Join me on the SOMA: Society Of Massage Archives broadcast, where host Kirby Clark Ellis and I discuss the history of MT regulation in ON & BC, similarities and peculiarities when comparing Canadian and American advancement in the profession, the generational divide that threatens our integrity and the challenges of unifying the profession. On Spotify https://open.spotify.com/episode/4UkQLx48Th0F05yCjsZDVm?si=gpkCY0LiQEmJq33j5qhTxw or YouTube https://youtu.be/0UM7Sn7iav4?si=nK8NReKY_cTn-DqB

1. What initially drew you to massage therapy as your vocation?

An unexpected but happy circumstance.  Dissatisfaction with initial career in data processing, I migrated to the fitness field, where I excelled.  I actualized my interest there, and was looking for something new when – leaving a fitness workshop – I passed the Sutherland-Chan School & Teaching clinic.  I had not experienced massage before, but read in fitness magazines that massage is a means of improving fitness performance and resolving physical injuries.  Several inquiries led to 2-day trial workshop, then a second dose when I was permitted to attend a sports massage workshop, instructed by the massage therapist for the Toronto ballet.  I struggled with returning to school, but eventually conceded.  The result is I’ve experienced a very fulfilling career, with many diverse experiences, including representing my professional association to government and insurers, lecturing at provincial conferences and massage training schools, and opportunities to consult and to coach.

2. What were your early influences?

My breadth and scope of the profession expanded considerably by reading American publications – Massage Magazine, MTJ and more recently the ABMP’s Massage & Bodywork publication.  I attended workshops initially with Upledger Institute, then intensively with Paul St. John re: Neuromuscular Therapy.  I’m an ardent fan of Deane Juhan, author of Job’s Body: A Handbook for Bodywork, of Thomas Myers, author of Anatomy Trains, and more recently, Gil Hedley’s anatomical dissection videos. 

I’m stirred by the professionalism of Sandy Fritz, Whitney Lowe, James Waslawski  and other American practitioners.  I appreciate the historical context of Don Hanlon Johnson in his compendium Bone, Breathe and Gesture, and Stanley Keleman’s Emotional Anatomy.  My skills attuned and refined considerably because of these American influences. 

I’m also influenced by Canadian exemplars – Pamela Fitch, Trish Dryden, Grace Chan, Doug Alexander, among others.  I’m particularly influenced by the massage therapists I’ve had a reciprocal care relationship with.  True learning in the lab – experiencing, observing and applying.

3. You hail from Canada.  Tell us about education, regulation and representation there.

First, I should qualify myself as just one of an estimated 23,000 massage therapists across Canada.  Each of the 10 provinces varies in its administration of education, regulation and representation.  I have met many massage therapists in my travels, lecturing in 9 of the 10 provinces.  I have a keen interest in history of society, and, pertinent to our discussion today, the history and professional culture of MT in North America.  I’ve come to understand our discipline is moved by both intrinsic and extrinsic forces.

Some quick facts about regulation and representation in Canada.  In my home province of Ontario, the Drugless Practitioners Act was enacted in 1919.  In 1935 our governance distinguished from physiotherapists to establish the Board of Directors of Masseurs of Ontario.  The Drugless Practitioners Act was repealed in 1991 and replaced with The Regulated Health Professions Act, bringing all regulated health disciplines under one umbrella act.  A few years later in 1994, the Massage Therapy Act came into effect, and the regulator was renamed the College of Massage Therapists of Ontario.

*note “college” as regulator, differentiated from a massage therapy school

As for our representative association, the Associated Masseurs was established in 1936.  The name later changed to Society of Registered and Remedial Masseurs of Ontario, and in 1973, the organization was chartered under the Ontario Massage Therapist Association. In 2010, the Association’s name was amended to the Registered Massage Therapists’ Association of Ontario.

As for education, in 1989 when I entered Sutherland-Chan, training was provided by four private vocational schools.  Education offerings eventually extended to community colleges and private career colleges, bringing the total programs in Ontario alone to 56.

British Columbia was the only other regulated province for many years.  In 1946, nurses and remedial gymnasts founded the Association of Physiotherapists and Massage Practitioners (APMP) of BC.  In the 1980’s, the physiotherapy association actively campaigned to discredit the training and scope of massage therapists. The APMP split representation, and massage therapists formed their own representative association in 1982.  The Registered Massage Therapists Association of British Columbia (RMTBC) is the current iteration.[i]

It’s important to note that while Canada administers “universal health care”, this government-endorsed health insurance does not extend to physical rehabilitative therapies, such as chiropractic, physiotherapy or massage therapy.  Yet, for several decades, massage therapy in British Columbia was included in the Medical Services Plan (MSP), therefore available to all citizens of BC.  BC RMTs could opt in for their services to be covered under provincial health insurance, removing cost barriers to patients.  The MSP for massage therapy was discontinued in 2004 – I believe – and now RMT patients pay out of pocket – or with employee health benefit plans – as in the rest of the country.

As for regulation, in 1995 British Columbia experienced an upgrade in health regulation similar to Ontario.  However, BC is again distinct, because in 2024 the health authority in British Columbia amalgamated 30 regulated health disciplines down to 6 regulators.  Now, massage therapists – in conjunction with naturopathic physicians, chiropractors and traditional Chinese medicine (TCM) & acupuncturists – are governed by one regulator – the Complementary Health Professionals of BC.  There is speculation the same amalgamation will happen in Ontario.

As for education, I am unfamiliar with the origins and history of the training schools in various provinces.  I couldn’t find any collated references, so I challenge the profession in Canada to undertake the important task of documenting and making available this history, so we can fill in the context.

For much of our profession’s history in Canada, only British Columbia and Ontario regulated the profession.  In more recent years, representative associations organized to serve somewhat of a dual role, until a regulator can be situated in place.  The third province to regulate – Newfoundland/Labrador in 2003, was followed by New Brunswick in 2011 and Prince Edward Island in 2019.  We still have 5 more provinces to regulate, plus 3 territories.

As per perspectives on Canadian representation and regulation compared to massage practitioners in the United States, I believe the following will be of interest to your listeners.  Through social media and other discussions, I perceive many American practitioners believe massage therapy in Canada is better positioned than in the United States.  That we’re farther evolved in education, regulation and representation.

Here are some things to consider about the status of massage therapy in Canada:  While we have “universal health care” in Canada, the physical therapies – physiotherapy, chiropractic and massage therapy, are excluded from provincial health insurance.  Individuals obtaining these services tap limited extended health insurance through their workplace, or pay out of pocket.  Currently only half of the 10 provinces are regulated, and none of the three territories to the north.

Registered Massage Therapists (RMTs) overwhelmingly work in private offices, spas or home-based practices. Other than a very few exceptions, RMTs are not in hospitals or community health centres, working with medical professionals such as doctors and nurses. 

The process to accredit MT training colleges across the country began constructively in 2015.  Many of the schools are not yet accredited.  In my province of Ontario, less than ½ are fully accredited. 

As for research, I greatly admire how the U.S Department of Health and Human Services funds the National Institute of Health (NIH) and it’s Center for Complementary and Integrated Health.  Our Canadian government provides nothing in similar endorsement. 

Previously, the provinces of Ontario and British Columbia contributed a combined $59K/year over 11 years (2006-2017) towards research initiatives in Canada.   Currently, the 10 provinces now invest a collective $10K CDN a year to the American Massage Therapy Foundation.

In Canada, we really struggle with moving the needle on some issues.  A revitalized campaign to remove a consumption tax “Harmonized Sales Tax” on MT services – a tax removed from most regulated health profession services in Canada – remains ungranted by the federal government.  This, almost 11 years after smaller, more “alternative” disciplines of naturopathic and acupuncture successfully became exempt. 

We regularly suffer undignified national media coverage – typically showcasing insurance fraud, association with the sex trade or acts of MT misconduct, and we have strained relationships with the insurers who approve claims for massage therapy care.

I don’t believe these facts are an ill reflection of decision-makers past or present in education, regulation and representation.  I believe they reflect our discipline’s challenges with getting sufficient engagement, transferring knowledge, galvanizing our practitioners and working collectively towards common, beneficial objectives.  I expect our American cousins have their share of the same problems.

4. From your perspective, what has been the historical trajectory of massage therapy?

As I understand it, there are a number of socio-economic influences that cultivated fertile ground for your massage therapy practice and mine as they exist today.  In a post-war economy, manufacturing sectors in North America switched from producing the machines of war to consumer goods – automobiles, washing machines, houses and road construction. 

Consumer demand drove economic growth, leading to job surplus and great demand for skilled workers. Employers offered high wages and employee health benefits to retain these workers, while trade unions negotiated better working conditions to provide workers discretionary money and leisure time.

These economic circumstances led to demand for massage therapy in at least five areas:

Rehabilitation – initially in the treatment of war wounds and the physical consequences of conditions like polio, massage therapy is now applied to rehabilitation of work-related and automobile crash injuries.

Athletics and fitness – With surplus time and an increased appreciation for health and vitality, people began exercising. These new fitness enthusiasts required massage for their acquired aches and pains. High-level athletes see massage as a must-have to ensure athletic performance.

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 to enjoy their status. The European spa offered a mecca to nurture one’s body beyond the objectives of injury resolution or pain relief.  Massage is a primary application in spas and includes various forms of hydrotherapies to enhance relaxation and wellness.

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 with discretionary income invested in psychotherapies, philosophical and religious studies and various forms of bodywork[ii] – all in aspiration for a richer human experience.

Worker performance and productivity – Employers want to maximize worker productivity and job satisfaction, while lowering absenteeism and employee turnover, in an increasingly competitive marketplace.  Progressive companies offer workplace wellness programs on-site – including massage services – to counter-act chronic postural stresses and strains from specialized workstations.

As an aside, and in this light of socio-economic progression, I believe it’s unproductive to reduce all massage therapists into a single identity, given the complexity of our origins.  It seems practitioner-centric arguments erupt over credibility and legitimacy, yet clearly massage therapists serve a variety of populations with particular needs. 

I believe we can embrace the originating roots of our profession, and serve our particular populations of interest without demeaning massage practitioners who serve different populations.  As Hunter Lovins said, “You have to take your values from your customers, your designs from nature, and your discipline from the marketplace.”

Incidentally, economic growth supported massage therapy and other wellness-focused industries to thrive.  As a result, investment in education, regulation and representation has flourished.  Currently, massage therapists across Canada invest millions of dollars every year to finance education, regulation and representation.  Think about that…a whole industry developed to support the infrastructure of our profession.  A question we might ask, “How’s our return on that investment?”  I suggest we regularly evaluate our investments in education, regulation and representation.

5. Why does the historical perspective of massage therapy as a vocation matter?

I applaud the efforts of the Society of Massage Archives for their efforts to preserve history.  Let’s be candid…we are having this conversation today in part because the history of our discipline is in danger.  I believe an understanding of history is essential to comprehending the origins, context, value and meaning of a discipline, and for transferring knowledge, skills and perspective while carving a path for the generations to come.  To understand why I’m very concerned for our collective history, I make a small digression.

Here’s a question for our audience: What is your relationship with the history and legacy of our shared discipline?  Do you hold it in regard…or contempt?  Are you ambivalent to the origins, consider them fossilized, and put your conviction in technology and “evidence-informed” practice?  If so, I have an argument for you to consider.

Outside our discipline, there is a broader cultural shift in the West that has been taking place since the world wars.  At that time, collectivist, “we are all in this together” values reigned.  But increasingly, we in the West have moved towards individualistic and materialistic values, starting with the Baby Boomers, and amplifying with Gen X, Gen Y, Gen Z, and the upcoming Gen Alpha. 

Our daily dialogue as evidenced through books, newspapers and social media have shifted from “us” and “we”, to “me” and “my”.  American psychologist Jean Twenge provides a cogent depiction in her 2009 co-authored book titled, Narcissism Epidemic: Living in the Age of Entitlement.  I recommend her more recent books on subsequent generations as well.

Our current popular culture worships celebritism.  We take our public health direction, political viewpoints, financial and relationship advice from actors, performers, athletes and social media influencers.  We distrust public authorities, blaming previous generations for the financial crisis, the housing crisis, the climate crisis, the job market crisis.  As a result, the subsequent generations appear to ignore and deplore tradition, experience, tacit knowledge.  This is devastating to a profession built on craft, on theory and philosophy, that grew based on the empirical experiences of those that came before us.

There’s good reason for subsequent generations to be terse and aversive.  In the West we have increasingly hijacked their hope and optimism.  No wonder the youth commonly relate to the homeless, the indigenous, ethnic minorities, people facing oppression of all types…because they themselves feel disenfranchised.

There’s an obligation for previous generations to clear the way, to recognize and address the crises of their generation so as not kick it down the road for the next generation to handle.  And I believe people of my generation X, and the previous Baby Boomer generation, have done quite a bit of kicking down the road.

Every generation faces its own challenges, unique to their time.  There’s always a gap between generations.  Older generations have an obligation to share their stories as anecdotes – not to direct or advise – so subsequent generations can benefit from their knowledge, experience and wisdom. 

Technology and the fracturing of our culture in the West has widened the normal generation gap, plus many of us will not pursue the vocations of our parents, so we look outward for guidance as opposed to the usual, tribal traditions.  We should remember that a reason for our success as a species is to combine the vitality, curiosity and innovative spirit of younger generations with the knowledge, wisdom and experience of the older. 

If you truncate the elder perspective, you eliminate hindsight and risk critical mistakes you would otherwise have anticipated.  And the elder wishes to be of utility to younger generations, to pass on what they’ve learned and then get out of the way for the next generation to forge their path and face the crises of their time.  In a generation that despises and disassociates from those that have come before, current generations reflect back the wounding they have suffered in feeling disenfranchised from next generations.  This dynamic is calamitous for all generations.

So what’s this have to do with the history of massage?  Plenty.  Our discipline was founded on the meticulous development of theory and philosophy, honed and improved with every passing generation of practitioner.  All of us that practice now, acquired knowledge and philosophy from the antecedents before us. 

But there’s been a shift in respecting those origins.  Along with the West’s abhorrence of anything that as come before, our discipline appears to be cleaning house on the founding philosophies and approaches.  Rather than valuing and properly assessing prior teachings, there’s a rush for credibility and legitimacy in the public eye, with attempts to discredit foundational theories rather than framing them as platforms to build upon.  That’s like attempting to build a house without laying the foundation.

Where our online discussions should be steeped in informed opinion, historical context, dignified dialogue and debate and infusing the best available evidence, the interactions often denigrate into attempts to score esteem points, an abandonment of consideration for others, and unproductive nastiness.  And we have to be cautious what is heralded as “science” is not scientism – a dogmatic ideology – that supplants true scientific inquiry. 

Our discipline is so fascinating – the intimate engagement with the psyche and soma through touch, with an opportunity for transformation – and we are fortunate to examine it rigorously and regularly.  We lose a lot of time bickering, when we could be using our precious energies to advance the discipline.

Of interest, I recently consulted the websites of both the regulator and the representative in Ontario.  I believed these long-established institutions would have something to say in reverence of the history of massage.  The regulator had a single paragraph re: history of regulation, while the professional representative lacked any historical context until I complained.  Then the latter quickly added a few paragraphs…hardly representative of the breadth and depth of our classic tradition. 

I find this example emblematic of the West’s current view of culture and tradition.  As author Stephen Jenkinson says in his book Come of Age: The Case for Elderhood in a Time of Trouble, “How are you to persist in a time bent on undoing what precedes it?”

History matters because it is the library of our guild; our theory and philosophy carefully curated and bestowed to the next generation.  Our collective history reflects our shared identity.  David Lauterstein equated our work as one of the non-verbal humanities. Empirical knowledge becomes the platform to test theories, commission research, and translate new discoveries.  Established theories are put up to the light, refined and honed by the subsequent generations to develop, innovate and weave their own perspectives into the discipline’s fabric.  And so, our discipline carries on.

In my view, without the context of history, our discipline is diminished to a collection of technical applications easily adopted by lesser skilled, inexperienced profiteers, who undermine the core and nobility of the discipline.  “History pulls us together”, as Sandy Fritz said.

Our discipline is capable of personally and professionally advancing the practitioner as it is promoting the well-being of the recipient.  Massage in its various forms is a meditative, contemplative art, infused with an increasing appreciation of the science that defines posture, function, behaviour, strain, allostasis and equanimity.  It’s wonderful stuff…and everybody should be receiving it!  Benny Vaughn said, “the role of massage therapists are to keep people connected to their humanness through touch.”  Brilliant words, Benny.

If you doubt our administrations to the body are any less than poetry, consider this quote from the reverent Deane Juhan, his book Job’s Body: A Handbook for Bodywork.  “Evolutionary sophistication has irretrievably forced humans to be clever in order to use our heritage for survival.  Our somatic education cannot be left to the unconscious unfolding of instincts and reflexes.  The rich potentials of our sophisticated biological inheritance necessitate some kind of conscious, exploratory and systematic way (bodywork and somatic education, for example) of teaching ourselves and our offspring how to successfully use, not abuse, the potent range of physical and mental possibilities contained within us”.[iii]

6. What do you wish to share with the next generation of massage therapists?

In my view, our greatest threat to the profession is a failure to utilize the rich human capital we have.  ABMP estimated in 2023, there are 321,000 MTs in the USA.  Estimates for Canada are 23,000, so combined we have 345,000 practitioners across our two countries who can be employed in government and insurer relations, public and media relations, gatekeeper HCP relations.  Rather than relying on volunteer Board of Directors or small operations teams with limited financing, let’s find a way to mobilize our masses towards shared objectives. 

I would love to see our professional organizations prepare us, yes, as practitioners – with critical thinking skills and research literacy, business acumen and technical proficiency – but also as agents of the profession in public education, public and media relations, and finding ways to integrate with like-minded complementary health disciplines.

I’d also like to see rigorous engagement with each and every practitioner, in the form of town halls, symposia, roundtables with subject matter experts, and other opportunities for dialogue and debate.  We have so much to work on!  From basic vernacular to assess and describe the histologic changes we feel with our hands, to commonalities among popular techniques, to practice approaches based on the best available evidence, to how we cope with serving varied populations and complex conditions, to positioning ourselves better with government, insurers, gatekeeper HCPs and the public media. 

Those we’ve placed in decision-making positions require of us to cogently define who we are, what we do, why it matters, and how our collective actions can benefit society.  So, so very much work to do!  And we need all of us actively engaged. Let’s stop magnifying that which separates us and instead find ways to bond and mobilize each of us.  We have very important work to do, and we must tap our collective agency if we are ever going to do it.

[i] Thanks to Bodhi Haraldsson for referral to Peter and Margaret Behr re: BC history

 [iii] Juhan, D., Job’s Body: A Handbook for Bodywork, Station Hill Press, 1987, pg 50.

I’m pleased to announce you can now access my past articles that appeared in Massage Therapy Canada magazine. MTC shuttered in 2023, sadly, after over 20 years of publication. I can now make my individual articles available to you – free to access – on subjects such as 1) Pricing Your RMT services 2) Reclaiming Sensibilities in an Unsensible Time 3) Incorporating Variables to Transform Your Practice 4) RMT Working Agreements…and many more. Please visit MTC articles | DonDillon-RMT and scroll until you find something of interest.

At your service,

d

The Ontario regulator – College of Massage Therapists of Ontario – has released draft health history guidelines, as an exercise in examining the “over collection of personal health information”. A discussion on the structure and relevance of conducting a health history is long overdue. I appreciate the framework the guidelines provide re: principles, inquiries not relevant/sometimes relevant and always relevant, with a focus on allowing the patient to control the amount of disclosure.

I have three arguments on how to improve the guidance document:
1) Quality-of-life questions re: regular exercise, sense of vitality, sleep quality and social engagement would be a helpful addition. Questions regarding occupation, recreation and social interaction provide a fuller context to the subject’s perception of their health and well-being. Without these, I argue, we are guilty of merely addressing the person as a physical/bio-mechanical entity.

2) Differential assessment questions deepen the inquiry and reduce risk of harm or adverse reaction to massage therapy care. We might consider a framework of identifying yellow or red flags, as outlined in Petty & Moore’s excellent text Neuromuscular Examination and Assessment.

For example, “How is your general health? Are you experiencing any feelings of general malaise or fatigue, fever, nausea or vomiting, stress, anxiety or depression?” Feeling unwell or tired is a common symptom with neoplastic disease, while malaise and depression can associate with rheumatoid arthritis.

“Have you or has anyone in your family been diagnosed with Rheumatoid Arthritis?” Collagen necrosis of the cervical vertebral ligaments is a concern in spinal mobilization, or other joints during the acute inflammatory stage. Care should be taken with movement of the neck.

“Have you received X-rays or other medical tests?” X-rays are ordered to diagnose fractures, arthritis and serious bone pathology such as osteoporosis or tumour, and to determine the extent of the injury following trauma. Other imaging includes CT scans, MRIs, myelography and bone scans. Considering the individual is undergoing such tests is a yellow-flag to be cautious in approach.

While I understand the scope of the CMTO’s exercise is to identify relevant and appropriate lines of RMT inquiry in the health history, and to position consent and disclosure squarely with the patient, I believe the regulator is facilitating an excellent opportunity for RMTs to build on their discernment and critical thinking when considering the risks of adverse reactions to massage therapy care, and that this opportunity should be seized to advance our discipline. See Dr. Donelda Gowan’s instructive thesis, Exploring Patient Safety Issues in Massage Therapy, and Understanding Patient Safety Incidents (Adverse Events).

3) There’s an opportunity to collect more qualitative data from our patient engagements while at the same time creating secure, comfortable boundaries for them. In Pam Fitch’s comprehensive Talking Body, Listening Hands: A Guide to Professionalism, Communication and the Therapeutic Relationship, she provides a simple graphic (chapter 7) for patients to indicate gradient levels of comfort with touch. The patient is encouraged over time to resubmit the graphic, observing how openness to touch and care changes positively over time. I suggest the CMTO’s draft health history guidance falls short in addressing such contextual issues and biopsychosocial frameworks in structuring the proper conduction of a health history.

Thank you for the opportunity to comment on this important exercise.

Beyond the practical matter of studying the subject of human anatomy, how can we deepen our appreciation? Anatomy fascinates us – its design, its brilliant function, its complexity. But it also repels us, as we view the unanimated body and are forced to reckon with our own mortality.

I’ve undertaken a serious study of anatomy these past two years. As I review the subject I originally studied over 30 years ago, I’m astounded at the breadth and depth I’ve been largely incognizant of. You really can study anatomy again, and again, and yet acquire new knowledge and perspective every single time. I’ve also taken up a childhood avocation – drawing – of which I’m applying to learning anatomy at a more sophisticated level, while appreciating the aesthetic of the human body. Images are peppered throughout this article.

For those of you who geek out on anatomy, and are interested in its aesthetic, here are a few resources:

Retired anatomist and surgeon Andrew Zbar produces Anatopod, a wonderful orated series that provides extensive anatomy review, history of cadaverization, anatomy and art, and colourful characters figuring into the history of anatomy. I featured Dr. Zbar in one of my articles for MTC.

Laura Ferguson, the former Artist-In-Residence at New York University, conflated her childhood experience of receiving surgical correction to roto-scoliosis coupled with her illustration skills. I find Ferguson’s resources help me reframe the subject of anatomy from a non-animated, technical subject, to embodiment and a comprehension of what it means to live through our bodies. Also check out the medical illustrations of Mike Natter, MD.

My two textbooks of choice to covet while listening to Andrew Zbar’s orations are the Netter Atlas of Human Anatomy and Carmine Clemente’s Anatomy: A Regional Atlas of the Human Body. Clemente’s atlas offers anatomical viewpoints unavailable in Netter’s more direct-on perspective, so I use both. I also supplement with the excellent Acland’s Video Atlas of Human Anatomy.

I’m consider the trip to North Carolina for two-day cadaver study with Experience Anatomy. I’m enjoying Gil Hedley‘s videos, and I highly recommend a romp through the virtual gallery at Getty’s Flesh and Bones exhibit. And if you ever have chance to attend one of the Body Worlds exhibits…wow! I attended about 15 years ago at the Ontario Science Centre in Toronto.

There are of course extensive books and computer apps that showcase anatomy and its artistic sides, so you can indulge in many ways. I encourage you to conflate your interest in anatomy with art, philosophy and science. I believe you will be richly rewarded.

I have nine questions for this year’s RMTAO AGM. You can see my questions for the past RMTAO AGMs 2020 – 2022 here.

1. In the Friday File, December 9^th, 2022 edition, M. Feraday reported, “I met with MPP France Gelinas, the NDP Health and Long-Term Care Critic.  Gelinas will be following up on our behalf after our upcoming meeting with Nadia Surani, Director of Primary Health Care at the Ministry of Health.  I also had positive meetings with the Minister of Children, Community and Social Services, Merrilee Fullerton; staff of the Minister for Seniors and Accessibility, as well as MPP Mary-Margaret McMahon and MPP Chris Glover. We are gaining support for our advocacy effort with the Ministry of Health from all these MPPs.”
   Questions:  What support, specifically and tangibly, are you asking from these MPPs?  If the MPPs granted your ask, what would tangibly change for RMTs in practice?
   
2. In the 2021-2022 RMTAO Strategic Plan Summary https://rmtao.com/about-rmtao/our-goals, one of the six objectives is “The profession of massage therapy participates in integrated team-oriented healthcare to achieve the best possible treatment outcomes for the patient.”  The RMTAO has promoted the inclusion of RMTs on teams in healthcare settings in a variety of its messaging in most recent years.  Yet we must consider serious barriers to inclusion: 1) education streams separate from gatekeeper health disciplines (MDs, RNPs, and increasingly DPharm and physiotherapists); 2) integrating health services endorsed by government/covered by provincial health insurance with services not covered 3) slow progression of research literacy and capacity in the profession; and 4) shifting our profession’s cultural thinking from sole practitioner practice to multi-discipline team settings with increased regulatory structure, among other barriers.
   
   Questions: What do you believe RMTs and their representative must do to qualify for such an integration?

3) In the 2022 RMTAO membership survey, under “resources”, additional requests from members include: regular updates on advocacy efforts (specifically HST); more posters, videos and shareable social media resources; access to research database and assistance with research analysis; editable social media templates; information re: prepping for retirement, assistance with peer assessments, raising RMT profile in medical community and mental health resources; information re: accounting, tax filing and audits; printed materials re: evidence basis for massage therapy; webinars demonstrating hands-on techniques; access to prior webinars; an explanation of how fees listed in the Services and Fees Guideline are calculated. 

Question: Will the RMTAO address these requests in future plans?

4) Follow up re: 2022 membership survey, re: Community-Based Networks (CBNs).  Fifty-seven percent of RMTs completing the survey reported they were unaware of these essential hubs of collegial support. 

Questions: What has the RMTAO done this year to raise the profile of CBN’s, and to train CBN leaders in meeting facilitation and promotion?  How has the RMTAO used CBNs as a direct source of two-way communication and interaction with its membership?  What are the RMTAO’s plans for further strengthening CBNs?

5) In 2019 the Ontario regulator halted its funding of the Massage Therapy Research Fund.  Despite a stated objective by all stakeholders – the regulator, the representative and the training schools – towards research literacy and capacity, it appears there is no concerted effort to fund this objective. 

Question: Is the RMTAO in discussions with the regulator to resurrect the Massage Therapy Research Fund?  If not, what conversations are the stakeholders having in ensuring the proper funding of research in massage therapy?

6) What are the RMTAO’s specific plans to increase member engagement and dialogue?  What are the RMTAO’s intentions to increase available data and statistics re: RMTs and their practices?

7) What is the RMTAO doing to advocate for populations who would benefit from massage therapy care, but don’t access due to financing or other barriers?

8) What does the RMTAO do for entry-level practitioners – besides hosting documents of the Resource section of the website – to properly mentor and ensure knowledge-transfer of best practices to these fledgling practitioners?

9) What variables does the RMTAO Board use in measuring influences on RMT practice – particularly government, insurers, gatekeeper health disciplines and public perception/media – and for forecasting to effectively prepare RMTs for the future?

I recently presented at the Canadian Massage Conference in Richmond Hill, ON.  Scott Dartnall of ONE Concept and a co-organizer of the conference asked me to provide a perspective on “the state of the profession.”  He implicated the breadth and depth of the problems facing massage therapists in Ontario and abroad.  The following is a transcript from my presentation.

I’ve lectured to thousands of massage therapists across this nation, and have personally spoken with hundreds over my 31 years in the field.  Many have expressed a particular pain point that can be summarized as this: the massage therapy profession has tremendous potential for contributing to society…why haven’t we hit our stride? 

Consider this: it required a quarter century to regulate just five provinces; the profession is largely research illiterate, with little support for our highly educated RMTs to advance; we endure tenuous relations with government,  insurers, gatekeeper health disciplines and media – all essential to the health of the profession; resources to regulate the profession far outpace resources to represent our collective interests; advocacy efforts on all fronts remain largely uncoordinated; we suffer irregular engagement or consultation with the decision-makers of our profession.  Thus, our collective potential is squandered. 

Today I ask you to petition with me for leadership reform – a reform that fully engages, advocates for and develops massage therapists (RMTs) in serving and educating patients at the front-lines of care.  What’s the state of the profession?  Why are we stuck?  Today I provide a prescription for the profession, and argue for the need to L.E.A.D.

Residing in Ontario, naturally my items for your consideration will be Ontario-centric.  However, I encourage you to review what I’ve provided, and consider examples in your own locale.

Before we answer Scott’s question re: the state of the profession, let’s frame the historic context, examining the socio-economic influences that cultivated fertile ground for your massage therapy practice and mine as they exist today.  In a post-war economy, manufacturing sectors in North America switched from producing the machines of war to consumer goods – automobiles, washing machines, houses and road construction. 

Consumer demand drove economic growth, leading to job surplus and great demand for skilled workers. Employers offered high wages and employee health benefits to retain these workers, while trade unions negotiated better working conditions to provide workers discretionary money and leisure time.

These economic circumstances led to demand for massage therapy[i] in at least five areas:

Athletics and fitness – With surplus time and an increased appreciation for health and vitality, people began exercising. These new fitness enthusiasts required massage for their acquired aches and pains. High-level athletes see massage as a must-have to ensure athletic performance.

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 to enjoy their status.[ii] The European spa offered a mecca to nurture one’s body beyond the objectives of injury resolution or pain relief.  Massage is a primary application in spas and includes various forms of hydrotherapies to enhance relaxation and wellness.

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 with discretionary income invested in psychotherapies, philosophical and religious studies and various forms of bodywork[iii] – all in aspiration for a richer human experience.[iv]

Worker performance and productivity – Employers want to maximize worker productivity and job satisfaction, while lowering absenteeism and employee turnover, in an increasingly competitive marketplace.  Progressive companies offer workplace wellness programs on-site – including massage services – to counter-act chronic postural stresses and strains from specialized workstations.

Economic growth supported massage therapy and other wellness-focused industries to thrive.  As a result, investment in education, regulation and representation has flourished.  Currently, massage therapists across Canada invest millions of dollars every year to finance education, regulation and representation.  Think about that…a whole industry developed to support the infrastructure of our profession.  Let’s evaluate how our investments in this industry are performing.

Education – Education has become more sophisticated over time.  Initial course offerings included massage theory, technique, myology/osteology, eventually adding neurology, assessment (ortho-neuro and musculoskeletal), regulatory standards, communications, ethics, and basic commerce.  The education of massage therapists originated in sole-program private vocational colleges, and now includes multi-program private colleges and public community colleges. 

In 2009 regulators met to begin the construction of entry-to-practice inter-jurisdictional competencies and performance indicators.  They eventually established a mandate for accrediting MT training colleges.  Accreditation includes an extensive audit of existing operations, and auditors determine if these align with desired quality of education and training.

 In 2015, the Canadian Massage Therapy Council for Accreditation (CMTCA)[v] begin it’s process of accrediting massage therapy training colleges across Canada.  Fast forward to Autumn 2022, just 4 of the 56 campuses in Ontario are accredited, with 16 campuses granted preliminary accreditation.

In recent years, some schools have closed or amalgamated.  In the USA there has been a significant reduction in the number of campuses providing massage training, year over year[vi], which may portend similar problems in Canada.  It appears in Ontario anecdotally (our decision-makers don’t appear to be tracking this) demand for RMTs significantly outpaces supply, and solicitation of prospective RMTs is left entirely to the marketing budgets of independent campuses. 

I’ve spoken with many RMTs who broker practice opportunities for other RMTs, and by doing so assume risk with larger commercial leases and operating costs.  These “practice brokers” are very concerned the wellspring of new graduates is not keeping pace with demand in the marketplace.  The pandemic and recent scandal regarding the certification exams[vii] only worsens this problem.

Let’s talk about knowledge transfer and apprenticeship.

Regulation – Before the Regulated Health Professions Act (RHPA) of 1991, massage therapy was regulated under the Drugless Practitioner’s Act of 1935.[xv]  Following the RHPA was the Massage Therapy Act (1994), Health Care Consent Act, Personal Health Information Protection Act (PHIPA), and other regulations and Standards RMTs must abide by.  Regulation serves to protect the public by holding RMTs accountable, demanding a high level of ethical fortitude.

Yet despite favourable support, regulation has been slow to progress across the country.  Ontario led regulation with the Massage Therapy Act in 1994, and British Columbia followed in 1995.  It took another 8 years to regulate Newfoundland/Labrador, and another 11 years after that for New Brunswick.  Prince Edward Island (PEI) became regulated in 2019, so all in all our profession has taken 25 years – a ¼ century! –  to regulate just 5 provinces.

This despite the formation of the Federation of Massage Therapy Regulatory Authorities of Canada (FoMTRAC) in 2003, and pre-existing regulation in Ontario and British Columbia.  Some would argue regulatory authorities don’t pass regulation…governments do.  While this is certainly true, I can’t help wondering why almost 20 years after the formation of FoMTRAC that regulation across Canada is not farther along.

Graciously, the regulator since 2006 has contributed towards the Massage Therapy Research Fund https://www.cmto.com/mtrf-funded-projects/ .  I suspect our regulator having the greatest resources to work with – and seeing an essential need for research literacy and capacity in the profession contributed over $450,000 in research grants since inception.  However those grants ended in 2017, and currently none of the key stakeholders to the profession are directly funding research.

The recent announcement by the regulator in Ontario to increase registration fees for active registrants by $100 (and $248.50 for inactive registrants), was met with great agitation by many RMTs.  If the number of registrants remains the same as 2021, the regulator will gain an additional $1.7 million revenues on top of $11.6 million it currently expects.  The regulator conducted a survey and received almost 2400 responses, with 95% of respondents saying “no” to the increase for active registrants. 

The regulator then held a Special Meeting of Council[xvi] to announce their decision.  Registrants, or “members” as they are referred to, were invited to attend but observe only.  Any participation was muted, in spite of the Registered Massage Therapists Association of Ontario (RMTAO) Executive Director assuring us the RMTAO was “monitoring the situation closely.”  The motion to increase fees passed without objection.  Is this proper consideration for people the regulator regards as “members”?

The cost of self-regulation appears to be a runaway juggernaut.  Referencing 2021 annual reports of both the College of Massage Therapists of Ontario (CMTO) and our representative RMTAO, revenues raised to regulate massage therapists in Ontario outpaced professional representation by a factor of more than eleven.[xvii]  Consider this: would the convenience of owning an automobile remain worthwhile if the fuel, maintenance and insurance for the automobile outpaced its utility by a factor of 11?

While the self-regulation model has benefits, it may prove unmanageable for RMTs in the long run.[xviii]  Regulation is expected to benefit a profession by increasing credibility and public perception, government funding and placement in community health care…funding and placement have not materialized, and credibility continues to suffer in the media.[xix]  Perhaps RMTs might consider less expensive forms of regulation,  such as an amalgamated regulator being considered in British Columbia.[xx]

Representation – Massage therapists rely on proper representation from their association to bring their collective interests to government, insurers, gatekeeper health care practitioners (HCPs) and the public media.  Such representation requires large amounts of pooled resources and representatives with skills and experience – a workload impossible for individual RMTs to undertake alone. 

RMTs also require the interaction of a community of their peers, and the opportunity to engage.  Platforms facilitating respectful dialogue and debate, local hubs to gather, symposia to share knowledge and perspective, town hall meetings to address pertinent problems and existential issues – all nurture the theory and practice of massage therapy.

Now there’s a cost to such services.  Across this country, massage therapists pay millions of dollars each year for executive director salaries, financing Board of Director meetings and association operations.  It’s fair to account for how the money’s being spent.

In mid-2020, the RMTAO suspended the members’ social media page on Facebook, when pandemic strife turned some online conversations into rageful, vitriolic arguments.  Fast forward to Autumn 2022, the page has not been restored.  RMTAO members have restricted opportunity for constructive dialogue and debate with their cohort to advance the theory and philosophy of practice. 

The 2020 COVID-19 lockdown and suspension of every RMT practice for three months was the perfect opportunity for our representative to sit down with us – virtually – to listen, to learn, to strategize, to plan, and eventually address the jugular issues facing the profession.   Regrettably, the RMTAO did not capitalize on this, but instead spent time regurgitating public health information already provided us through the regulator and public health.

The RMTAO is missing out in every conceivable way to engage its members – town hall meetings to engender robust discussions, symposia to share knowledge, perspective and evidence, round-table discussions with subject-matter-experts that can lead to strategic planning, and surveys to accumulate data and perspective essential to decision-making.

Local hubs, “Community-Based Networks” can act as a forum for dialogue, debate and support for RMTs in their geographic area.  Yet these hubs receive scarce training, support or interaction from the parent association.  If “association” is in the title, why isn’t the RMTAO associating more with its members, or facilitating regular engagement between members?

And what’s taking HST exemption so long?  The GST was applied to massage therapy services in 1991 – the same year the RHPA was enacted.  In 2014, smaller and arguably more “alternative” professions providing naturopathic and acupuncture services achieved HST exemption[xxii].  How?  These groups identified their target, focused their efforts, hired lobbyists, advanced regulation in more provinces, and eventually applied for HST exemption.  And they did it over eight years ago.  What’s taking our profession – larger and more centrist in philosophy – so long to achieve the same measure?

Per 2021 figures, less than 44% of RMTs registered as active with the regulator are active members of the RMTAO.  What’s the reason for this lack of confidence in our representative association?

Massage therapists require information to make important decisions in their practice: business expansion, serve new markets, seek cost efficiencies, invest in more training.  Yet there’s a paucity of information.  The last RMTAO earnings survey was conducted 10 years ago, and the last comprehensive survey by the regulatory body is almost 20 years old[xxvi].  If you’re considering a major professional decision like expansion or launching a new practice location or are prospectively looking at massage therapy as a career, you’ve got nothing but antiquated and incomplete data to go on.

In the RMTAO’s 2022 Membership satisfaction survey, respondents clearly identified the need for RMTAO to offer better client education materials, detailed advocacy updates particular to HST exemption campaign, access to research database, inclusion in government healthcare initiatives, workshops offering practical massage therapy techniques, and increasing the public profile of RMTs to the general public.  Hello RMTAO…are you listening?

Examples of Good Leadership

Despite the apparent failures in education, regulation and representation I’ve accounted for, I also wish to account for work well done.  Some of the problems I’ve cited are systemic problems affecting an inchoate professional culture still growing and developing.  Many individuals in the three areas of industry mentioned have worked hard and produced considerable gains for the collective.  Many are good people, trying to do a good job, in challenging circumstances.  Let me cite here just a few examples of good leadership demonstrated in our profession.

Massage Therapy Association of Manitoba (MTAM) funded a series of simple, impactful ads carried on the side of city buses in Winnipeg.  These ads cleverly and cogently put the topic of massage therapy  squarely in front of the right audience.

Registered Massage Therapists Association of British Columbia (RMTBC) launched a number of short videos[xxxii] to educate the public.  You can view these effective videos on their website.

The former RMTAO administration – when Kristen Bokalo was Chair and Andrew Lewarne Executive Director – did marvelous things.  They conducted Town Halls across the province with members, addressed big issues like the Greenshield “Elephant in the Room” campaign, performed two earnings surveys over a 4-year span so we’d have relevant, reliable information.  And, coordinated by their proficient operations staff, the RMTAO sent 42 delegates in 2018 to meet Members of Provincial Parliament (MPP) and senior policy analysts at Queen’s Park to request inclusion in discussions on chronic pain and palliative care.  This was a time of a highly functioning and effective representative.

Here’s another example.  ONE Concept began over 15 years ago when Scott Dartnall and Monica Pasinato-Forchielli jumped in to save the annual conference held by Massage Therapy Canada magazine.  The owner/publisher at that time became ill and was unable to orchestrate the final 6 weeks.  This was also a time when the RMTAO took a long break from holding conferences, so there was really no other avenue for RMTs to gather, dialogue and enjoy rich interaction with colleagues. Scott, Monica and other partners eventually developed the Canadian Massage Conference (CMC) to include more workshops, a larger exhibit hall, international speakers and now, virtual streaming during the in-person conference.  Massage Therapists need to gather, to engage, to dialogue and debate.  The CMC remains the most consistent and comprehensive venue to do just that.

L.E.A.D.

I began my presentation by petitioning you to consider leadership reform – a move away from the top-down, autocratic structure to a framework that fully engages you, advocates your interests, and assists you in transforming patient education at the front-lines of care.  The current model is authoritarian, places power of decision-making in a small number of hands, fails to broadly consult the RMT population as to their circumstances and needs, and fails to make use of our rich human capital via incorporating every massage therapist in the planning and execution of decisions that affect us all.

L.E.A.D. is an acronym for Leadership – Engagement – Advocacy – Development.  I propose we adopt these four variables as our measuring stick.  Just as our patients look to us for positive outcomes, let’s measure the progress of our decision makers by the quality of these outcomes.

Here’s what our profession could function like if we all stood up, spoke up, and leaned in:

Leadership – Your leaders would be among the people, not above them.  Your leaders would meet with you regularly, ask straight questions about your experiences, make plans and centre priorities along outcomes meaningful to your interests.  Your leaders would keep one eye to the future while managing day-to-day operations.  They would collaborate with strategic partners within the profession, in community health care and integrated medicine to better position massage therapy in society.  Your leaders would engage you in complex problems – such as how to better serve under-served populations.  Your leaders would collaborate with their contemporaries in other representative associations, combine resources and nurture effective government, insurer, gatekeeper HCP and media relations campaigns.  Your leaders would be in the business of serving your collective interests effectively.

Engagement – Your leaders would engage you through surveys, town halls, local hub gatherings, and social media.  They would solicit your ideas and perspectives, and listen intently to what matters to you.  These decision-makers would put you in touch with others facing the same pressing practice problems, and support us collectively towards resolving the sticking points in practice.  You would be recruited at every step of the process, using your boots-on-the-ground expertise to tackle the systemic problems facing the profession.  You would be granted regular opportunity and support to share, dialogue and debate with your colleagues. Evolution of the theory and practice of massage therapy would be – literally – in your hands.

Advocacy – Your leaders would advocate confidently to powerful extrinsic authorities – government, insurers, gatekeeper health disciplines and the media – with the resources you’ve provided them from your membership fees.  And they would generate constructive results!  Through shared resources, your leaders would design national public and media education campaigns, and provide you graphics, animations, informational pieces so you could contribute every day in your practice to positive public perception.  Together, every day, we would transform how government, insurers, gatekeeper health disciplines and the public/media view the profession…for the better.

Now, the “A” in advocacy has a corollary.  Our educators, representatives and regulators are only partially responsible for the outcomes of our profession.  Each of us has a role to play.  “A” alternatively stands for Agency…our agency.  I regret we’ve learned to fear the regulator, to entrust our representative without regular scrutiny, and it’s left us all passive and frustrated.

We exercise agency when we inform ourselves on the collective problems we face, when we engage colleagues in dialogue and debate, to work through our theories and philosophies of care, when we address our representatives, directly, and advocate for our needs and preferences.  For our decision-makers to be fully functional, they require our involvement in making the decisions that affect each and every one of us.  So, attend gatherings with your colleagues, talk things out, it’s OK if you disagree…it forces you to strengthen your arguments or alter your position based on new information.  This is how the profession matures.

In Closing

You are the key element, the missing link in the machinery that’s required for essential change.  Exercise your agency – knock on the doors of your decision-makers and demand competent Leadership, broad Engagement, effectual Advocacy and rich Development.  The society of Massage Therapists, if properly applied, can contribute immensely to challenges faced by community health, productive workforces, and underserved populations.  The stakes are high for all of us, and particularly if you’re closer to the entry-level stage of your practice.  Go ahead, knock on that door…and do not leave until you have been listened to.

Post-Script

For those with interest of richer context, I’ve provided references below.  Many of these references originally appeared in Massage Therapy Canada magazine, now shuttered. These references are largely mine, and admittedly fail to properly reflect a cadre of opinions. I entreat you to review the references that interest you, which I trust might awaken an eagerness within you to learn more on the historical and political context of our discipline.

[i] https://dondillon-rmt.com/wp-content/uploads/2025/05/MTC.Spring2015_Boombustbane.pdf

[ii] https://dondillon-rmt.com/wp-content/uploads/2025/05/MTC.Aut2009_takeSpaSeriously.pdf

[iii] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTCSpring2021_Touch.Language.pdf

[iv] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTCSum2021_Innate.Potential.pdf

[v] https://www.cmtca.ca/

[vi] https://www.abmp.com/updates/blog-posts/massage-schools-stay-resilient-during-covid-19-pandemic?fbclid=IwAR3dKa5ohj725bkrkd82W1O4bAJIN-J2rt_00uX6wIr353A2FyE7NjlnDGA

[vii] https://www.cmto.com/cmto-releases-scores-continues-to-investigate-cheating-in-rmt-certification-exams/

[viii] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTC.Wint2013_Research.Relevant.pdf

[ix] https://rmtao.com/Media/Default/MTT/OMTA_July10.pdf (pages 6-9)

[x] https://rmtao.com/Media/Default/MTT/Final%20PDF%20Fall%20(1).pdf?fbclid=IwAR2D5pFl1BT6lP6BiFDrna-S4S22eh8e7qB20X-wDz2mODRsZnpmXvlU5no (pages 16-17)

[xi] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTC.Sum2016_toolsteamtech.pdf

[xii] https://open.spotify.com/episode/6tstyNHD4FeL4IA6zdecjC

[xiii] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTC.Spring2018_brain.drain_.pdf

[xiv] https://rmtao.com/Media/Default/MTT/MTT_Summer2018.pdf?fbclid=IwAR2FQLIcDkG3sPPWaPSsloB2d5gSwZLa7_50-xUMroXHCTjpWBn9MyfJjDw (pages 21-24)

[xv] https://www.cmto.com/wp-content/uploads/2021/12/Article-No.-4-Winter-Spring-2019-1.pdf#:~:text=The%20Drugless%20Practitioners%20Act%20required%20Massage%20Therapists%20to,examination%20and%20prove%20that%20were%20qualified%20to%20practise.

[xvi] https://www.cmto.com/materials-and-livestream-link-special-meeting-of-council/

[xvii] http://dondillon-rmt.com/self-regulation_time-to-pivot/

[xviii] ibid

[xix] http://dondillon-rmt.com/cbc-article-illuminates-alarming-vulnerabilities/

[xx] https://bchealthregulators.ca/health-regulation-in-bc/regulatory-modernization/

[xxi] https://dondillon-rmt.com/wp-content/uploads/2025/05/MTC.Aut2014_common.good_.pdf

[xxii] https://dondillon-rmt.com/petition-rmtao/

[xxiii] http://dondillon-rmt.com/toronto-star/

[xxiv] http://dondillon-rmt.com/when-an-investigative-reporter-from-the-cbc-calls/

[xxv] http://dondillon-rmt.com/cbc-article-illuminates-alarming-vulnerabilities/

[xxvi] An Environmental scan smaller in scope than it’s predecessor was published in 2022 https://www.cmto.com/wp-content/uploads/2022/10/CMTO-Environmental-Scan.pdf

[xxvii] https://dondillon-rmt.com/wp-content/uploads/2025/05/MTC.Sum2015_change.perceptions.pdf

[xxviii] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTCSum2018_vulnerable.pdf

[xxix] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTC.Wint2017_integratedHC.pdf

[xxx] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTC.Wint2015_are.you_.employable.pdf

[xxxi] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTCSpring2022_PursuitWellness.pdf

[xxxii] https://rmtbc.ca/media-events/rmtbc-in-the-news/

[xxxiii] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTCAut2021_Critical.Thinking.pdf

[xxxiv] https://dondillon-rmt.com/wp-content/uploads/2025/03/MTCSpring2020_Politisize.Me_.pdf

Thank you to those attending the MTC forum June 18th. Thank you also to our sponsors, and of course Massage Therapy Canada for hosting the event.

I promised resources for further study on the subjects I spoke of:

Pricing Your Massage Therapy Services, Massage Therapy Canada, Autumn 2016

In for the Long Haul: Designing Your Practice for Longevity, Massage Therapy Today, Summer 2018

Construct Your Delivery of Care Model, Massage Therapy Today, Spring 2017

Tools, Team and Technology. Massage Therapy Canada, Summer 2016

On Practice: From Entry-Level to Established Massage Therapist (2021) – chapter “Pay Yourself”

The regulator for massage therapists in Ontario announced a $100 increase in registration fees for 2023.  Shortly after, social media exploded. 

If active registrants – according to the CMTO 2021 annual report – remain at 14609 (fee increases by $100) and inactive registrants at 1254 (fee increases by $248.50) then the regulator will draw an additional $1,718,519 from Ontario RMTs this year over 2021 revenues of $11,649,949. (That is, an increase above previous revenues from active registrants of $1,406,900 and inactive registrants $311,619).

In 2021, revenues for the regulator exceeded those for representation (RMTAO) by a factor of 11. In 2022, they will be even greater.

I expect some RMTs will respond to news of the fee increase with “is the privilege of self-regulation worth the cost?”  I think it’s a good question worth exploring, and I trust my colleagues might entertain this argument with a frank and respectable discussion.  I’ll state up front I support regulation as a mechanism to define standards and ensure the public quality of care and accountability of practitioners.  I do wonder if RMTs can afford the current level of self-regulation, and what other options are possible.

Opinions on social media deplore the dramatic hike over the previous year, particularly against income losses during pandemic lockdowns and appointment cancellations due to exposure/testing positive.  I note the 2023 fee will be 53% higher than 2016 – a 7.5% increase/year over year during this timeframe.  As RMT service fees are subject to market forces: what health benefit insurers will reimburse for claims, changes in client discretionary income, inflation, and fees comparative to similar services – it’s improbable RMTs feel confident raising their service fees at this pace.

The RMT profession has coveted the ideal of self-regulation.  We suppose it provides status, credibility, higher public perception.  Unfortunately, self-regulation across Canada is taking a long time (ON 1994, BC 1995, NFLD/LAB 2003, NB 2014, PEI 2019) despite the formation of the Federation of Massage Therapy Regulatory Authorities of Canada (FOMTRAC) in 2003.  Search “massage therapy” on any major media outlet, and you’ll be disappointed by the story lines. And despite regulation, our profession hasn’t progressed much by way of inclusion in hospitals, community health clinics, or funding under provincially sanctioned health insurance.  We’ve been invited to the dinner party, but there’s no setting for us at the table.

It appears our profession has trouble galvanizing on critical issues.  For example, in 2014, smaller, arguably less mainstream disciplines naturopathic practitioners and TCM practitioners/acupuncturists organized, strove for regulation across provinces, and successfully had their services deemed HST exempt. https://www.massagetherapycanada.com/new-naturopathic-acupuncture-hst-exemption-a-wake-up-call-to-massage-therapy-profession-2314/.  The MT profession is finally progressing on the issue this year. https://www.crmta.ca/wp-content/uploads/2022/03/Formal-Request-Ltr.pdf

I wonder if massage therapists in Ontario can afford such a comprehensive level of self-regulation.  Costs are steep: College of Massage Therapists of Ontario (CMTO) revenues in 2020 were $12,020,822 (most recent year available), eclipsing dollars spent on professional representation at $1,087,832 (2020 financial statements – RMTAO).  Therefore, 11 times the resources are spent on regulation compared to representation of massage therapists in this province.  And discipline cases have been steadily rising https://www.cmto.com/concerns-complaints/hearings/discipline-decisions/ so the costs of self-regulation can only go up.

Ian Kamm, RMT, presented a compelling presentation at Sutherland-Chan in February 2019 where he pondered if self-regulation was essential.  He analyzed the history of CMTO discipline summaries, and encouraged attendees – many former or existing students of his – to become more involved in the advocacy of their profession https://sutherland-chan.com/wp-content/uploads/2019/02/FingerPrint.v42.-Ian-Presentation.pdf.  You’ll find some of my thoughts on Ian’s presentation here https://tinyurl.com/2p8f4mf6

Perhaps RMTs should consider alternatives to this level of self-regulation.  Types of umbrella regulation exist for professions like physician assistants, pharmacy assistants and physio/occupational therapy assistants. https://www.collegept.org/rules-and-resources/working-with-physiotherapist-assistants  British Columbia health regulators have proposed regulatory modernization, which includes the amalgamation of regulators.  In their proposal, “Regulatory College of Complementary and Alternative Health and Care Professionals”, Chiropractors, Naturopathic Physicians, Traditional Chinese Medicine Practitioners & Acupuncturists, and Massage Therapists would be amalgamated under one umbrella. https://bchealthregulators.ca/health-regulation-in-bc/regulatory-modernization/

We may, on reflection, determine self-regulation comes at too high a price, given the profession’s poor progression on research literacy and capacity, comprehensive public and media campaigns, developing strong relationships with government decision-makers, gatekeeper health disciplines and insurers…all affecting massage therapy care from becoming more accessible. 

Perhaps we are due for a strategic pivot – amalgamating with like-minded health disciplines or seeking inclusion under the umbrella of a more established profession like physiotherapy or nursing. These options might make costs, and professional representation, more achievable.  I encourage readers to contact the decision-makers in your professional associations, and entice them to a round-table discussion on the subject.

I’m excited to be presenting “Design Longevity into Your Massage Therapy Practice” at the MTC Forum this June 18th in Kitchener. This is a live, in-person event, COVID protocols in place. I’m missed connecting with colleagues in person and I look forward to seeing you there.