damaging medication? Surgery for a muscle spasm? Curiously and despite many similarities, physiotherapy is not an “alternative therapy.” This sort of distinction must stop. There are countries in Europe that have recognized what is axiomatic and placed physio and massage under one license.

The truth is that language plays a substantial role in how opinions are shaped. If we are to start seeing changes in how we are viewed as regulated health professionals we have to start talking like regulated health professionals. Therapists must stop using jargon language like “client” when referring to patients because it’s more “empowering.”

Two things: 1) They’re seeking physical therapy and not an opinion on carpet samples; 2) You’re not their shrink. You have no business “empowering” anyone and they came to you because in some area of their body, they’re feeling less power.

Like a cancer we must excise the language of the esoteric from our profession. Treatment-room talk of “energy” or the healing power of “crystals” and “colour therapy” has no place in massage and only serves to make us look foolish. The therapist may not believe that it’s quackery but it’s most assuredly seen as quackery. The public and the medical community expect to hear us talk of what we know; not what is not provable.

Several years ago, a few American automakers began using the services of cultural anthropologist G. Clotaire Rapaille whose work involves studying and delineating between the rational or “cortex” impressions of consumers and their deeper unconscious or “reptilian” responses.

What he found while researching the issue of safety among SUV buyers was that because they were higher up in the cab, giving the “feeling” of being in command and all-powerful, their reptilian response led them to feel safer. At the cortex level, however, they understood that because they were higher up there was an increased risk of a rollover.

As we know, automobile marketing is seldom about safety and always more about “feeling.” Similarly, and in a variety of ways, certain unconscious feelings around massage therapy have become fostered in the public imagination. Registered massage therapists know that their long-term patients trust their knowledge and value the care they receive.

In 1997, however, we were dealt a blow when we lost our Initiating Health Practitioners (IHP) designation meaning that we could no longer offer direct assessments or insurance billing to those people involved in a motor vehicle accident, without first  the involvement of a GP or Chiropractor. Under Mike Harris’ insurance-friendly Conservative government, costs were effectively offset then from the private sector (the insurance industry), to OHIP because now doctors had to be consulted before treatment plans could be completed. When I spoke with Policy Analyst, Thomas Xavier, of the Ministry of Health’s Program Policy Branch, he concurred that this was a reasonable conclusion. The more significant fallout from this action however came in a more subliminal form.

With stricter guidelines in place for the employment of massage as a modality in the treatment of MVAs, one would have to forgive the public for believing that, in a way, we had been demoted, because we had. Now our clinical findings were no longer good enough but had to be “okayed” by a “real” medical professional.

In a further setback, and a move designed to ensure that therapists cease providing MVA treatments altogether, the Insurance Board of Canada (IBC) recently announced that their industry would now pay only $49.00 per one hour treatment, effectively two-thirds the going rate. 

These moves serve to devalue us in the eyes of the public giving them the “feeling” that we’re not as legitimate as others in the Regulated Health Professions. Some members of the profession believe that the OMTA negotiated this $49.00 rate with IBC.

But as massage therapist and OMTA Board of Directors member, Richard Jaunzemis put it: “That’s crap. IBC came to us and told us how things were going to be. There was no negotiation. The board members are all RMTs. Why would we negotiate something that was detrimental to our livelihood?”

Point taken. IBC, didn’t need to negotiate as the OMTA represents only 20 per cent of Ontario’s approximately 7,000 therapists.

Among the Registered Dieticians, Physiotherapists and Chiropractors I spoke with, none have an overly enthusiastic view of their associations and few believe they’re getting their money’s worth. It’s the classic psycho /political divide we see in all areas of life between the “workers out there” and the “bureaucrats inside.”

Associations may be flawed, but they are the best hope for a unified voice when trying to effect change through various levels of government and there’s no question that non- members also benefit by their efforts.

However, the membership must ensure that their Association is vigilant in demonstrating ongoing accountability and transparency.

After my largely unsuccessful attempts at extracting even the most rudimentary of statistics from the OMTA, I have to wonder if the afore-mentioned values are being nurtured.

As massage therapists, we all have stories to tell that would add to the list of challenges our profession faces. For it is a “Profession,” a simple fact that is often forgotten when we’re struggling with physical exhaustion and the psychological pressure of a particularly slow month.

Therapists are human and that is both our weakness and our strength. We are not an inconsequential part of Ontario’s medical services but we do have an inferiority complex.

A positive public impression of massage therapy depends not only on the efforts of bureaucracies, but more significantly on how each therapist conducts their practice.

There are few other therapies that resonate, on as many levels, in the human organism, as massage.

Our patients look to our services for a host of reasons and sometimes, as in the cases of Officer Cabot and Mrs. Danson, we can help prevent serious alternative measures.