Self-Regulation…Time to Pivot?

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.

3 thoughts on “Self-Regulation…Time to Pivot?

    • Hi Debby,

      Thank you for posting, and glad to hear you’re open to a dialogue.

      The next step, following the Facebook discussion should be a survey and facilitated discussion by your professional representative association. They have the utilities and contacts to open the subject up for dialogue and debate.

      Please write them and express your earnest expectation for dialogue and representation on the matter.

      I can put it out there, but it requires other RMTs to say “Yes, let’s do it.”

      Thanks for your support.

  1. Once again great research and article- Thanks.
    Join- be re adopted back into nursing. Yes sign me up.
    Or investigations need a serious up date- PM me.
    HST- treating spouses- things never review in due time .
    When did salaries go up from 24% of a small budget( 2004)
    Why are we still in expensive real estate – younge st!

    Do we need an outside audit?

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