Think Canada’s MT Infrastructure is Superior to the USA’s?

This is a response to the first part of episode #1 Massage Therapy Without Borders where cohost Canadian RMT Cathy Ryan provides a helpful but not complete picture of the massage therapy infrastructure in Canada. So, I just had to say something. 🙂

Hello Cal and Cathy,

I’ve just come across your podcast and have been enjoying the quality of content.

image, https://www.cgai.ca/canada_us_relations_on_the_eve_of_prime_minister_trudeaus_visit_to_washington

I appreciate the unique opportunity your podcast provides for discussing massage therapy from a more integrated North American perspective. 

In speaking with my American colleagues, I believe there has been an artificial divide between USA and Canada massage therapy (MT) issues.  We share many of the same opportunities and frustrations across the border.  We can and should be working more closely together.

In your podcast you invited feedback, so in response to that invitation, I’m writing to fill out more of the picture regarding your episode #1.  While co-host Cathy Ryan provided a fair assessment of some of the aspects of the Canadian MT infrastructure, your listeners may be interested in greater context, and perhaps particularly the egregious bits.  I hope you’ll take opportunity to delve further into the Canadian context in a future podcast.

I’ve been surprised when my American colleagues have expressed a belief that Canada’s MT framework has its act together.  They perceive the standards are high, education in Canada is superior and integration into health care is de facto.  That spurious perspective requires an upgrade.

Here are some things you should know about the Canadian MT infrastructure:

School accreditation is occurring in only 4 of 10 provinces (and BC was a late entry) and none of the territories.  https://www.cmtca.ca/post/2019/10/01/cmtca-will-resume-providing-accreditation-services-for-massage-therapy-education-programs  Therefore, efforts to increase the quality and standardization of education for MTs in Canada is fractured at best.

Regulation is slow.  It’s taken 25 years to regulate only 1/2 the provinces: Ontario 1994, BC 1995, Newfoundland/Labrador 2003, New Brunswick 2014 and Prince Edward Island 2019.  Even longer if you consider Ontario had basic regulation in place since 1918. https://www.fomtrac.ca/

The Canadian Massage Therapist Alliance (CMTA) is a coalition of the various MT provincial associations.  While it’s mandate is ambitious http://www.crmta.ca/?page=8 the CMTA does not produce an annual report on its actions, despite being financed by membership dollars directly.  In the last five years it produced a cross-Canada scan https://secure.rmtao.com/blog/national-environmental-scan-of-massage-therapy  and is involved in a national campaign to deregister from the consumption tax (HST).  However without annual reports, it’s hard to discern how active or effective the CMTA is.

Canadian MTs appear to suffer from inactivism, despite every reason to act in their best interests.  In Ontario, a province with over 14,000 RMTs http://www.cmto.com/key-publications/annual-report/ only 43% are members of their professional association.  It’s hard to fathom why the association – which represents MT interests to government, insurers, gatekeeper HCPs and the public/media – would not engender overwhelming support from all MTs, despite effective representation under a paucity of support and resources.

The cost of regulation is huge.  In Ontario, the regulator takes in 12X the professional association’s budget.  The cost of regulation is terribly disproportionate to the cost of representation, and RMTs should be very concerned about sustainability.  To its credit, the regulator has graciously allocated a small amount of its budget towards the Massage Therapy Research Fund.  This is something the professional association cannot afford to do, despite its mandate to support research.

RMT earnings are concerning.  Here are some numbers from the Registered Massage Therapists’ Association of Ontario (RMTAO) from their most recent earnings survey of 2013:

Average income hands-on/direct care $39,163 (before taxes)
Majority of respondents do not work outside MT practice (therefore, only source of income).
21 hours/week ‘hands-on’, Avg volume of patients – 19.3/week
9.5 hours/week – business activities
50%+ respondents would work 10 additional hours/week, but fear physical strain, lack clients, or fear “burn out”
Only 54% are satisfied with earnings – many would work more if not for the previously mentioned concerns.

From the report, “56% not earning what they expected…because of market saturation, inconsistent pay, lack of public understanding (re: MT profession).…told earlier / during training they would be making much more than they do.…MVA (automobile) insurance and HST (consumption) taxes have negatively impacted finances.”

There are other issues facing Canadian MTs.  They lack coordinated public and media relations in response to increasingly negative news stories re: insurance fraud, inappropriate touch or associations with the sex trade.  MTs are over-reliant in remuneration from employee health benefit plans. 

Despite regulation, the public does not perceive massage therapists working in health care because they are overwhelmingly not integrated into provincially-funded and endorsed health care settings, and their services are subject to a consumption tax (HST) that most health care services are not. 

In Ania Kania-Richmond’s 2013 look at hospital-based massage in Canada, few hospitals offer massage therapy, and for those that do, they are not providing care directly to hospital patients. “It is important to recognize that a significant activity of massage therapy in hospitals is focused on hospital staff and employees…over half of the hospitals that responded in this study provided massage therapy to employees only.” https://www.cmto.com/assets/MTRF-Project-Summary-Kania-Richmond.pdf 

There are a few exceptions where MTs are working directly with patients https://www.massagetherapycanada.com/coming-soon-podcast-episode-6-working-with-vulnerable-stigmatized-patient-populations/ but these are indeed exceptions. 

Our profession also lacks a strategy to provide care to underserved populations in public health – those in palliative and hospice care, the elderly, children with illnesses, the homeless, refugees and indigenous populations.

There are many things I admire about our American cohort.  You’ve managed to indeed incorporate massage therapy into direct patient care https://www.healwell.org/what-we-do/research and http://blogs.jefferson.edu/atjeff/2011/07/08/treating-chronic-lower-back-pain-with-massage/   The US Department of Health and Human Services under the NIH provides funding for research into Complimentary and Integrative Health https://www.nccih.nih.gov/, something not endorsed by our Canadian government.  And the Massage Therapy Foundation https://massagetherapyfoundation.org/ appears to be very progressive in generating research dollars and promoting research literacy. 

 I know the massage therapy profession in the USA has faced its own challenges in defining identity, insurer relations, school accreditation, generating research and promoting professionalism.  But I would not put its growth or evolution below our advances in Canada.  Hopefully we can find more ways to collaborate between our countries on shared interests, and move the profession to the next level of development.

Thanks for the show, and I look forward to future episodes!

3 thoughts on “Think Canada’s MT Infrastructure is Superior to the USA’s?

  1. Thanks for this information. I too have been listening to massage without borders – I recommend it and really appreciate the effort. It’s very helpful to have this further perspective. Whole the US and Canada have different legal and regulatory issues and a different type of health care system ( of that we actually can be a bit envious) we also have many issues that we could collaborate on very effectively. Education is one – creating great up to date content and best practices. This leads into the issue of integration into health care. There are many barriers there but as an educator I have focused on (tried to anyway!) shifting the curriculum to include elements that will prepare students to work in that setting. It’s a bit of chicken/egg situation bc there are no ready jobs to walk into in heath care facilities – so do they need that? My thought is yes – then we arrange to have clinical hours in those institutions- then they get used to having us and we do a good job there A them perhaps they can be allies to remove other barriers such as payment issues. This is not my original idea of course!! But it would be great to collaborate with others on proper educational content and best practices in hospitals/care home/hospice etc. maybe if we build it ( our capacity, they will come (to help us).

    Another area is the public image of the profession if you will. We seem to share very similar problems and concerns. This we could def collaborate on.

    Maybe it’s time for a “CAN/AM” conference – virtual for the time being

    • Thanks Jennifer for your points on collaborating in education, insurer relations/claims reimbursement and public/media relations. All opportunities for collaboration. And yes, let’s do a CAN/AM virtual symposium and bring the brightest lights together to provide context and tackle the big issues!

  2. I spent several months with extended family in two states last year, both California and Idaho.
    Both states their annual fees for professional membership were at least half of Ontario’s. They welcomed me to join after writing their exams. Dollar for Dollar our regulatory body is highly over priced. I’m sure each regulatory body has similar mandates and responsible.
    It was very tempting to stay there for financial reasons, but my family is here. For the future I am considering working only 6 months of the year in the U.S. and not in Canada.

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