I’ve been deliberating for some time over whether to raise my professional service fees.  My practice is located in a small city where an automaker – the major industry in this town – laid off thousands of workers years ago.  Tourism and other industries have suffered, and I suspect many shopkeepers and service providers have wrestled with their pricing decisions for fear of customer reprisal.  It causes me to reflect on how I, and indeed my colleagues, set pricing.

How do we set our pricing?  Is pricing based on the type of massage or sector served (rehabilitation, spa, integrated wellness, in-chair massage)?  Time-length of session?  Inputs of labour or added elements like hydro\electric therapies or special hand-tools?  Are some outcomes (pain reduction, better mobility) more valuable than others (reduced anxiety, relaxation, better sleep quality)?

What role does wealth of the local economy, reliance on generous employee benefit plans, competition with peers or other services promising similar benefit play?  What are our own beliefs about the value of our work, our relationship and experiences with money, and what we believe patrons are willing to pay?

Pricing is how the practitioner “captures” the value they offer to the marketplace.  “Price transmits the most important signal to the customer…what the (practitioner) believes the product is worth”, states Ronald J. Baker, author of Pricing on Purpose:  Creating and Capturing Value.  Read the whole article at Massage Therapy Canada magazine

On the Canada Broadcasting Corporation (CBC) program Cross-Country Check-Up May 1st, a discussion on whether tighter regulations for alternative health care ensued. This was prompted on the recent conviction of the parents of Ezekiel Stephan. Ezekiel died when his parents refused to take him to a physician despite life-threatening symptoms and instead administered homeopathic remedies.

You can find the full broadcast at http://www.cbc.ca/radio/checkup/should-alternative-healing-be-more-tightly-regulated-1.3557679

Part of my submission was read on-air (43:06 into broadcast) and my full submission follows below.

re: Should Alternative Health be More Tightly Regulated?

Yes. Yet, there’s a better question, “Do Canadians have access to the most efficacious health care?” The case of Ezekiel Stephan and his parents is a tragic one, and could have been avoided – not by more regulation per se – but better methods at improving user information (and informed choice) and treatment efficacy.

By linking clinical outcomes via technology and reported patient experience to a national database, the public would clearly learn what methods were working and which were suspect. In an age of user experience, it would be health-care users – not political lobbyists – determining what methods were sanctioned based on efficacy.

It’s very difficult for emerging health professions to receive necessary health care funding or research dollars. These emerging professions are not included in the consideration of public health care, even when they are regulated.

Massage therapy, for example, has been regulated for almost 100 years in Ontario, the last quarter century under the Regulated Health Professions Act. Yet despite the rigors of regulation, massage therapy is not funded by Ontario’s health plan, is subject to the HST (because over half of the other provinces are not regulated), and is precluded from hospital patient care, Community Care Access Centres or public health settings. This preclusion despite evidence showing efficacy in the treatment of conditions such as lower back pain, treatment of anxiety and depression.

Massage therapy was overlooked when the Ministry of Health and Long-Term Care announced its Lower Back Pain Pilot Program. The profession was later thrown a bone when the Ministry agreed to inclusion at only one of the test sites (out of seven), and treatment delivered by students at a training school, not seasoned professionals.

Western medicine has a political choke-hold on funding and government support. But medicine didn’t always have the public confidence. Before the Flexner report (1910) commissioned by the Carnegie Foundation, medical schools of varying quality operated in the marketplace. Hospitals were not seen as places of recovery, but of dying. See Patricia O’Reilly’s book “Health Care Practitioners in Canada” to see how politics played heavily in credibility and funding in health care.

People that pursue medical degrees typically come from wealthy families who provide philanthropic donations to hospitals and medical colleges. Pharmaceutical companies also inject millions of dollars into positioning their products in the application of western medicine, ultimately affecting the type of interventions that are endorsed by government.

Proponents of western medicine may cry “where’s the science?” and bemoan a paucity of research for these rival interventions. This detracts from the problem that small professions just don’t have the money.

Small professions are expected to self-fund research to prove efficacy, while western medicine is supplemented from a variety of wealthy sources. It’s a chicken-and-egg outcome for less resourced disciplines to prove themselves.

Western medicine practitioners are already working with chiropractors, massage therapists, naturopathic practitioners and a variety of what is usually termed “Complementary and Alternative Medicine” (CAM) practitioners. I concur, all these professions can and should do more to demonstrate efficacy in their approaches. But the way the system is set up now, these other professions don’t stand a chance.

The National Institutes of Health branch – National Center for Complementary and Integrative Health – is funded by the US Government to explore efficacy in alternative approaches to western medicine. I would like our government to shift from a “prove it to me” stance to a “let’s prove or denounce it together” approach.

The parents of Ezekiel Stephen made a terrible mistake. That mistake could have been avoided if our health care system truly integrated the best of various forms of medicine, funded research in emerging professions that show promise through reported direct user experiences and measurable outcomes, and governments that determine access to services based not on the politically savvy but on efficacy.

As I was reflecting on Ontario’s Proposed Clinic Regulation, I considered possible solutions.  Regulation can be an expensive process requiring lots of oversight and reach.  Measuring its effectiveness in actually dealing with the problem could be difficult.

What if the profession could influence the RMT culture in a broader way, a way that would give practitioners more agency in their interactions with employers/landlords/practice brokers?

In an article published in Massage Therapy Canada, Spring 2016, I outline such an idea:

“Massage therapists are among a number of regulated health professionals that work as contracting “freelancers,” tenants under a larger business, or employees. Cross-contamination of the different working arrangements is common in our profession, and creates confusion, tension and corruption of business models, as well as risk of misclassification by Canada Revenue Agency.

The solution? Ask regulatory colleges and professional associations to hire legal counsel to draft employment, tenant and contractor/freelancer contracts, complete with all provisions regulated health professions must adhere to. Financial compensation, hours of employment and other non-regulatory variables specific to the common employment contract would be added as an addendum to further define the relationship.

Employers are already complicit in privacy legislation and mandatory reporting – if their employed regulated health professionals demonstrate incompetence, incapacity or abuse. A common contract containing all regulatory requirements legally bind both practitioners and the employers they work for, extending regulator influence beyond the practitioners they regulate.”

Read the whole article at:

http://www.massagetherapycanada.com/opinion/proposed-ontario-clinic-regulation-%e2%80%93-an-alternative-3182#sthash.Ns1GEocl.dpuf

On the heels of my articles featuring top 12 desired practice management software features, and an interview with 6 RMT-software developers , I want to ask you directly, “Can we tighten our assessment and outcome variables in our charting practices?”  I’m wondering if our profession can collectively get tight around what we assess, how we measure it and how we qualify change brought about by our hands.

1. Posture – (spine) kyphotic, lordotic, scoliotic
   Posture – (shoulder & pelvic girdle) tilt, twist (torsion), protract (draw out) or retract (drawn back)
2. Range-of-Motion – full, limited, impaired (alternative degrees of motion)
3. Muscle (motor) test 0 – 5
4. Palpation: tension, tenderness, texture, temperature
   (3 grades each, see table below)
5. Numeric Pain Scale 0 – 5 (0 no pain to 5 excruciating pain
6. Neurologic/orthopedic tests  + or – (positive or negative)
7. Pain questionnaire – score (Vernon-Mior, Oswestry, DASH, Lower Extremity Functional Scale, etc)

Why would I suggest doing this?

1) Communication – if we’re all measuring the same variables we can engage in professional inquiry and qualify our experiences within and outside the profession

2) Credibility – using a common lexicon and producing the same outcome measures despite different practitioners contributes to the sophistication of research conducted and results measured.  Credibility is essential to health care funding and gatekeeper HCP confidence in referrals.

For those who attended Work that Charting! at the Canadian Massage Conference this past weekend, here’s a sample of the completed Assessment/Treatment template for you to study.

If you’re interested in the methodology and accessing the templates, the revised self-study workbook will be available in the coming months.  Keep posted on our Facebook page or sign up for announcements.

“Hi Donald.  Thanks for your email and comments. You make some good points.  The article was really a look at how we use benefits at different ages and stages and how that has changed rather than suggesting that they aren’t needed or helpful. They are certainly needed and certainly beneficial.”

(regards) Adam Mayers, Personal Finance Editor Toronto Star| 416-869-4821 amayers@thestar.ca

Hello Adam, and thank you kindly for responding back.

I appreciate that your intention was to write the article highlighting how people use their employee health benefits at different ages and stages.  While your article could have referred to more data, and indeed in a more objective way, I suspect many found your intentions arcane and purposefully inflammatory.

I read Mr. Willow’s white paper you referenced, Employee Benefits Plans Not Reflecting Canada’s Health Challenges According to New Study, and Mr. Willows presents a sincere concern with how health benefits are utilized.  We collectively would do well to heed his advice.  However your article focuses on comments not included in the document, and I’m assuming were made in a private conversation.  Mr. Willows is portrayed as skeptical and ignorant when referring to chiropractic, physiotherapy and massage as “the Three Amigos”, massage “as a lifestyle”, “a special treat” and “considered something for the wealthy”.

Your article provides me with the impression that the sharing of data or trends from Greenshield’s study – indeed helpful and useful information for workers, employers, insurers and health care providers alike – is shadowed in a pall of antagonism and distrust for the intentions of these health care providers.

There was so much good information that could have been extracted from the Greenshield paper.  For example, Mr. Willow’s describes how only 1% of benefits are utilized on dietitians and nutritionists.  He hints at the social determinants of health, and sets up an opportunity to discuss how worker benefits could be better prescribed and directed, perhaps in line with personalized medicine.

We must all ask the question; if workers are not making the right choices with their available benefits, how can we ensure best evidence and health policy direct them?  Perhaps there is a way to align the interests of workers, their employers, insurers and health care providers.  This focus is where your article could do the most good.

Mr. Willows references concern for benefits used by people of younger ages.  I think this is reflective of the societal impact on health at younger and younger ages.  I certainly see this in my practice.  Mr. Willows may be interested to learn that, beyond the treatment of strain and pain, massage therapy in implicated for health enhancement and wellness, which contributes lower health costs.  C.K. Andrade in her seminal book Outcomes Based Massage recognizes benefits beyond simply injury rehabilitation, including: improved energy and sleep, better social functioning and family relationships, a sense of well-being, improved mood, relaxation and coping skills, mindfulness and greater life satisfaction, positive attitude and empathy towards others.  Cultivating these health benefits could go a long way to addressing the serious, insidious illnesses Mr. Willows references.

Resources are limited, and more cost-benefits analyses are needed in the utilization of employee health benefits, no question.  I suggest not inflaming the relationship between insurers and health care providers but instead using the media to foster a dialogue on how to better care for workers with the resources available.

Thank you,

Don Dillon

cc David Willows, Vice President, Strategic Market Solutions, Green Shield Canada david.willows@greenshield.ca

In the article The Rise of the Three Amigos of Health Care,  http://www.thestar.com/business/personal_finance/2015/04/13/the-rise-of-the-three-amigos-of-health-care.html?referrer=https%3A%2F%2Fwww.google.ca%2F Adam Mayers presents valid concerns for how employer-sponsored benefit plans are utilized.  He describes specifically physiotherapy, chiropractic and massage therapy providing “soft benefits” ie: harder to measure – and the associated costs that could affect money spent on pharmaceuticals.  I’m writing to add additional context to the concerns Mr. Mayer raises.

There is a surprising lack of financial support for treatment of the structural components of the body that help us to move – muscles and connective tissues.  Chiropractic and physiotherapy were removed from the provincial health plan in 2004 – presumably to shunt dollars to treatments for heart disease, cancer, diabetes and other chronic illnesses with some association to lifestyle choices.  Massage therapy – despite being regulated as a health profession in Ontario since 1919 – has curiously never been covered under OHIP.

Provincial funding for orthopedic treatment of osteoarthritis or severely traumatized joints is not extended to strains and sprains affecting the everyday function of people.  It appears these injuries and ailments hold low priority, and employers – rather than our health care system – are mandated to pay for them.  Case in point – a person experiencing soft-tissue and joint injuries in a motor vehicle collision must tax their employer-paid benefits first before applying for claimant-paid auto-insurance benefits.  I’m not sure why employers aren’t up in arms over this and organizing a response to the insurance industry.

I wonder if Greenshield in their data review has considered that rising expenditures in these areas are a shift from drugs to physical/psychological therapies as a reflection of the population preferring less invasive or dangerous interventions to pharmaceuticals or surgery.  Judicious treatment of soft-tissue injuries may preclude or limit the need for more invasive interventions, or obviate the serious side-effects associated with the ingestion of pharmaceuticals such as Non-Steroidal Anti-Inflammatory drugs (NSAIDs).

True, there is a lack of accountability on how employee benefit plans are used.  Employers trust employees to search out practitioners in the open marketplace that can help them address various symptoms affecting health and wellness.  There is currently no measure in place to assure the employer that the benefits have been well directed or effective.

Practitioners – the vast majority ethical, compassionate and competent – are penalized for excessive or unnecessary billing only if there is an investigation by their regulatory body or a criminal conviction.  No question, a few unscrupulous providers are casting a dark pall over the reputations of the majority of these regulated professionals.  As well, more accountability for how these benefits are used is long overdue.

Perhaps designing a system similar to a trust fund – where employees and employers pay in – and health professions provide approved treatment plans substantiated by the best evidence available – may improve the situation.  The current system that pools risk to lower costs creates incentive for employees to use plans without judicious consideration (or accountability to the employer) of where and how the money is spent, and incentive for insurance companies to deny claims or discredit credible services to improve profit margins.  Turn “soft benefits” into hard by establishing clear workplace outcomes – reduced time off work, increased job satisfaction and sense of well-being – and ensure workplace benefits are used toward those outcomes.  Practitioners could be registered and would lose access if outcomes were not reached.

Its unfortunate Greenshield refers to these 3 regulated health professions in a derogatory manor.  Of particular concern is Greenshield’s vice president David Willows referring to massage therapy as “a special treat”.  As mentioned, massage therapy has been regulated in Ontario since 1919 as a health profession, and demonstrates effectiveness in the treatment of headaches, lower back pain, arthritis-related stiffness and pain, muscle discomforts related to pregnancy, and most recently efficacy in the treatment of anxiety.  It appears Mr. Willows is unaware of the evidence favouring massage therapy to address a number of health concerns.  Ironically, employees in the insurance industry – along with the technology and finance industries – are cited as some of the greatest users of employee benefit plans.

It would be helpful if Greenshield and the insurance industry worked in collaboration with research and educational institutions to draft a cost-benefits analysis how physiotherapy, chiropractic and massage therapy may off-set costs that would typically show up in the provincially-funded medical system.  The insurance industry may complain of the rising use in employee benefit plans, and employers are justifiably concerned about shouldering these costs, but is this a red herring?

Without study, we won’t know if in fact expenditures for these “3 Amigos” may actually be saving the provincial health care plan a considerable expense.  Job-related stress, for example is estimated to cost the Canadian economy $16 Billion dollars/year.  As per Mr. Willows claim about the drugs that can “send you from bed back to work”, please elaborate…I’m unaware of such miracle drugs and would be quite interested in their efficacy.

As for the mention of children receiving care, it appears we are seeing children at younger ages developing the same afflictions their parents and grand-parents suffer from.  Perhaps the focus should be on correcting the social-economic mechanisms that affect quality of life and trigger repeated responses to stress rather than precluding populations simply because they appear novel in our consideration of health and quality of life.

You may also like:

Insurance Adjudicators Assume Gatekeeper Position http://massagetherapistpractice.com/insurance-adjudicators/

Insurance Claim Challenges: A Problem More Insidious than Fraud http://massagetherapistpractice.com/insurance-claim-manipulation-a-problem-more-insidious-than-fraud/

Insurance Coverage for Massage Therapy: Going, going…gone? http://massagetherapistpractice.com/insurance-coverage-for-massage-therapy-going-going-gone/

I was reading this morning about Zeel: Massage on Demand.  With an app on your smart phone you can book a same-day, in-home massage, designate the type and duration (60 or 90 minute), and the practitioner comes to you.

Zeel is membership-based, and for $99/month (more in some upscale areas) plus built-in tip and taxes, you receive a monthly massage plus a massage table you retain in your home.  You can purchase more massage sessions at the same $99 price if you choose.  Zeel also offers a corporate chair massage service.

Zeel counters the greatest obstacle to in-home massage…the practitioner having to lug in the table every time.  In using smart phone technology to select, book and pay for your massage, Zeel has maximized convenience and time savings for the user while appealing to our ego’s need to be nurtured in our own space.

How much more often will users book a massage when they’re regularly reminded of the massage table in their home?  I predict this will be very, very big.

Another service, Pager, provides a similar service but by bringing physicians to you.  Home visits by a doctor, no crowded waiting rooms with contagious people, no-surprise fees up front…wow.  Truly service built around the patient.

Delivery-of-service models for massage therapy emerged from physiotherapy and nursing applications during the World Wars, the European Spa, athletic massage and the human potential movement in the 1970’s.  However with the advent of technology and large companies in the rehab and spa sectors brokering massage services and creating new work opportunities for practitioners, it appears change is happening in the profession at break-neck speed.

While many massage therapists assume they will work as self-employed contractors, the marketplace is presenting new challenges.  With more competition, higher costs to entry-level practice and the demand for sophisticated business skills, massage therapists (RMTs) are increasingly forging a career in corporations brokering massage therapy services.  RMTs require training to ensure they are work-ready, and strong candidates will need to display a number of qualities to be considered highly employable.

How employable are you?  Do have excellent qualifications?  You have your RMT registration…what other transferable skills or value do you bring to the table?  How about actual business experience in customer service and sales?  Large businesses that broker RMT services have multiple locations and considerable resources, and are looking for skilled practitioners with a team spirit, passion for service and strong customer service skills.

Many companies employ RMTs – LifeMark (CentricHealth), Massage Addict, GoodLife Fitness, Hand & Stone Massage and Facial Spa, and large spas like Elmwood Spa.  These corporations invest capital, provide strong branding in highly-visible commercial real estate, strong marketing campaigns and operating systems, support staff and business expertise, and a long-term commitment to see the business grow and evolve.  These corporations have multiple locations and considerable resources, and are looking for skilled practitioners with a team spirit, passion for service and strong customer service skills.

The marketplace has changed!  Previously conducive to sole practitioners, the marketplace increasingly asks for convenience, lower cost or better value.  Many people feel safer with the recognition of a national brand and commercial site.  Just like 3-D printing is disrupting manufacturing, the internet has disrupted media / publishing and the smart phone disrupted just about everything, the way people access RMT services is being disrupted, competition has become fiercer and we are challenged to adapt to these new circumstances.  Consider that these large companies actually provide a solution to a chronic problem in the RMT profession, that of providing a well-managed, viable business to work in.

You might say, “I’d rather be self-employed!”  Wonderful!  Do you have the capital to finance a business start-up, and the money to keep it going until profitable?  Do you have a network of contacts that will show up at your door to purchase services from you?  Do you have real business experience and competence in accounting, marketing, customer service and operations? Do you possess the commitment necessary to work long hours and foster growth in your enterprise?  If not, you may not have the resources to work for yourself.  Four out of five businesses fail within 5 years of start-up, the main reasons being negative cash flow and lack of owner business experience/competence.

I’m not saying there is no place for private practice.  We will always need entrepreneurial types with specialized skill sets to serve niche markets.  I’m saying that it’s harder now for an RMT to accumulate the resources needed to maintain a sole practice.  Our profession can learn something from these businesses that broker opportunities for RMTs.

Benefits of employment

Why would an RMT consider these employment opportunities?  Many of these corporations offer:

• Incentives and bonuses
• Comprehensive employee health and dental benefits package
• Appointments booked and confirmed by support staff
• All supplies provided
• Extensive marketing campaigns to build your client/patient base
• Paid training and professional development opportunities
• Income tax/payroll deductions at source
• Flexible schedules – work full or part-time
• Electric tables / ergonomic aids
• Team environment and collegiality
• Computerized appointment and record-keeping system
• other positions (non-physical) within the company.

What’s more, these businesses are already capitalized – no financial output required by the RMT!

These businesses are highly sophisticated. They have researched their target market, have catered service to be truly client/patient-centric, launch frequent and targeted marketing campaigns, they know how to expand and to mitigate risk, and have established branding and reputation.

Complaints from RMT Employers

In my discussions with owners/managers from several of these companies, I have listened to criticism and concern about workplace-readiness of massage practitioners.  Concerns include:

• Practitioners see themselves as individuals and have trouble integrating into a team practice
• Practitioners demonstrate care for the client/patient, but are inattentive to the larger client/patient experience re: workplace cleanliness, freedom from clutter, first impressions
• Although well prepared in the academics of health sciences, regulatory requirements and basic massage techniques, practitioners are frequently untrained in critical skills of customer service, sales and promotion, and business operations.
• Practitioners fail to invest in their practices, running between several locations, being unavailable for more work at the primary location. One business owner iterated, “RMTs need to temper their expectations of growth, and learn to cultivate their practice in a primary location.”
• Practitioners solicit clients/patients from the business and steer them to the practitioner’s home practice or other location, extorting the established relationship and acquisition costs paid to acquire that client/patient by the primary business.
• Practitioners often don’t understand the principles of cash flow and profit/loss or the costs of running a sustainable business. They frequently demand financial terms that are not in line with the assets they bring (or fail to bring) to the business.

Sure-Fire Ways to Get Fired:

• Complain to clients/patients about dissatisfaction with pay or workload, or press religious or political beliefs or personal issues while providing service
• Leave the therapy/spa room in a mess, and damage the quality and image of the business
• Discuss client / patient personal information in public spaces
• Steal, lie, cheat, harass fellow workers or patrons
• Show up late, miss shifts, be unkempt in appearance and otherwise be unaccountable

Complaints in any relationship should be taken to the source…not vetted through the client/patient who has paid to receive professional services.  Workplace hygiene and safety is the responsibility of all employees, and client/patient information should only be discussed in the confines of a private space.  The offensiveness of the final two points is obvious.

Employment Worries:

RMTs may be cautious to seek employment.  They fear giving up autonomy or control over business variables, or they may be suspicious of the intentions of business owners, particularly if non-RMTs.  Let’s address some of the common misconceptions:

Inferior pay – Practitioners are convinced they’ll earn less income if employed.  Consider the Registered Massage Therapists’ Association of Ontario (RMTAO) income surveys of 2009 and 2013, reporting average gross income of $39,100 direct hands-on care ($38,500 in 2009).  These stats are largely reflective of RMTs who designate themselves “self-employed”.  If you compare the take-home pay (after business expenses taken off, remaining money to live from), to an RMT employed in one of the corporations mentioned, in an apples-to-apples comparison you may be surprised who comes out on top. What matters is not what service fee is charged, but what you take home at days-end to live off.

Further, many employed RMTs have access to equipment that lessens strain/increases work capacity, incentives and bonuses and higher traffic potential.  While it’s true you can earn more working for yourself (because you’re not paying someone to broker capital, contacts, competence and commitment for you), will you?  You must have sufficient amounts of the 4 C’s to launch and sustain a business.

Inferior skill – Another argument I’ve read on social media is the belief that RMTs who seek employment over self-employment are somehow defective.  “They must be inferior if they’re working at someone else’s business.”  I’ve met RMTs with 8, 15 and even 24 years registered that happily work as employees.  They recognize the advantages to employment in these larger enterprises and prefer the resources and business savvy these large companies offer.  I’ve personally received excellent care at several of these businesses.

Exploitation – Whenever you have to work with other people, in any type of business sector or workplace, exploitation is possible…even in small private practice settings.  RMTs used to complain (and still do) about chiropractors and physiotherapists before other these large corporations were on the scene.  Let’s be clear – you are responsible for advocating for your interests and to understand the full scope of your rights.  Study labor laws, seek counsel from lawyer on contract negotiations, press the RMTAO and RMT schools to form functional relationships with major employers, utilize the experiences of others on social media.

If you sign a bad contract or fail to assert yourself when there’s an attempt to take advantage of you, that’s all on you.  Educate yourself and assert your professionalism.  You can take steps to dramatically reduce the chance of exploitation.

Become highly employable:

If a practitioner can bring value to the business in the form of high retention, drawing business in, supporting other team members and contributing in positive ways to the workplace, they will ultimately be rewarded with bonuses, premium shifts, employee benefits and opportunities for advancement.  Unlike private practice, working for a corporation provides alternatives for generating income not directly related to hands-on care.

The best employees demonstrate friendliness but are not over-bearing, enthusiastic while being empathetic, show initiative and competence but are not arrogant, and are authentic and gracious in service.  They recognize they are a part of a larger integrated team and strive to accomplish goals common to the mission of the business while supporting and encouraging fellow workers.

Here are some tangible ways of increasing your employability and value in a company:

• Be well-dressed, engaging and researched for your interview
• Be prepared with questions to ask about the business
• RMT designation is not a guarantee of quality – employers will often ask for a short demonstration of your skills and client/patient engagement. Be willing
• Be prepared to commit to a trial and see how the relationship will work out
• Ensure clients/patients feel safe, warm and comfortable in your presence…always
• Empower patients/clients by letting them dictate comfortable and tolerable pressure, temperature and other experience variables
• Look for ways to add value to the patient/client experience. As Disney said, “Do your job so well they’ll want to come back to see you do it again.”
• Be gracious – lower table for an easy transition to standing post-session, provide water/recovery aid at the end of session.
• Focus on the primary issue and get results in that session.
• Design and present a plan to help patients/clients accomplish their long-term goals.
• Get massage yourself, learn from others while investing in your own health and wellness
• Share remedial exercises and helpful information…be a resource
• Be a team player, show initiative in creating a better workspace for all

In Closing

Our professional culture does a dis-service in encouraging RMTs only to be self-employed.  Without the 4 C’s many are doomed to poor outcomes.  I encourage you to go and sit interviews with as many of these corporations as you can, learn about what they have to offer.  You might be surprised how attractive being an employee can be.  And should you accept a position, prepare to work hard to be as employable and retainable as you can be.

Greetings! Over the last half year I’ve sorely neglected my blog to write in Massage Therapy Canada’s blog, particularly on “touchy” issues (I know, horribly punny).

First I wrote on how acupuncture and naturopathic services – once considered fringe and alternative – surpassed massage therapy in gaining exemption from the HST consumption tax in Ontario.  How embarrassing for RMTs!  How illustrative of our profession’s ability (or not) to work together on substantive issues. http://www.massagetherapycanada.com/content/view/2314/41/

I also spoke up on what amounts to professional snobbery of massage therapists working in spas.  Spa massage is a key component of the heritage and growth of the profession, and spa therapists needn’t apologize or be made to feel inferior.   http://www.massagetherapycanada.com/content/view/2346/41/

Next, I decided to tackle some of the misperceptions regarding membership-based massage businesses.  No doubt this business model is disruptive to the way we’ve done business in the past, and is frightening many practitioners.  However, I encourage RMTs not to let fear be their counsel and instead explore opportunity in engaging and even integrating this newer platform of delivering massage services.  http://www.massagetherapycanada.com/content/view/2384/41/

Finally, I took exception to some of the conclusions drawn by an RMT new to practice suggesting, I perceived, that RMTs weren’t acting morally if not adopting research into their regular practice.  I suggested she may not be sensitive to the concerns of seasoned RMTs, nor our strained relationships with insurers.  http://www.massagetherapycanada.com/index.php?option=com_content&task=view&id=2397&Itemid=132

I’ll make you an agreement.  I’ll keep writing if you keep reading, thinking, applying, advocating and pushing for a better profession.  Deal? Hope to see you at the Massage Therapy Canada Business Forum, September 14 http://www.massagetherapycanada.com/businessforum/

dqd

Dear Mr. Lewarne, ED, RMTAO   Andrew@RMTAO.com

Congratulations on your appointment to the position of Executive Director, Registered Massage Therapists Association of Ontario.  I’m writing today as a long-time RMTAO member to express my hopes and aspirations for you in your tenure, and to affirm an urgency which I hope you will take to the task at hand.

We all acknowledge the association has been hamstrung in selecting and retaining an executive director to see the association through the long term, and as a result it’s been hard on the board to maintain even basic operations.  Accolades to staffers Jill Haig, Rachel Chuffart and Valbona Kapastra!

As you have served on the board for a number of years before this ED assignment, you’re aware in the past 5 years the RMTAO has employed two Executive Directors – each lasting less than 2 years each.  You, Mr. Lewarne are the third, and I suspect RMTAO members have great expectations of you.   RMTAO members rely on their association to advocate their interests to outside influences – some potentially harmful to massage therapist practice – and to bring us together in dialogue and debate to work through our profession’s issues and engage us in the solutions.  We are hopeful that you will apply a direct hand so the RMTAO can now move forward on achieving outcomes long-overdue outlined in the RMTAO board’s End Policy.

Five Years with Little Progress

The Ends Policy – the desirable outcomes for the profession as identified and set by the board – was ratified in 2007 and revised in 2013.  The Ends Policy is the RMTAO’s benchmark, defining where the association is going and what it looks like when it has arrived.  These are the every-day targets you, in your command of the association’s resources, are shooting for.  It’s how RMTAO members determine if you’re on track and are reaching your targets.

End Policy objectives:  the profession 1) has a clear and visible identity 2) has the highest professional standards 3) engages a culture of inquiry 4) is recognized by the public, health care professionals and other stakeholders as a valued health care option 5) engages in inter-professional collaboration to achieve best possible patient outcomes and 6) is prosperous and financially viable.

The RMTAO record for meeting RMT interests in the last five years isn’t good.  It doesn’t appear the RMTAO since 2007 has moved in any way towards these desired ends, and in fact, status for RMTs on a variety of important fronts has declined.  Despite RMTAO Chair Krystin Bokalo’s assertions at the last RMTAO AGM that the revised Ends Policy is “dramatically different”, I suspect if you review the two together you’ll find they are quite similar.  In effect, we can and should measure whether and how much the RMTAO has moved, since 2007, toward achieving its objectives.  Let’s compare what is with the above stated objectives:

1) The RMT profession is maligned frequently in the media with an identity of prostitution, insurance fraud or as a fringe, unsupported-by-evidence wellness modality.  In recent media coverage into sex-trade workers using massage services as a front, journalists have interspersed the title “massage therapist” when referring to sex trade workers, leading to public confusion and harmful association.  To RMTAO members’ knowledge, these representations are not being responded to/corrected by the RMTAO.

2)  The association, regulatory body and 49 training schools in Ontario do not appear to be working collaboratively, as was premised in the Strategic Plan of 2009 http://www.cmto.com/cmto-wordpress/assets/strat_plan.pdf.  These stakeholders and their members/students should be regularly engaging in discussion on education and training, lobbying government policy, improving relations with gatekeeper health disciplines and the public/media and negotiating with insurers on fair compensation for services.

3) The “culture of inquiry” objective has been facilitated largely by the regulatory body’s mandate to include some instruction in research literacy in training college programs.  As far as we can tell, the RMTAO hasn’t moved this forward.   It’s been the regulatory body that has contributed to supporting research grants in organizations such as the Interdisciplinary Network of Complementary and Alternative Medicine (IN-CAM), not the RMTAO.

4) Massage therapy is not recognized as a valued health care option – services are not covered by the provincial health plan and are subject to the onerous HST consumption tax where chiropractors, physiotherapists and recently naturopaths and acupuncturists are not.  Naturopathic and acupuncture services were announced in the 2014 federal budget to be HST exempt.  This is embarrassing for massage therapists because our profession is larger, had a head-start in positioning mainstream and now has been out-paced by services once considered fringe.  Along with greater regulation and HST exemption come higher credibility and consideration in health care and insurance funding…we’ve been left behind.

Adding insult to injury, the newly regulated kinesiologists were invited to participate in the Ministry of Health and Long Term Care Low Back Pain Strategy.  Massage therapists are glaringly absent from the recommended provider list.

5)  The RMTAO appears to only sparsely interact with other stakeholders, and there’s little evidence in inter-professional collaboration on any of the key issues.  The RMTAO finally attended a meeting of the Canadian Massage Therapist Alliance this Autumn – after several years refusal and only upon intense pressure by RMTAO members demanding they participate.  There appears to be still a long way to go before the RMTAO participates in necessary national strategies like repairing relations with insurers.

6) For the profession to be prosperous and financially viable, it must encourage an environment of innovation and opportunity while addressing its core problems – unviable, time-and-labour intensive work models, unsustainable inter-professional business agreements, poor credibility with government, insurers/funders, gatekeeper health care practitioners and the public/media, and an inability to deal with exploiters that profit from the lucrative popularity of massage therapy services.  The RMTAO has negated forming strategic partnerships with other provincial associations or established Complementary and Alternative Medicine (CAM) professions like chiropractic, naturopathic and traditional Chinese medicine/acupuncture that have similar objectives and could jointly work towards these objectives.

RMTAO: In the Business of Serving Members?

Part of the RMTAO’s difficulty maybe with the organizational model it operates under.  The board consists of up to 15 volunteers but only three paid staff to carry out the work of the association.  A ratio of 5 deliberators to 1 worker…too many chiefs, and not enough warriors!  Compare this to the Massage Therapist Association of British Columbia (MTABC).  The RMTAO has a larger board, only a third of the staff (MTABC – 9 staff), and according to 2012 records only half the operating income.  Despite association dues 3 times the RMTAO’s, the MTABC maintains 80% of the RMTs in their province as members, compared with under 50% retention for the RMTAO.

Further, the RMTAO board has been plagued with member-relation issues.  Board members are consistently absent from discussions in the RMTAO social media forum.  This forum is a direct opportunity for members to engage their representatives on the RMTAO board.  While it is understandable board members need to be discerning in their responses – ensuring they are reflecting the mandate of the association – by the tone of much of the social media conversation I think RMTAO members see the board as aloof and disinterested in the issues that affect practitioners daily.

RMTAO members have chronic concerns, and they need facility to voice those concerns, have them acknowledged and be guided how to act on them, or have the collective concerns advocated for them by their association.  Perhaps the RMTAO, instead of positioning the board as the profession experts, could instead trust their front-line members as the experts.  Go to the profession to determine your direction, have the board examine the input and craft policy, and you, as executive director can carry it out operationally.  The current operations appear slow, unresponsive, and don’t allow members opportunity to engage or feel empowered in influencing decisions that affect them in everyday practice.

There is really only one opportunity – the annual ½ day RMTAO AGM – to discuss issues directly with board members.  At the recent AGM only 33 members (out of 4700 RMTAO active members, or over 10,000 RMTs in the province) were in attendance, indicating to me RMTAO members do not feel their voices matter, and they cannot influence board policy.

Compare this to my visits to the Association of New Brunswick Massage Therapists (ANBMT) AGM in late 2013 where of 440 total members about 100 were in attendance.  At the Massage Therapist Association of British Columbia (MTABC) AGM in 2012, over 200 RMTs were in attendance in a province with less than 5000 RMTs.  It appears in other provincial associations, members have more confidence and a sense of agency in influencing policy decisions by their respective boards.

Let’s Make This Personal

Mr. Lewarne you are aware that I’ve been increasingly critical of RMTAO operations over the last 5 years.  You may also be aware that before that time, I was a strong advocate of the RMTAO and used my writing and speaking opportunities to engender support for the association.  Perhaps you’re wondering what drives my criticism.  When the College of Massage Therapists of Ontario released its survey of the profession in 2003, as a practitioner with a young family I was struck by how influences outside my control – government policy, relations with insurers, gatekeeper HCPs and public/media, economic conditions/recession and exploiters of massage therapy—  could negatively and irreparably affect my practice.

I wrote about these threats in a series of articles in the OMTA (RMTAO) publication The Body Politic in 2004/2005, and updated in Massage Therapy Canada over the last few years.  In my capacity as a speaker or in chats on social media, I’ve had many RMTAO contact me with concerns about these threats, with the frustration and fear that they are not being countered by their professional association.  This is why my call for RMTAO reform becomes increasingly louder every year, and I will continue to diligently push the RMTAO to critically examine its operations and perception of its role in improving the lot of massage therapists in Ontario.  I expect you will find other RMTs eager to do the same.

What RMTAO Members Need…Clear and Simple

The RMTAO is in the business of providing membership services…bottom line.  Registered Massage Therapists rely on their professional association to represent and advocate their interests:

• to government – to influence health care      and taxation policy, and advocate to the regulatory body;
• to insurers – ensuring positive relations      with insurers and employers offering worker benefit plans, identifying and      rectifying barriers to claims and practitioner reimbursement for services;
• to gatekeeper health disciplines – to      strengthen confidence and credibility in the profession, hence referrals      for and authorization of care;
• to public and media – to pervasively and      consistently present positive information, position the profession      effectively and to mitigate harmful media messages and exploiters who      would profiteer from the popularity of massage therapy

In addition to external advocacy, RMTs rely on their association to:

• Poll practitioner information – income      levels, work capacity versus workload, sectors worked in, problems getting      in the way of practice – and provide statistics to help guide practitioner      practice and encourage prospective RMTs;
• Facilitate professional development, not      only by organizing speakers and workshops but creating opportunities for      practitioners to gather, to dialogue and debate and ultimately define      their future through rigorous discussion.       It’s the outcome of these discussions that should guide the board      of directors in their policy and allocation of resources, not their own      opinions;
• Partner with other RMT associations to      collaborate on the advocacy measures mentioned above.  These objectives are more effectively      reached in collaboration than by any sole association.  The association can also partner with      other professions or industries with common objectives to magnify advocacy      initiatives;
• Provide premium pricing on common and      desired products and services for RMTs such as insurance, technology,      education and training, practice management software, etc.

What Will You Do with This Opportunity?

Mr. Lewarne, I don’t need to tell you that the vocations and very livelihoods of massage therapists rely on an effective association to secure opportunities and mitigate threats.  You have served as a long-standing board member before accepting this salaried position as executive director.  Five years have passed, with only decline in the political and economic position of massage therapists in Ontario.

I hope you will not deliver more of the same, but will act to deliver the services clearly defined in this letter, and take the difficult but necessary steps to reform operations at the RMTAO so it can do what it is designed to do…represent its members interests and deliver essential services effectively.

Yours sincerely and earnestly,

Donald Q. Dillon, RMT     OMTA/RMTAO member since 1990.    don@MassageTherapistPractice.com

cc:

Krystin Bokalo, RMTAO Board-Chair   Board_Chair@rmtao.com

Debbie Wilcox, RMTAO Board Vice-Chair   Board_Vice_Chair@rmtao.com

Tracy Lovitt, RMTAO Secretary   Board_Secretary@rmtao.com

Copy this letter and add your signature to send to the RMTAO Executive Director, Chair, Vice Chair and Secretary.  Or, feel free to reference this letter or cut-and-paste portions in your own writing campaign.