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.

Marshall McLuhan is famous for saying “The medium is the message”, inferring the context of how a message is delivered is as important as the content.  I’ve taken material I’ve been writing about for 10 years and summed it up in – what else – a rap song!

Or, you can think of it as political poetry, highlighting the threats facing the profession and some promising opportunities we can act on if we choose to act together.  (Make sure to read to the end for the good stuff!)

I may be lyrical, but I’m not musical.  Perhaps you can take this poetic attempt and put it to music.  I’d love to see your renditions on YouTube!

At your service.  dqd

Hey Massage Therapist…Spoken Word Poetry

Hey massage therapist, are you interested?
Hope so… your livelihood and vocation are being tested.
You insist massage therapy is “health care”, complain you’re not being treated fair.
Gatekeeper providers surmise, “Massage treatment plans…why should we authorize?”
Government and insurers skeptical, “Without research, you’re just not credible.”

“Palliative, not curative”, massage claims appear too assertive.
Paucity of evidence, treatment guidelines lack precedent.
Funding forfeit, legitimacy in question.
Claims denied in auto insurance and worker’s compensation.

Chiropractors, physios add the proviso “We’ll authorize your care,
once we’ve taken our share.”
Public and media laud, “Why massage associated with prostitution and fraud?”
Employee health benefits – less than workers used to get.
Recessive economy… affects earnings, benefits and massage care delivery.

Government imposes regulation, yet offers no Medicare remuneration.
Goods and services tax loads a competitive disadvantage on all our backs.
Health care restructure…physiotherapists are the new gatekeeper.
Will PT Assistants provide massage, curtailing referrals to the massage practitioner?

Profiteers exploit massage popularity.  Practitioner earning surveys
portray income paucity.
Social media sentiment –complain of part-time income but full-time requirement.
Massage delivery-of-care model time and labour-intensive
…there’s only so much care you can give.
We need to support innovation, technology and collaboration.
We can blame ourselves for the state our profession is in.

Not earning enough income?  Don’t blame practitioners-turned-business-owners!
Our professional culture needs a wake-up call and a massive make-over.
Ontario RMTs need a strong association – scant resources and small staff equals
scant representation.
Bureaucratic quagmire and policy futility – RMT interests in Ontario, our focus should be.
Strategic plan, Ends policy…can we please see progress and bypass the hyperbole?
Inaction, rhetoric – we need progressive representation, not a train-wreck.

Your profession is in jeopardy…are you feeling the anxiety?
Take interest, show initiative…your bright ideas, energy and attention please give!
Look collectively to solid opportunity.  Take a stand, and alter your glum reality.
Collaborate across the country – share resources and creative currency.

Campaign for inclusion in Medicare and other types of insurance plans
…woo gatekeeper and insurer relations for proper consideration.
Chronicle “big picture” problems and track RMT demographics.
Incorporate funding, marketing and social media tactics.
Coordinate evidence-based practice, symposiums and public/media relations.
Use virtual and regional groups to build community, tackle key issues and take action.

Work with organized CAM professions.
Move farther, faster sharing training, research, advocacy, public and media relations.
Capitalize on employee benefits and workplace wellness.  Bypass the health care regime
…show corporations how massage addresses pain, strain and stress.
Care for tension neck, repetitive strain, carpal tunnel syndrome, state and trait anxiety.
Address job-related stress, absenteeism, work satisfaction and be an asset to the company.

Baby boomers and their brethren – an opportunity in the making.
People want wellness within their lifespan, will pay for massage beyond
employee benefit plans.
Boomers support their kids and grandkids
…prefer to limit muscle relaxants and pain meds.
Human potential, athletic performance, quality of life
…all values desired and worth their strife.
So massage therapist your livelihood and vocation are at stake.
What next steps do you plan to take?

– Donald Quinn Dillon, 2014

Dear Canadian Massage Therapist Alliance (CMTA) Representatives,

I am writing as an RMT in a non-participating province (Ontario) who wishes to partake in the benefits a national RMT organization can offer.  Specifically, I’m writing with two requests for the CMTA to consider:

I) That an affiliate membership be created for practitioners of non-participating provinces to benefit from CMTA membership

2) That CMTA membership benefits be tangibly and clearly defined

First, affiliate membership.  The Registered Massage Therapist Association of Ontario (RMTAO) states it is unwilling to be involved in the CMTA due to human resource and financial considerations.

The RMTAO maintains it can unilaterally contribute to RMT concerns at a national level, despite its stated financial and human resource limitations.  I’ve suggested to the board that RMTAO resources can be used most efficiently in collaborating with other provinces towards a national strategy.  It is regrettable that, despite numerous invitations by the CMTA to collaborate, the RMTAO has repeatedly declined.

Perhaps a CMTA affiliate membership can be created to accommodate practitioners who support the work of the CMTA but cannot access benefits from their provincial association.  Although some CMTA benefits may not be possible to service non-participating provinces, other benefits could easily be transferred to affiliate membership.  However, I believe these benefits could be more clearly defined to appear tangible to those interested in affiliate membership.

Second, I request CMTA benefits be broadened and more clearly stated.  The Canadian Massage Therapist Alliance (CMTA) serves 7 member provinces – British Columbia, Alberta, Saskatchewan, Nova Scotia, New Brunswick, Newfoundland/Labrador and Prince Edward Island – and the North West Territories.  The CMTA’s stated objectives are: i) preserving and improving insurer relations ii) supporting regulation in all provinces and iii) encouraging research initiatives.

I suggest there is an opportunity to more clearly define tangible membership benefits in the alliance, some of which would be completely transferable to practitioners in both members and non-member provinces.  As well, there is a need to differentiate CMTA benefits from provincial association benefits so that associations do not feel threatened by perceived competing CMTA interests.

I recommend the following four roles of the CMTA:

1) CAMPAIGN – advocacy of MT interests and building relations with insurers, gatekeeper HCPs, government and the public/media are important considerations both locally to practitioner practice and nationally in shaping favourable policy and relationships.  Associations often attempt to manage these provincially, but the CMTA could coordinate the design of media campaigns to share with all provinces and territories, eliminating duplication and waste while presenting a united and consistent national message.

2) CHRONICLE – Practitioners are interested in news that affects them and their counter-parts in other provinces/territories.  The CMTA could present “Big picture” views with an exclusive monthly newsletter, ongoing blog and perhaps telecast reporting advocacy campaign results, trends in the profession, RMT demographics, and developments in regulation, research and education.

Perhaps there’s an opportunity to partner with Massage Therapy Canada magazine to provide national news with a customized regional feature.

3) COORDINATE – To build credibility with government, insurers, gatekeeper HCPs and the public/media, practitioners require treatment guidelines (eventually supported by evidence-based practice), trained spokespeople regionally for advocacy relations, and other projects best coordinated by a national alliance.  Associations can put forward thought-leaders and strong candidates for working groups to finally address these essential projects.

Further, working groups already exist with FOMTRAC re: accreditation and IN CAM re: research, so rather than duplicating efforts the CMTA can involve itself in encouraging the growth and development of these agencies and benefit from their produce.

4) COMMUNITY – practitioners often work in privacy with patients/clients and opportunities for sharing experiences and debating key issues with colleagues unfortunately presents infrequently.  The result is a stagnating of the profession, inhibiting evolution and innovation.   The CMTA can offer virtual symposiums – coordinated with localized, in- person gatherings with live-streaming – on critical issues (example TED.COM).  This shifts the top-down hierarchical approach to putting the issues directly to the front-line practitioners who experience them daily.

I suggest these roles are supportive, and differentiated from the role of the provincial professional associations.  The provincial associations can provide six essential services:

1) POLL members re: income, workload versus work capacity, delivery of care model, rural or urban, age, years in practice, affiliations, education, etc. so the profession can understand its needs and challenges better.  Technology can be used to collect information, collate data and communicate findings and trends valuable to existing practitioners and all industry stakeholders.  This information can be shared with the other provinces via the CMTA.

2) PUBLIC & MEDIA relations – the CMTA can help coordinate key messages, but provincial associations are most effective in disseminating at their level.  Each province can have trained P/M & R people to respond to negative press while punctuating key tenets of the profession.

3) PROFESSIONAL DEVELOPMENT – provincial associations can hold workshops on professional issues and provide opportunities for members to gather.

4) POLITICAL advocacy – the CMTA can provide national representation re: government, insurance industry and gatekeeper HCPs, but really need the ongoing legwork and resources best applied by the provincial associations.

5) PARTNER – as indicated by the CMTA, RMT provincial associations benefit from collaboration on a number of national – and even international – issues.  There is also opportunity at the provincial level to partner with like-minded groups eg: chiropractors, naturopathic practitioners, TCM/acupuncture practitioners, physio- and occupational therapists, fitness/wellness experts, towards common objectives

6) PREFERRED PRICING – provincial associations can take advantage of volume pricing on behalf of their members for products/services of interest such as various forms of insurance, technology, publications, legal and business services.

To create a more responsive national alliance, the CMTA requires funding and operational management.  While I understand availability of resources is always a concern, I suggest with clear, tangible benefits of CMTA membership defined, we can start to look at viable ways of financing the projects.

For example, crowd-funding for specific objectives may be an answer…drawing resources from many varied stakeholders and interested parties to see an objective through, rather than always relying on the finite resources of provincial associations.

I am happy to address any of these questions and suggestions with representatives of the CMTA.  Thank you kindly for your time and consideration in reviewing my requests.

Warmest regards,

Don Dillon, RMT

In early January I sent a letter to the Registered Massage Therapist Association of Ontario (RMTAO) outlining my concerns of several chronic deficits in operations http://massagetherapistpractice.com/letter-to-rmtao-fortune-favours-the-bold/.  In June I received a response from the RMTAO that I’ve pasted below with my additional comments.

I’m hoping you’ll read the response below, gather your thoughts and respond directly to the RMTAO.  Find a list of the directors and staff at https://secure.rmtao.com/about/association_contacts or email direct at info@RMTAO.com.

Dear Mr. Dillon,

 Thank you for your letter received January 1^st, 2013. The Board values the input it receives from members. It is through this ongoing input that we can understand the needs and concerns of our members and better address the issues facing our profession. We encourage all members and non-members to communicate their thoughts to us.

The RMTAO continues to strive for increased communication from its members. There are a number of exciting initiatives in development that we hope will indicate that the voices of the members have been heard. You may have noticed one of our initiatives recently which was a short survey was sent to all members. We hope that activities like this will allow members the chance to express their valued opinions.

You raise several issues in your letter that we would like to address. Firstly, you suggest that the cost of membership to the RMTAO be increased significantly and that the current model is not financially viable. At the most recent Annual General Meeting, the association’s Executive Director Bryn Sumpton presented the 2012 financial report in which he indicated that the RMTAO is currently operating at a surplus and that membership continues to rise. Both facts indicate financial viability and sustainability.

Thank you, RMTAO board members, for responding to my letter.  You are correct I suggest the RMTAO raise fees four-fold, to be in line with other RMT associations, so the RMTAO can effectively meet the needs of RMTAO members.  For example, the RMT associations of British Columbia (MTABC) and Saskatchewan (MTAS) have significantly higher membership fees than the RMTAO, despite having far less of a pool of members to draw from.

The RMTAO does not have sufficient resources to provide essential services to its members.  Essential services include: public and media relations and protection against exploiters; gathering, collating and sharing industry information; advocating RMT interests to government, the insurance industry and gatekeeper health disciplines; and collaborating with other RMT associations and like-minded professions to advance research, regulation/policy and reasonable, unfettered compensation in invoicing insurance programs.   The RMTAO does offer opportunities for securing preferential rates on products and services, and professional development courses, but these could be expanded considerably with a larger staff and more resources.

The RMTAO surplus in 2012 of $143,000 was surprising – given the aggregate deficit of $76,000 reported in 2010/2011 and the consequent hiring an executive director and additional staff member.  It is curious how the RMTAO created a surplus with just a marginal increase in membership while adding two staff members.

In your celebration of the financial report and membership rising, I encourage you to look carefully at your numbers.  The RMTAO did enjoy a boost of 1000 additional members from 2009 to 2010 – after the Strategic Plan was announced.  It appears member optimism faded however when the plan did not materialize, and RMTAO growth in 2011 was 500.  It was even less in 2012 at about 370.

In 2011 when the RMTAO membership increased by 500, CMTO active members grew 1600…in effect the RMTAO is not capturing the hearts and minds of the majority of new graduates.   If RMTAO active membership (as of Sept 30, 2012) is 4371 and CMTO membership is 10,800 at the end of 2011, RMTAO representation is about 40% of all RMTs in Ontario. Compare this to BC or SK RMT associations who boost 80% representation of RMTs in their province.

Again, without sufficient resources the RMTAO cannot effectively advocate for the interests of its members.

Further, you suggest that the number of Directors of the Board is cumbersome and ineffective. We would like to point out that serving as a Director of the RMTAO is a volunteer position. There are numerous committees required for continued operation of the Board. Reducing the number of Board members would in fact increase the amount of time individual Directors donate, thereby becoming an onerous task and slowing the progress of all the various aspects of the work. We would like to note that currently the Board is operating below the authorized number of Directors allowed according to our by-laws. The Board believes that as representatives of the entire membership it is important to include the many varied voices to provide for a balanced and well thought out viewpoint on all the issues being considered.

I understand the governance model the RMTAO is employing, and I suggest this is the main problem. The RMTAO should not place the important job of representing RMT interests across the province on the shoulders of a large volunteer board.  A small, action-oriented board and a large paid-staff contingency can do a much better job.  MTABC for example has 9 board members (one is past-chair) and 9 paid staff to carry out the direction by the board.  Compare the RMTAO volunteer board at 14 with only 3 paid staff.  And despite MTABC membership fees 4+times higher than RMTAO fees, the MTABC retains 80% of RMTs in their province – compared to 40% in Ontario.  BC RMTs purchase membership because the value of membership is clear.  Your operations model is the problem, not the cost of your membership.

A large board deliberates excessively and is slow to move initiatives forward.  A streamlined board takes its cues from its membership – not itself.  It makes well-counseled but expedient decisions and directs staff – via the Executive Director – to carry decisions out. I argue the organization structure of the board and its governance structure is not serving its members interests.  As an example, I challenge you to show proof in the last 7 years (since Andrew Parr, Executive Director resigned) where the association has effectively provided the essential services I’ve listed above.

I suggest the board not be attached to its governance model, but instead actively serve both the immediate and long-term interests of its members.

The individual mandates of the RMTAO are ever evolving as with any organization. Overall, it acts as an advocate for the profession. The Board believes this can be achieved in a number of ways. The decision to not belong to the CMTA, as an example, is something that has been a focus of discussion on several occasions. Shortly, a position statement will be published detailing our current decision. Among the reasons for declining to be a member is the view that the financial obligation of membership is not warranted until the CMTA can provide clear goals with a comprehensive and accountable organizational structure.

The Board believes that it can continue to act to support the profession on a national stage through other avenues. This can be done through letters of support to other provinces, taking an active role in the development of national competency standards and accreditation, and the support of other Regulated Health Care Professionals to name a few. The decision to turn down membership with the CMTA was not taken lightly, nor is membership in it viewed as the only way in which we can maintain a national presence.

I have spoken to representatives of other RMT provincial associations, and they cannot understand the RMTAO’s position to deny collaboration with the Canadian Massage Therapist Alliance (CMTA).  The CMTA serves 7 member provinces – British Columbia, Alberta, Saskatchewan, Nova Scotia, New Brunswick, Newfoundland/Labrador and Prince Edward Island – and the North West Territories.  The CMTA’s primary objectives are: i) preserving and improving insurer relations ii) supporting regulation in all provinces and iii) organizing research initiatives.

The CMTA has represented the member provinces for the last five years at the conferences of the Canadian Life and Health Insurance Association (CLHIA), and the Canadian Health Care Anti-fraud Association (CHCAA).  CMTA representatives Brenda Locke, ED MTABC and Lori Green, ED MTAS have gathered information from insurers regarding their concerns with massage therapy claims.  In response, the CMTA has actively invited non-participating provinces to get involved in improving insurer relations, and designed a standard RMT receipt at the request of insurers.

However without a unified collaboration by all provinces and territories, the RMT insurance strategy appears fractured and a clear message regarding evidence-based practices or cost-effectiveness of massage therapy care, incoherent.  The province with the largest number of RMTs – Ontario, is not a member.  Embarrassingly, despite very limited resources the RMTAO appears to suggest it can forward these national initiatives alone.

An historical perspective – then Ontario Massage Therapist Association (OMTA, precursor to RMTAO) Executive Director Andrew Parr expressed concerns with the financial structure of the CMTA in 2005 and advised the OMTA (RMTAO) board to halt the OMTA’s involvement.  Under Parr’s direction the OMTA attempted later to form a coalition with Manitoba, which subsequently failed.  RMTAO members should be informed that, since then, CMTA representatives have openly welcomed and encouraged the RMTAO to explore both the CMTA’s mandate and financial structure, and earnestly wishes Ontario – the province with the largest number of RMTs in Canada – to collaborate on initiatives beneficial to RMTs across Canada.

We have an insurance crisis on our hands.  In Ontario in the last decade we’ve witnessed the insidious increase of denial of RMT treatment plans in auto insurance and WSIB (worker’s compensation).  More recently, there’s anecdotal evidence to suggest insurers are denying employee claims for RMT services under their workplace benefit plans.

According to the original CMTO survey, 74% of patients/clients pay for massage therapy services with some type of insurance program.  Progressive and aggressive undertakings by insurance companies to prevent fraud and discourage claims for massage therapy care will have devastating effects on practitioners.

Bottom line…the RMTAO cannot pursue RMT interests provincially or nationally without shared resources and collaboration.  The passive “letters of support” and the proclamation that the RMTAO “can maintain a national presence” is grounded, I suggest, in rhetoric and not reality.  Please consider the vigorous objections you’ve received at every RMTAO AGM in the last 7 years as well as in social media and commit to collaborating with the CMTA on national RMT interests.

We hope that you find our response to your satisfaction. Again, we would like to thank you for your comments and your candor. The RMTAO is continually looking for volunteers and ambassadors and we would welcome you to encourage members to contact our office. We would also like to see more active involvement and development of our Community Based Networks should you wish to consider helping further.

Yours truly,

The RMTAO Board of Directors

As you know I’ve been one of the RMTAO/OMTA’s strongest advocates in my professional tenure.  I have promoted the importance of professional association membership in my speaking and writing campaigns across Canada.  I am adamant now more than ever that the RMTAO must examine its path and processes and align them tenaciously with those of its members.

With the release of Report on the Massage Therapy Census 2003, commissioned by the College of Massage Therapists of Ontario – my sense of urgency to address the pressing issues of our profession has grown desperate.  Since then I’ve written extensively and have been welcomed by RMT associations and schools across Canada to speak about the threats against viable RMT practice – specifically unfavourable government health care policy and taxation, stonewalling by the insurance industry, skepticism by gatekeeper health disciplines and profiteers who would exploit the popularity and value of massage therapy.  I’ve discussed the implications of a down economy on discretionary income and workplace benefit plans, and hence on the direct financing of massage therapy services.

While I’ve received sincere interest in these topics, and despite best evidence that the profession is facing serious challenges to its existence, I’ve been unable to move those that have the authority and resources to improve the lot for RMTs in Ontario and in fact throughout Canada.

If you check your records you will find I am perhaps one of the most decorated volunteers the OMTA/RMTAO has.  I’ve received two Hands of Thanks, the President’s Award of Merit and the Ken Rezsnyak Award of Merit from the OMTA for my volunteer efforts over the years.  I’ve represented the OMTA/RMTAO in discussions with the health professional coalition regarding auto insurance, with representatives from the insurance industry, and the WSIB.  I’m also one of the organizers of our successful Niagara RMT community-based networks.  Despite my apparent contributions to the profession, I have failed to move the board to consider the weight of their actions, or particularly, inactions.

I feel greatly disappointed and frustrated that at this most urgent time, the RMTAO seems increasingly less capable to deal with the aggressive threats to viability of RMT practice.  I will continue to do my part to rally RMTs across Ontario to push for an effective association that will consider the big picture, take into account the real threats facing viability of RMT practice and forge strong relationships and share resources to ensure the longevity and viability of massage therapist practice.

See you at the next RMTAO Annual General Meeting.

Respectfully,

Donald Quinn Dillon, RMT

There you have it my colleagues.  I’ve fought hard to push for RMTAO reform for the betterment of all RMTs in Ontario, and you can judge the RMTAO’s response for yourself.  If you believe the RMTAO can do better, if you think your interests can be better represented, then you need to make your voice heard.  Come to the next RMTAO AGM or sign your proxy to a fellow member that can represent your values.

Nothing is going to change until you change something, and if your practice, your livelihood, your profession is important, then you need to get off the sidelines and make your voice heard.

This is your livelihood, your vocation, your profession.  Only through sheer volume of response can RMTs hope their professional association will take the steps necessary and urgent to support viable massage therapist practices.

I’m counting on you.  dqd

Recent discussion on Facebook suggests massage therapist claims are facing increasing scrutiny by adjudicators of employee workplace benefits.  Paid for by the employer, employee health benefits are considered part of the employee’s salary and accountability for presenting and defending suggested treatment plans and intended health outcomes falls to the massage therapist.  It’s the employee and employer…not the insurance adjudicator, who should decide whether to seek massage therapy and proceed with a treatment plan.

 Massage therapists – and indeed all providers who bill for compensation against these plans – should feel extremely uncomfortable about non-medical administrators approving or denying claims from plans financed not by the insurance company, but by employers and their employees.  Insurance adjudicators are largely not medically trained and cannot make judgments about necessary care.  There’s a conflict of interest – insurance companies are motivated primarily by profit…the more claims denied or reduced the higher profit margin to the insurance company for administering the plan.

Insurance is pervasive – home insurance, mortgage insurance, life insurance, disability insurance, auto insurance, health and dental insurance, commercial and professional liability insurance…there’s even insurance to ensure you can pay your credit card, or if your big screen TV dies.  Insurance was created to mitigate risk – to spread risk of loss over a large number of clients and pay out claims against some form of loss.  The insurance company brokers this transaction and receives a commission for administering the plan.  Logically, the fewer claims the insurance company has to pay out, the more profit it makes.

Government appears to favour auto insurers and WSIB (worker’s compensation) over providers, sympathizing with the insurance industry’s complaints of fraud and escalating costs.  Insurers are increasingly concerned with fraud – as we all should be – and have taken great steps to prevent it.  It appears, however, insurers are pushing beyond plan administration towards a decision-maker or gatekeeper role.  This means adjudicators not trained in health science are determining whether a claimant will receive care, what type of care and how much.  Insurance companies post record profits while providers experience increasing downward pressure on their fees.

Here’s a recent post by a massage therapist on Facebook,  ”I treat clients at a software company 1-2 times per month and now my work there is on hold because almost all of my clients at that office are currently being audited….One employee (shared) his submissions were declined for massage and chiropractic at another office… The employees are very frustrated right now, (they experience) crazy deadlines, work overtime constantly and sit at computer 8-12 hours per day… They all need treatment just to maintain work productivity.” –  H.C., RMT.

This RMT went on further to say the company’s human resource manager is having difficulty getting her calls to the insurance claims adjudicator returned.  How have we allowed insurance companies to demand premiums up front, then arbitrarily decide to pay claims or not?  What other product or service can you purchase that you’re not guaranteed to receive the benefit of that product/service?  What are corporations, businesses, employees and consumers not shouting loudly against such practices?

I’ve written previously on initial steps the insurance industry has taken to preclude massage therapy claims http://www.massagetherapycanada.com/content/view/2061/, on the reports of massage therapy claim fraud http://www.massagetherapycanada.com/content/view/1706/ and how I suggest the insurance industry’s practices are intentional and deplorable http://massagetherapistpractice.com/insurance-claim-manipulation-a-problem-more-insidious-than-fraud/.  You may also appreciate my particularly frank criticism of the insurance industry’s practices http://massagetherapistpractice.com/dear-insurance-industry-you-suck/

No question, the massage therapy profession contributes to the problem.  We lack treatment guidelines and evidence-based practice showing efficacy and effectiveness in treating a variety of common problems experienced by workers.  We’re small and disorganized, lacking a consistent public and media relations platform to spread news of the benefits of massage therapy.  We need to correct these things, and to create solid relationships with the insurance industry so employers and their workers can receive the health benefits they’ve paid for.

There’s no question that the insidious attempts by the insurance industry to deny claims and exclude massage therapy service coverage is one of the most serious threats facing the massage therapy profession today.

I encourage you to get on the phone, right now, with the executive director or president of your massage therapy professional association.  Tell them you’re very concerned about this problem and ask them what concrete steps they are taking to meet this challenge.

Insurers cite rampant insurance fraud and declare escalated costs due to over-billing providers and pain-focused, manipulative claimants.  I don’t doubt unscrupulous providers or claimants are a problem, yet I wonder if the practices of insurance companies themselves are contributing to a larger concern…one that threatens the very integrity of care where a third party pays for therapy.

In a recent discussion on social media, I shared how an insurance adjuster and I engaged in a very congenial conversation “across the fence”.  The adjuster asked why – despite the Financial Service Commission of Ontario (FSCO) Professional Services Guideline (PSG) “maximum hourly rates”http://www.fsco.gov.on.ca/en/auto/autobulletins/2012/Documents/a-03-12-1.pdf  – would I submit an invoice for my regular fee.  She was genuinely concerned that the claimant would bare the difference and couldn’t understand why I wouldn’t work at 2/3 my standard fee.  “Doesn’t your regulatory body mandate this?  Don’t RMTs know the fee schedule?” she inquired.

I maintained a friendly discussion, sharing my experiences both representing the professional association at insurance negotiations, providing assessment in Designated Assessment Centres (DACs), and as a practitioner working with auto-insurance claims for many years.  I didn’t ask, but perhaps I should have, “If you showed up tomorrow and your employer expected you to do the same work at 2/3 pay, would you?”  This is the essential point that the Financial Services Commission in apparent collusion with the insurance industry during the 2010 changes to auto-insurance in Ontario seemed to miss…practitioners set fees based on market forces and in consideration of operating costs and profit/loss parameters.  An imposed, arbitrary fee schedule doesn’t eliminate these considerations, and in fact only spurs providers to game the system and look for other ways to make ends meet.

It appears that “maximum hourly rate” has been translated by the insurance industry and their government cohort to mean “the practitioner should not bill more”.  I’ve been privy to RMT discussions where insurance adjusters in fact chastised the RMT for billing their standard rate, discouraged the claimant for paying a co-payment, and complained to the RMT for even considering such practices, suggesting they were in some way unethical.  Insurance industry pundits appear not to account for the practitioner’s operating costs or break-even point…although the insurance industry’s posted record-breaking profits seem to indicate they are well aware of their own.

Further, the PSG states, above the section re: Maximum Hourly Rates that “Insurers are not prohibited from paying above any maximum amount or hourly rate established in the Guideline.”  So how is the practitioner acting unethically in billing their standard fee if the insurance company has within its ability to pay it?

A shout-out to the insurance adjusters out there – providers working in this insurance system risk having claims denied, have to prepare extra paper work and wait 30 days or more for payment, while in the non-third party marketplace patients/clients are willing to pay full fees without risk or wait required of the provider.  The current system provides real dis-incentives for providers…don’t be surprised if you don’t get the behavior you had hoped for.

WSIB (Worker’s Safety and Insurance Board) holds even more uncertainty in my experience, and is even more closely tied with government operations.  In the last 3 work injury claims I’ve applied to WSIB for, all have been turned down flatly even though they were legitimate work injuries.  Reasons cited,  “The claimant took too long to file (3 weeks) so it can’t be work related” and “Well they’re already working with a physiotherapist so they don’t need massage.”  No exploration into my findings, no questions re: my clinical rationale…just a flat “no”.  http://www.wsib.on.ca/

Further, the WSIB has worked into policy that a provider cannot bill the patient the difference between what the WSIB pays and the provider’s regular fee schedule.  The provider if they accept the case must as well accept the loss.

Let’s turn for a minute to the real inequity auto insurance forces on employers paying for employee benefit plans.  Auto insurance regulation requires persons injured in an auto accident to supplement their care first through worker benefit plans.  This means those benefits are unavailable for the reminder of the benefit cycle for other work-related health concerns the employee may have.  Auto insurance premiums are paid by the claimant…why are employers implicated in paying the initial bill?  Why are employers not screaming?  I imagine every Chamber of Commerce, every small and mid-sized business, every corporation and all their employees would have something to say about this policy.

Provider professional associations play a role in advocating members’ interests to government, the insurance industry and gatekeeper health professions to ensure opportunity to bill for rehabilitation services.  Reimbursement despite legitimate claims is not automatic, and in some cases must be fought for.  The Canadian Massage Therapist Alliance http://www.crmta.ca/?page=10 has as a primary focus meeting with the “Canadian Life and Health Insurance Association, the Canadian Health Care and Anti-fraud Association and individual insurance companies on issues of mutual concern.”

Should RMT associations across Canada pool resources in support of the CMTA, work accomplished would be exponential.  Despite requests by members at every Annual General Meeting, the board of the Registered Massage Therapists of Ontario repeatedly decline the opportunity to be involved.

The insurance industry presents as a health care hegemony, maintaining in some cases untrusting and manipulative relationships with both providers and claimants, spinning fraud and abuse to an ill-informed public and media.  Claimants and employers pay insurance premiums dutifully and expect some compensation when calamity strikes.  A “Good Neighbour” the insurance industry is not.

What would be a better solution? i) Ensure an automatic level of compensation in both auto insurance and WSIB that can proceed immediately for the patient’s interest.  Auto insurance has the Minor Injury Guideline, which in many respects is a good model. ii) Allow claimants to pursue further funding through litigation against the offending party if their cases are complicated iii) Allow claimants access to the regulated health provider of their choice, limiting bottlenecks and power differentials currently employed in a gatekeeper-driven model iv) Ensure transparent accountability by insurance companies, providers and claimants v) Do not dictate fees, but require measured outcomes and intermittent reports to show progress.

A more radical approach is to employ health and insurance trusts where forced-spending on behalf of citizens towards their personal costs are then are directed by the claimant as they see fit.  No large, profit-centred insurance industry determining access to care, no claims denial or years of litigation and appeals trying to get fair treatment, and an information-savvy citizen putting their dollars where they are best invested.  What do you think?

The 2009 joint RMT strategic plan between Ontario’s RMT professional association, regulatory body and training colleges was launched 4 years ago with much fanfare.  Unfortunately the announced and much celebrated union seemed to fall apart soon after, with each organization pursuing its stated goals somewhat independently and without regular report.

Massage practitioners feel disappointment over this failed attempt most acutely these days, given the economic climate and threats to RMT practice viability I’ve written of previously.  This last four years were a real opportunity to pool resources, collaborate and get some real work done and the opportunity has been squandered.

The strategic plan announced a lofty vision, but I think it’s objectives were intangible and hard to measure.  “We’ll put an astronaut on the moon within a decade” Kennedy said, and every American could focus on that goal.  The 2009 RMT Strategic Plan for Ontario was less tangible, and perhaps that was one factor in its failure.  The other – a seeming disinterest by the decision-makers and stakeholders in collaborating in the trenches together to get this very important work done.

I suggest an alternative plan – tangible, clearly defined, and doable within the realistic confines our profession faces in this economy and as a health care service.  The outcomes can be clearly measured, and collaboration amongst stakeholders/decision-makers is essential to execution of the plan.  From my recent article in Massage Therapy Canada:

Cultivate thought-leaders
I think we should focus on bringing our brightest together in a physical or virtual symposium to discuss the key issues: finding viable business models, determining how to support RMTs-turned-business owners; learning how to manage multiple identities/market sectors served; ensuring the quality of training colleges, accreditation and interjurisdictional competencies; mitigating incredulity with government, insurance industry, gatekeeper disciplines and pubic/media; and advancing regulation and research. The objective of this think-tank: put forth tangible solutions to address core profession issues head on.

Involve all stakeholders
Once initial recommendations are formed, we would share the findings with massage practitioners across the country for their reflection, input and to enrich the plausible solutions put forth. Educators and training school administrators, regulators, researchers, suppliers, publishers and employers would all be invited to help us shape our direction.

Get to know ourselves
We need to poll practitioners across the country on key benchmarks – net income levels, work capacity compared to actual workload, type of practice/market sector served, age, gender, rural or urban, perceived obstacles to work (physical, business or manual/technical expertise, resources), years of practice and employment status – employee, self-employed or business owner of group practice. We will need a lot more information regarding the health and demo/psychographics of our practitioners if we are to support them in building practices.

Ensure resources for professional associations
In order to function at optimal levels, our associations need to hire great support staff and ensure sustainable funding for operations. Associations can pool resources and leverage power to obtain preferred pricing for member services/products, launch a national public/media relations campaign, offer excellent professional development programs, support research, exert political influence on government health-care and taxation policy, improve insurance industry and gatekeeper health practitioner relations while dealing with exploiters and profiteers, and continue to poll members as to viewpoints, professional practice benchmarks and emerging expertise.

Collaborate
RMT association representatives would identify shared resources, craft strategic plans and take initial steps to actualize the objectives in tandem. Inherent in carrying out the strategic plan is the convention that common operations can be better served through national collaboration rather than reinvent-the-wheel, “made-in-so-and-so” policies.

Raise the bar on education
We need to support training college accreditation, compliance with inter-jurisdictional competencies and health-care regulation and support evidence-based practice. Admittedly, we need to dovetail these objectives while acknowledging the diversity of practice and holism of philosophy that constitute massage therapy’s identity. We are not physiotherapists or chiropractors . . . our rich, interwoven, multifaceted history requires a different future than other professions.

Provide a hand-up to practitioners
We should continue to strengthen RMT practice with mentoring, semi-annual virtual symposiums and community groups. RMT practice can be isolating – RMTs must get together more for dialogue and debate. The eventual and hoped for result . . . innovation and evolution.

Join forces
Eventually the organized and united massage therapy profession could consider partnering with major CAM professions and corresponding industries in fitness and wellness to exponentially increase marketplace presence and power. Common objectives include training and education, research and developing evidence-based practice, lobbying government and insurance industry for more favourable policies and compensation, and financing strong public and media relations. Combined efforts would help to position health and well-being as a societal ethos . . . something that is part of the culture and fabric of society.

What do you think about this strategic plan?  I would love to read your thoughts.

dqd

Dear colleagues,

I have submitted a letter to the Registered Massage Therapist Association of Ontario (RMTAO) requesting their urgent consideration of four initiatives I believe essential to the good health and future of the profession.  The board has received my letter and has promised a critical review in the upcoming early March meeting.

I wrote this letter because I, like you, rely on a strong professional association to advocate for massage therapist interests and provide essential services.  Although established for almost 22 years now, I still rely on the professional association to support me in providing my craft and earning my livelihood, and ensuring the same opportunity for the practitioners that follow.

I believe in this economic climate and its associated challenges that bold moves are necessary.  Our profession simply isn’t keeping up with the rapid changes happening in and to our industry, and I’m calling on our elected board of directors to consider strong and clear action in four areas.

For my arguments to carry weight, the board needs to hear from many RMTs, both from within Ontario and broad, as to how important these initiatives are for massage therapists everywhere.  Please consider sending your support in an email to info@rmtao.com, or if you’re an RMTAO member you can find the RMTAO officers at https://secure.rmtao.com/connect/with_rmtao/connect_with_rmtao.htm

Your practice, your profession, your livelihood.  Please send a positive, affirming message today.

Here are my recommendations:

i) Better Use of Knowledge-Capital:   We have articulate, brilliant thought-leaders in this profession with foresight and hindsight…and we’re squandering their gifts.  We have entry-level practitioners with energy and new ideas, and we’re not channeling their enthusiasm effectively.  Our profession faces serious threats and it needs to create organized opportunities for exchange.

Along with the down-turn in Ontario’s economy, massage therapist practice is ravaged many threats to viability, including unfavourable government health care and taxation policy, insurance claim denial and reimbursement issues, territorial gatekeeper health disciplines (and their ambitious assistants) and profiteers and exploiters who would cash in on the popularity and funding (via workplace benefit plans).

We read in social media RMTs are finding it harder to access and service claims in auto-insurance and WSIB.  RMTs are experiencing more claim denials and resistance from gatekeeper health professionals asked to authorize treatment plans.  Insurance fraud and a paucity of credible research leads to skepticism from insurance adjudicators.  These threats are emerging, insidious and imminent and a profession-wide discussion and response is long past due.

We need to tap into our profession’s thought-leaders and employ them in think-tanks in addressing the core issues.  We need town-hall meetings, virtual symposiums and social media to hear from open-eyed front-line RMTs in daily practice as to their experiences and struggles.  We need to engender two way communication, dialogue, debate and ultimately action towards looming threats and plausible opportunities.

ii) Collaborate with RMT Associations (and eventually) Kinship CAM Professions – the Canadian Massage Therapist Alliance has as its mandate to foster research, build relations with insurers and support regulation in the Canadian massage therapy profession.  Its membership includes 7 provinces and 1 territory.  The province with the largest RMT representation – Ontario – is not a member.  With a national body, resources could be pooled in public and media relations, preferred pricing in products and services for members, education and training, advocacy to government, insurers and gatekeeper health disciplines.

Further, we can consider building formal relations with kinship CAM (Complementary and Alternative Medicine) professions chiropractic, naturopathy, and acupuncture/ traditional Chinese medicine – all pursuing similar objectives in education and training, public and media relations, favorable government policy and fair insurance claim reimbursement.  Collaboration could achieve far more than the current modus operandi of acting unilaterally, and should be considered a primary objective in the RMTAO’s strategic plan.

iii) Make Operations Sustainable – The decision some years ago to lower RMTAO membership rates to attract members gained a marginal increase in membership but left the organization with a short-fall of resources (deficits in 2010/2011). [1]  With scant resources, the RMTAO can employ only three staff members, while the board is over-weighted at 14 volunteers.  Compare this to the Massage Therapist Association of British Columbia (MTABC) who, with a smaller number of RMTs to draw from, posted generous income over expenses[2], twice the operating budget of the RMTAO, and maintain a staff of nine.

Remarkably, the MTABC retains 80% of all BC RMTs as members (RMTAO’s retains 41% of all RMTs in Ontario) despite the fact the MTABC membership fee is four times more.  I propose the operations model is not sustainable, and the association in unable to serve the needs and expectations of its membership.  I suggest tripling the membership fee for the 2013 year to bring in needed resources, reduce the board to 6 members for faster decision making, and increase the staff to six to better implement board directives.

iv)  Collect, Collate and Share Professional Data– RMTs have minimal information about the profession to make business decisions or measure efforts against benchmarks.  The RMTAO can poll members annually and collect information such as:

• age, gender, location, years in practice
• sector served (spa, rehab, CAM, workplace wellness)
• estimated work capacity/week, and average workload/week
• annual net income (line 236 of tax return, after business expenses but before personal income taxes deducted)
• other sources of income earned a) within RMT profession b) in a non-related field
• employment status:  employer/business owner or employee/contractor RMT
• qualitative Qx: a) Do you enjoy your work? b) Have you any health effects from work? c) Do your earnings provide for you, or do you need more than your current income for basics? d) What are the core problems/issues facing the RMT profession?
• read annual report RMTAO Y N?  CMTO Y N?

This information can be captured, collated and then shared to help RMTs make better business decisions and provide essential information for prospective RMT students or those close to graduation.  Better yet, the RMTAO can join with the regulatory body (CMTO) to collect essential information across a broad scope of the profession.  This service alone would be a clear advantage of RMTAO membership.

Thank you for your time and careful consideration.

Don Dillon, RMT