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?

“Massage Therapists across Canada invest millions 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 are performing.”

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, house 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:

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.[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 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, only 4 of the 56 campuses in Ontario is 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], and we should search for 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 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.

When I consider my conversations with RMTs, and the social media chatter I peruse, I conclude there are large gaps in knowledge transfer and apprenticeship in our profession.  Gaps include understanding the efficacy of massage therapy and accessing the available research[viii]; business acumen in operations, marketing and administration[ix]; an understanding of contracts and working agreements[x]; proper body mechanics and delivery of care design that preserves the practitioner’s body[xi]; the history and scope of our profession; communication, setting boundaries and managing confrontive or predatory behaviour[xii] in clients. 

I regularly perceive RMTs in social media asking questions that should be tacit knowledge, included in their initial education and training.  Our profession requires constructive ways to assist massage therapists in properly acquiring and understanding the available knowledge within the profession and mentoring them in the maturation of their practical and operational skills.  With only 4% of RMTs in the total Ontario population in the cohort of 25 years of practice or more, RMTs also require support in building longevity into practice[xiii].  We can float all boats with the same tide, and raise the excellence in practice for all RMTs, if applied properly.

Regulation – Before the Regulated Health Professions Act (RHPA) of 1991, massage therapy was regulated under the Drugless Practitioner’s Act of 1935.[xiv]  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. 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[xv] 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, resources (revenues in) paid to regulate massage therapists in Ontario outpaced professional representation by over eleven times[xvi]  Consider this: would the convenience of owning of 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.[xvii]  Regulation normally benefits a profession by increasing credibility and public perception, government funding and positioning in community health care…funding and positioning have not materialized, and credibility has suffered in the media.[xviii]  Perhaps RMTs might consider less expensive forms of regulation,  such as an amalgamated regulator being considered in British Columbia.[xix]

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.  In addition, associations can scale the costs of client education materials, offer protection from exploiters and profiteers, form strategic alliances[xx], accumulate essential data for practitioners to use in decision-making, and a menu of competitively priced services, such as professional liability insurance.  This is what an effective representative looks like. 

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 unique opportunity. 

The RMTAO has been 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 aren’t they associating more with their 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[xxi].  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?

I remain particularly critical of the RMTAO’s failure to build closer relationships with Greenshield Canada after it’s “Elephant in the Room” campaign[xxii], designed to undermine claimant confidence in MT care.  As well, we can begroan the banal responses offered by our representative to serious national media inquiries[xxiii] in the last 2 years regarding the profession’s position on insurance fraud[xxiv], association with the sex trade, and the prioritization of RMTs to access COVID vaccines.

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. *Note, an environmental scan of a narrower focus was thankfully conducted in 2022. 

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 little to go on but antiquated and incomplete data.

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?

There are other issues facing the profession.  Managing a complex professional identity[xxv], how to establish credibility, regular reports of sexual misconduct[xxvi], irregular collaboration between stakeholders, forging strategic alliances with other health disciplines[xxvii], determining fair remuneration for massage therapists[xxviii], addressing the cult-like ideology manifested in the wellness industry[xxix]…all require deep, rich conversations to resolve.  And all require much better leadership than our decision-makers have demonstrated thus far, and far more engagement of each and every practitioner.

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[xxx] 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.

Development – Your leaders would develop you as 1) a practitioner – critical thinking[xxxi], research literacy, business acumen, technical proficiency – and as 2) an agent of the profession – skills in public and media relations[xxxii], patient education, integration with complementary health disciplines.  These leaders would regularly monitor and collect critical data from the profession to observe trends, sharing their analyses with you so you can make informed day-to-day decisions in practice.  Your leaders would recognize and acknowledge exceptional members, “train the trainers” and make succession plans for training the next generation of leaders.

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 32 references below.  These references are largely mine, and admittedly fail to properly reflect a cadre of opinions.  Despite the cost and the consequences to one’s practice and livelihood, few seem interested in investigating and reporting on the history, culture and context of the MT profession. I wish more MTs would join me in exploring this subject, and  I entreat you to review the references to acquire a more comprehensive view of the profession’s culture and politics.

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[i] https://www.massagetherapycanada.com/boom-bust-bane-and-breakthrough-2544/

[ii] https://www.massagetherapycanada.com/take-the-spa-industry-seriously-1503/

[iii] https://www.massagetherapycanada.com/touch-is-our-language-reclaiming-sensibilities-in-an-unsensible-time/

[iv] https://www.massagetherapycanada.com/our-innate-potential-participating-in-the-creation-of-ourselves-as-rmts-and-beyond/

[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://www.massagetherapycanada.com/research-made-relevant-2137/

[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://www.massagetherapycanada.com/tools-team-technology-3272/

[xii] https://www.massagetherapycanada.com/podcast-episode-7-responsibilities-communication-skills-and-interpersonal-challenges-for-rmts/

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

[xiv] https://www.massagetherapycanada.com/overview-of-the-history-of-regulation-of-the-massage-therapy-profession-in-canada-1378/#:~:text=The%20Ontario%20Government%20expanded%20the%20professional%20recognition%20of,of%20masseurs%20under%20the%20Drugless%20Practitioners%20Act.%202

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

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

[xvii] ibid

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

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

[xx] https://www.massagetherapycanada.com/common-good-

[xxi] https://www.massagetherapycanada.com/new-naturopathic-acupuncture-hst-exemption-a-wake-up-call-to-massage-therapy-profession-2314/

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

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

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

[xxv] https://www.massagetherapycanada.com/time-to-snub-professional-snobbery-2346/

[xxvi] https://www.massagetherapycanada.com/are-rmts-disproportionately-vulnerable-to-allegations-of-sexual-misconduct-4169/

[xxvii] https://www.massagetherapycanada.com/a-model-for-better-health-care-3474/

[xxviii] https://www.massagetherapycanada.com/are-you-employable-2496/

[xxix] https://www.massagetherapycanada.com/the-desired-state/

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

[xxxi] https://www.massagetherapycanada.com/critical-thinking-in-practice-14-questions-massage-therapists-should-ask-themselves/

[xxxii] https://www.massagetherapycanada.com/politi-size-me-massage-therapists-are-passionate-but-they-need-to-be-political/

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.

In this week’s RMTAO Friday File Board Chair Ian Kamm announced his wishes to survey the membership re: massaging spouses. It’s hard to comprehend why the Board Chair is dedicating any time to an immutable regulatory policy, and especially when:

• the profession has recently twice suffered negative media coverage, yet there appears no initiative taken towards a national media response team
• the RMT/ACT (for HST de-registration) website has been offline since last year
• the Resources page for members on the RMTAO website has been “under construction” for over 2 years
• the last member earnings survey is almost 10 years old, and the last comprehensive survey of the profession (commissioned by the CMTO) is almost 20 years old
• The Canadian Massage Therapist Alliance – a coalition of the sister provincial associations – appears inactive. Their last Facebook post is from October 2019
• the Community Based Networks (CBNs) – the hubs of support for many RMTs – are under-resourced and under-utilized
• the main point of engagement for RMTAO members – the social media page – has been unavailable for interactive dialogue and debate for over a year

In fact the usual opportunities members would expect from their professional association to dialogue and debate, to grow and evolve the profession – symposia, round table discussions with subject matter experts, town halls – are not currently offered by the professional association.

And the same old, persistent struggles for the profession – defining professional identity, supporting research and higher education for RMTs, mentoring RMTs at the entry-to-practice level, positioning MT in the health care system, HST de-registration, raising business acumen across the profession, improving relationships with insurers and gatekeeper health practitioners, ensuring across-the-board quality education and accreditation of training schools, supporting RMTs who face barriers to practice due to ethnicity, culture or gender, and strategizing how to bring massage therapy care to more people facing barriers of inequity, bias and trauma – go largely unaddressed.

Send a message to Ian Kamm, Board_Chair@RMTAO.com, and tell him where you would prefer he spend his time and attention.

Since publishing Massage Therapist Practice in 2010, I’ve been considering how to effectively raise the practice/business acumen of all massage therapists up to the same level. It seems to me, knowledge and experience transfer on these subjects has suffered within our profession. Typically, roles and expectations in a business relationship are incompletely defined. And, we can do better with providing practitioners practical ways to attract and retain clients (patients) to grow and sustain their practices.

So I’ve amalgamated some helpful information from my 30 years in the field as contracted practitioner, practice broker for other practitioners, and now in private practice. In my cross-country lectures, through social media or in direct conversations, I’ve tapped the experience of hundreds of massage therapists I’ve been fortunate to visit with, learning about their pressing practice problems.

The product of these conversations and experiences is the treatise On Practice: Entry-Level to Established Massage Therapist. I’m making available, with my compliments, the first part of the curriculum in electronic format. Part I targets entry-level (0-5 years) practitioners or students, but seasoned practitioners may find something of value too. Massage Therapists who broker practice opportunities for others, will certainly want to share it with their budding associates.

Please share broadly with practitioners you believe could use a firmer foundation in their practices. Use this information however it might benefit you. I would be grateful for any feedback you might provide as I work on the latter section over the next 1/2 year. You can reach me at don@DonDillon-RMT.com.

With sincere gratitude.

d