a community of practitioners
A new working model for massage therapists is emerging rapidly and perhaps insidiously. In the first of this two-part post, we’ll examine critical factors changing the way massage therapists work. Part II will examine the changes and challenges the new work environment will provide.
Since the distinct separation from the physiotherapy and nursing professions, massage therapists have largely been self employed working from home or renting space from another RMT, chiropractor or physiotherapist.
In this period massage therapists have benefit from a strong economy – particularly the industrial illnesses the industrial age manufactured. Conditions such as workplace-related musculo-skeletal disorders (WRMDs), repetitive strain injuries and job-related stress syndromes were borne from our industrial - and then information - revolutions. In the strong economy North America has enjoyed since the Second World War, workers have had access to generous employee benefit plans, higher discretionary income, comprehensive health care, and worker’s compensation plans or auto-insurance funding for rehabilitation.
Massage therapists are not covered by Medicare, often not trained in fundamental business skills and lack investment capital to open their own business in commercial property. Therefore they rely heavily on patients/clients with high discretionary income, generous workplace benefit plans, third party coverage from auto insurance or worker’s compensation claims and direct referrals from business-savvy, established “gatekeeper” health care providers to grow their business.
Influence from the Outside
But this seemingly never-ending prosperous run is grinding down with economic recession in North America, and, frankly, the massage therapy profession is not prepared for these imposing, external factors quickly changing the employment of massage therapists:
· Workplace benefits Claw Back - disappearance of manufacturing and related jobs in North America and the recessive US and Canadian economies negatively impact employee benefit plans and worker utilization of massage therapy.
· Disproportionate Taxation – in a number of Canadian provinces, pressure by manufacturers on government to increase their input tax credits with harmonization of the goods and services and retail sales tax imposes greater taxation on massage therapy services from 5% to 13%. Many competing services such as chiropractic and physiotherapy are not subject to these taxes. I’m concerned many massage therapists (MTs) will absorb the tax within their profit margin for fear of patient/client reaction, but will end up sinking their business by choking their profit lifeline.
· Massage as assistive care - Auto insurance and workers compensation claims require gatekeepers to authorize massage therapist access to funding. This limits MTs to providing care as secondary/ancillary health providers with guarded access to capped funding.
· Growing Competition – Physio/Occupational Therapy Assistants, kinesiologists and other assisting providers to primary gatekeepers may usurp MT employment by providing “massage” in-house. There’s a profit motive by gatekeepers to keep care in-house rather than referring down the street to independent MT.
· Incredulous - insurers and governments are sceptical of MT results without degree-level education and evidence-based practices. No credibility…no funding.
· Exploitation – problems internal to the profession (see below) leave profession vulnerable to commoditization and exploitation by ignoble exploiters, in addition to guarded funding by government/health care and insurance industry
· Large, business-savvy well-financed spas and rehab facilities - self-employed MTs are converting to employees. Practice management provided in exchange for autonomy.
· Threat to Primary Funding Source - Insurance fraud, association with prostitution and illegitimate care taint public perception. Profession credibility and funding suffer.
Entropy from Within
The massage therapy profession is ill-prepared for the previously mentioned encroachments in part because of problems generated of its own creation:
· Incongruent goals – massage therapists lag behind other health disciplines in evidence-based practices, public relations strategy, school accreditation, regulation and credibility. Yet some MTs oppose degree-level programs and research as onerous and expensive—especially if the MT is part-time or is not reliant on their MT income as their primary income source
· Distrust of organizations - Some MTs oppose regulation—they view regulation by government as a cash-grab and intrusive – and are unsure of benefits of self-regulation.
· “It can’t happen to us” thinking – given the prior environmental factors taking place, change is imminent. For those MTs that say “that can’t happen here / to us…” I encourage a reality check.
· Varying Standards - MT teaching institutions display wide variance in quality of education and training. Most are non-accredited.
· Identity / Brand Confusion—spa therapist or rehabilitation therapist? Health care profession or personal service? All-inclusive, diluted identity maintained by practitioners attempting too broad a scope of practice leads to marketplace confusion and subsequently impaired credibility, reduced referrals and limited funding dollars.
· Incongruent Beliefs—Many MTs vie for status and recognition as health care professionals; they feel entitled to same privileges bestowed to other health care providers yet may be unwilling to become research literate or support research and higher educational requirements. Some MTs believe massage therapy should be restricted from laypeople applying massage - yet they themselves won’t support the mechanisms that lay ground for restricted application (controlled acts) to lay persons.
· Disorganization - Professional associations struggle to convey value of membership and gain majority of MTs as members. Insufficient membership limits resources for advocacy and public relations. Great and clearly targetted resources are required to position massage therapy favourably.
An Era of Change and Challenge
These internal and external pressures are changing and challenging the employment landscape for massage therapists across North America. In our second post (coming later November 2010) we’ll look at how the working environment is changing for massage therapists.
Don Dillon, www.mtcoach.com