“A picture is worth a thousand words”. I think it beneficial to size up the direct, external threats to massage therapist practice. Perhaps this image will spawn a grassroots of support and democracy towards tangible solutions.
i) Government health care and taxation policy is unfavourable to massage therapists. Despite regulation under the same act as physicians, nurses, physiotherapists and other disciplines, massage therapists are not covered under the provincial health care plan. Worse, taxation on massage therapy care at 13% is onerous to patients and at competitive disadvantage with main competitors physiotherapists and chiropractors.
ii) Massage therapy care is currently covered – partially or fully – under many workplace benefit plans. These plans were inacted post World War II where there was a surplus of work and limited supply of skilled workers. The Baby Boomers saw huge increases in salaries and benefits, and have enjoyed unparalled wealth in North American history. However, massive inflation met those salary increases and relocation into major cities with subsequent generations having far less discretionary income to work with. We may expect a reduction in workplace benefits throughout a number of industries/sectors.
[A surplus of educated and skilled workers = decline in company’s need to offer workplace benefits to retain workers].
According to some surveys, 75% of RMT patients/clients rely on workplace benefit plans to cover their care. With a reduction or elimination of benefits, viability of RMT practice is in jeopardy. Further, there appears arbitrary and sometimes adversarial access by RMTs to insurance compensation schemes for worker’s compensation and auto insurance claims. Additionally troubling, massage insurance fraud is gaining more attention. RMTs are looking for reliable funding but may find access to these sources tenuous.
iii) Gatekeeper health disciplines determine whether massage therapy treatment plans are approved or denied. RMTs rely heavily on positive relationships with these gatekeepers. However, RMTs are one of the few health care disciplines without a degree-level program and sufficient evidence-based practice/research. As well, most RMT professional associations are under-resourced to properly position their members as health care providers. Our profession lacks credibility as such with gatekeeper health disciplines. To be recognized fully as a health profession, we’ve some decisions to make.
There is a move in health care to reduce reliance on well-paid physicians and nurses and shunt comparable work to physiotherapists, pharmacists and nurse practitioners. These latter three disciplines received increases in scope of practice in Ontario within the last two years.
In addition to accomodating the shift from high paid physicians and nurses to well-trained but lower paid health care disciplines, there is an additional shift to pass workload onto assistants – PT/OT assistants, pharmacy assistants and nursing assistants or personal support workers. This further lessens the cost of delivering health care.
My question: will PT/OT assistants be taught basic massage technique to provide under the auspices of the physiotherapist, at a profit to the employer physiotherapist? Would physiotherapists continue to refer to RMTs if they had lower-paid assistants in-house? Would the public, funneled directly into physiotherapy care rather than less-resourced small massage therapy practices, be aware of the difference? Time will tell, but the incentives are certainly there.
iv) Profiteers and exploiters – poor quality training facilities, discount packagers, non-regulated posers – take advantage of massage therapy’s popularity. These malevolent benefactors directly impact RMT quality of care and reputation, RMT income levels and leveraging opportunities, insurance fraud and treatment plan denial rates, and public and media perception. Disorganized and fragmented in resources and focus, the massage therapy profession is particularly vulnerable.
We’ve named the problem – who’s got a solution to put forth?
One of the things I have noticed, is our tendency to work as sole proprietors. One person, alone in an office, with the goal of expanding and bringing in a junior person, who then builds their client base and leaves to go work on their own after a year or two, brings in someone else who’s new, and so on. To me, this is extremely inefficient and wasteful! I think we could do a lot better by “joining forces” and pool our resources in a massage therapy co-op. This could accommodate both full-time and part-time therapists, and would reduce office costs. Funds could be pooled together for advertising and equipment, and it would also help in building up a sense of community, too. You would also have the same visibility of a large clinic, but still be able to point your career in the direction you desire. It wouldn’t be for everybody, but I do believe (with proper contracts in place!) it is a viable option. Also, with reduced expenses, come some interesting possibilities. A therapist could simply enjoy their increased profit, or they could choose to reduce their rates to accommodate for increased taxes, reduced insurance availability, provide assistance to lower-income clients, etc.
I still remember when you came to speak at my school (ACTM), Don, and you broke down the income expectations for someone with an equivalent level of education. I think it worked out to between $15 and $18 per hour. I’m wondering if we haven’t set ourselves up in a paradigm that just can’t work. We need to charge high rates in order to pay our overhead, but is it really appropriate for what we offer, and for what people can afford to pay?