Archive for Licensing and Legislation

Massage Therapists Getting Younger

July 6, 2009 Julie Onofrio Licensing and Legislation

Massage therapists are getting younger or so The AMTA Massage Industry Research Report says:

Nearly sixty percent (57.8 percent) of school administrators responded that the average age of students has declined at their school in the past five years, according to the 2008 AMTA Massage School Survey. School administrators estimate that the average student is 30 years old, with 36.6 percent being 25 years old or less.

Previous statistics from both the AMTA and ABMP showed the average age of massage therapists to be around 44.

Why is massage attracting younger people and what will the effects on the profession be from this change?

Massage schools enrollment is declining which means that massage schools are needing massage students.  Massage schools are recruiting high school students to fill their massage schools.  Federal Grants are also available to massage students which allows younger people without much money to go to massage school.

My website www.massage-career-guides.com which used to be www.massagetherapycareers.com was overwhelmed with questions from high school students asking about careers in massage and what was required to get into school.  Their biggest concern was over whether or not you had to take math and how much you could make.

My career in massage has been a lifestyle and journey.  It was and still is a calling – something that I was just meant to do.  Through it I learn a tremendous amount about myself and about what it really means to be a massage therapist.  I became a massage therapist because I love learning about health and I like helping people (which of course was also loaded with learning opportunities!).  If high school students are drawn to the massage profession because they don’t have to take math – what will that do to the quality of massages being done and the massage profession overall?

I also was quite intrigued by this discussion on linked in or facebook  (I can’t remember which or find the post) talking about younger massage students who were always texting during massage school and even during a massage!  They were doing it to prove that they could and they said something like ‘the client won’t know anyways’!!

These younger massage students are also the one’s who are getting jobs at places like Massage Envy that don’t pay much so it is keeping Massage Envy in business (Is that a good or bad thing?  we really don’t know that either- more posts coming!)

My concern over younger people joining the massage profession is also about whether or not a younger massage therapist can really understand what massage really does and be able to understand the therapeutic relationship and create and hold boundaries.  But I guess I didn’t get it either when I first started 20 years ago and many older adults don’t really get it either.

I am also concerned about the level of service that younger people provide (or not provide) just in the way of basic communication skills and customer service.  When I go into spas and find younger people working the appointment desk I just cringe at the things they say – “All deep tissue is the same” is my favorite!

I used to be totally against licensing of any sort and of even requiring massage training beyond 100 hour of education because that is all it really does take to be able to just do an efficient massage (That will be a whole other post soon.)  I now am thinking that it would be best if younger massage students did get 3-4 years of massage school that could add in the extra training in ethics, business and communication skills as well as learning to be present and work with the therapeutic relationship.    If this is going to be a continuing massage trend- students and massage therapists getting younger – we need to keep up with the changes and not let these students be left behind.

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Massage Therapy Classes

July 13, 2008 Julie Onofrio Licensing and Legislation

One of my gripes about the massage profession and the process of professional massage licensing is the fact that the National Certification Board of Massage and Bodywork (NCBTMB) requires that massage students take classes in Traditional Chinese Medicine (TCM) and understand how the meridians work in the body.  Just a few years ago there was only one test and that required knowing the meridians.

While I am all for TCM and go to acupuncturists myself for many various ailments – can you really learn enough about the meridians in a weekend workshop to be able to know what to do to work with them? Is it really necessary for massage therapists to know about meridians to have a successful massage practice?

To me TCM is a lifestyle and lifelong learning process. It takes a few years to be proficient in something like this. I personally do not anyone working on my meridians after taking a weekend workshop.

While the NCBTMB also has another exam where they don’t require having to know meridians they call the other exam – the National Certification in Therapeutic Massage. You don’t have to know about meridians but you do have to know about posture and alignment.  That to me is what a bodyworker knows since most of my extensive training (about 6 years of my 20 years in the massage profession) were spent learning structural integration.  I became a bodyworker after that. The test that requires knowing the meridians is called the National Certification in Therapeutic Massage and Bodywork. So apparently just because you know the meridians you can call your self a bodyworker.

The whole thing is very confusing because the profession has no clear definition of what the terms massage or bodywork even mean.

Now here is the thing – If you want to study meridians and TCM please so so and study it with all of your heart.  But don’t make me learn it or have anything to do with it.  I have no interest in it or have the time (1 year or more) to put into learning something like that.  It is not needed to practice massage successfully.

Yes it can help you if you are interested in it but making it a requirement is beyond ridiculous.   If you are a TCM practitioner I am not saying your work is not valid or important so please don’t take this personally.

The whole problem lies in the not knowing what is really needed to be a successful massage therapist.  From what I understand the NCBTMB does do surveys on what classes people have taken and they ask if people have studied meridians.  Of course they have studied it because they made it be a requirement!  Is it necessary?  NO.

Basic massage skills do not require knowing the meridians or anything about them or any branch of traditional Chinese medicine.

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Massage Politics

June 24, 2008 Julie Onofrio Ethics, Licensing and Legislation

One of the biggest controversies in the massage profession has to do with the licensing and regulation of massage therapy.  There are 38 states in the US that require massage therapists to have some type of licensing.  Each state differs in the amount of education, classes and definitions of massage therapy which makes it very confusing to understand.   The non-licensed states also have varying requirement to practice massage with the biggest problem in CA where each city has different requirements.

The groups that advocate licensing state that the reasons for wanting licensing are to protect the public from harm, create more professional standards of education, reduce the number of prostitutes doing massage to name a few.   The thing is that there is no proof that massage has caused significant harm to people.  Keith Grant has done an initial survey of medline on the cases of harm that are done to massage clients.  How much harm can be done in doing massage?  What is the definition of harm?  Is it harmful to have a massage therapist who says they are doing deep tissue massage when it is really swedish massage?  Is it harmful when a client leaves feeling more sore than when they came in?   Will any amount of education really influence the massage therapists skills and reduce the ability to do harm?

If there were a high degree of harm being done, wouldn’t our liability insurance rates reflect that?  And how much harm do over the counter drugs do?  I just recently had a friend who had excruciating back and abdominal pain for over a year and it turns out it was an over the counter drug causing it.  Is that harmful?

What list of side effects could be created to inform the public and teach the public to take responsibility for what happens in their massage?

The number of hours of education varies greatly as well as the topics of courses.  I for one started in 1987 doing massage after having 250 hours of massage school.  I was the last year of students to become a massage therapist at that number of hours.  The number of hours of training was going up to 500 hours in a few months and for no reason at all as far as I could see – no testing to see if it was needed… no research…no case studies, no statistics that showed that having more education would help create a more successful massage therapist.  The one thing I did notice was that once they did raise the number of hours, the massage schools increased their hours of training to exceed that 500 hours so that they could get more grant and loan funding for students.  I would love to see if the number of students/graduates jumped at that exact time!   The thing is that we have no information on what it does really take to be a successful massage therapist.  It is more than just doing a good massage.  You also have to be a business person.  But massage can be learned in a basic 100 hour massage class.  Keith Grant also has some information on that topic in his white paper “Issues in Massage Governance” (pdf).  He also noticed the same coincidental increase in the number of hours and the number of grants/loans.  He also talks about how people learn and sites that people learn better in smaller training programs and the preferred method is apprenticeship programs.  There are a few states that do allow apprenticeship programs to be counted as massage training – WA State being one of them.  It was actually the whole reason I started this website -www.thebodyworker.com but the thing is that you can only teach one student at a time unless you want to make it into a formal school, which doesn’t make it profitable.

This is the only information that I have seen that gives any insight into the issues that we are dealing with.  If there are some other studies, information, proof that more hours of education are needed to be a successful massage therapist then I would love to see it.

CA also has the highest number of massage therapists despite them having this licensing problem.  I think that most can become a massage therapist with 100 or 250 hours of training – correct me if I am wrong.  So is it the number of hours of training that make a successful massage therapist?

The thing is that when people hear that after taking 1000 hour training classes I think that they somehow think it to mean that they didn’t need to take that many hours or that it is implied that they aren’t knowledgable or that more training is not beneficial.  It could be beneficial to people who take it but it is not needed to be a successful massage therapist – that is all that it is saying.

The idea that massage therapists need all this medical training etc is really not true.  It doesn’t mean that it could help to have extra classes and training.  It does not mean that more training can give you more confidence and skills but they are just not needed to do a basic relaxation massage which is also very therapeutic.  After 20 years of doing massage and learning structural integration, triggerpoint therapy and many other things I actually am going back to studying the affects of touch on healing.  I once thought as an overzealous massage student that if everyone got a massage once a week (now I would say 3 times a week!) there would be world peace and now I would add – a great reduction in the number of diseases and health conditions that are on the rise.

So I actually don’t care much about licensing these days anymore despite this long post.  I just write to hopefully inform someone and to inspire others to seek the truth.  I am more than open to hearing any more on this topic, but quite frankly – I just want to do massage! (and write about it!)  I sometimes get tweaked and think I should join AMTA or get ABMP more involved especially when I think about the state of insurance billing for massage therapists here in WA State – which talk about a mess!  That’s a whole other category here.

So do you think you could do a really great massage just having 100 hours of training just on doing massage?   I have lots of friends who have that number of hours because it used to be that number a long time ago.  They are all still in business but it seems the more recent grads with 1000 hours can’t seem to make it.  What does it take to be a successful massage therapist?  Is it the number of hours of training?  Is it some secret method?  Is it just about the person and who they are and what they want in their lives?

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Medical Massage or Not

May 7, 2008 Julie Onofrio Ethics, Licensing and Legislation, News

One of my pet peeves in the massage profession has been this whole idea that medical massage is the future of the massage profession and that the massage profession should get involved with working with doctors and insurance companies as contracted providers. I am referring to working with HMO’s and PPO’s as a regular contracted provider and also some auto insurance companies who have joined networks. Medical Massage is not being defined by the massage profession itself so the insurance companies are doing it for us. Being in WA State where we are allowed to become contracted providers with insurance companies, I have been privileged to witness the demise of insurance billing in a few short years. This is what is happening here in WA and some reasons why we need to think twice about wanting to work with insurance companies.

  1. The insurance companies are constantly reducing the allowable fee (what they pay you and that you accept when under contract with insurance companies.) When I first started in about 2000 accepting insurance one company paid me about $90 an hour which was a very acceptable rate. Within a few years they reduced that rate to less than $70 and it continued to be that same rate until this year when they gave us a $.40 raise – yes that is forty cents when the price of gas is sure to go over $4.00 a gallon.
  2. The insurance companies are also constantly reducing their benefits in their policies with people. For example – one company who used to allow 45 sessions of massage and PT combined a year now only allows 14 sessions a year.
  3. The insurance companies are constantly making it harder to get paid. One company in particular will ask that we prove medical necessity after 4-6 sessions of massage and then deny any further treatment no matter what it seems.
  4. The insurance companies set the allowable fees and usually send out a rate chart in the beginning of the year or when you first contract with them. Although it hasn’t happened to me yet as a massage therapist, I have heard from a few chiropractors and an acupuncturist that they change their mind in the middle of the year and say they are paying too much and reduce the rates and MAKE YOU PAY BACK THE DIFFERENCE – yes I am yelling- and there is nothing that can be done except to pay them back or they will take it out of future payments. I do know of one Naturopath who almost went out of business because of it.
  5. Out of network providers may often get paid more than in network providers- yes this is a fact too. There is one company doing just that. If you are out of network they only pay a percentage of the bill usually, but they pay contracted providers so poorly that even the percentage of the full bill which usually is about $132 (UCR) works out to be more than they pay contracted providers
  6. One such health network includes a list of auto insurance companies who are using provider networks and rules to pay for services rendered. This means that you have to accept a reduced rate of pay.
  7. Most of the companies have not increased their allowable fees since I started with them in 2000. So no raise for a contracted provider -not even to reflect a cost of living increase.
  8. Insurance companies are also creating educational requirements for credentialing meaning they are saying what training and education is required to become a member with them. It doesn’t matter that we are licensed by the State Board of Health. The insurance profession is defining the massage profession.
  9. Affinity networks are discount networks that some massage therapists unknowingly join thinking that they will get more clients not understanding that they are also taking a big cut in fees.

So does that make you still want to join a provider network and be able to bill insurance companies for your massage services?

See also the Insurance Billing Section on www.thebodyworker.com

2005 Guest editorial in Massage Magazine

Issues and Ethics in Billing Insurance Companies

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The future of the Massage Profession

April 4, 2008 Julie Onofrio Licensing and Legislation

With so many concerns of the economic challenges that are being faced and will be faced with what does the future hold for the massage profession? As a massage therapist for the last 20 years and an avid participant in the many online groups and through contact with my many readers, I can see that most of the massage profession struggles to get by. (Maybe it’s just because you don’t hear as much about the successful stories. They are out there though, I am sure.)

ABMP reports in their metrics section at www.massagetherapy.com that :

Average massage-related income for massage therapists in 2005 was $18,950, with a median income of $14,500 (2005 ABMP Member Survey)

Total earnings by massage therapists, including their earnings from other employment, were $32,506 (2005 ABMP Member Survey).

First-year practice average income was $9,589, reflecting the challenges of establishing a professional-service practice (2005 ABMP Member Survey).

ABMP estimates some 50,000 massage therapists leave the profession each year.

The average age of ABMP members graduating in 2007 and entering the profession is 44. The median age is 45.

Close to 83 percent are women and 54.5 percent are married.

As massage therapists look for other ways of making a living they are choosing to take low paying jobs just to get by. Massage Envy was one of the top franchises last year and this I just found online so I am not sure how true it is “As of this month, Massage Envy, which was founded in 2002 and reported nearly $100 million in sales last year, has 120 locations and 248 more under development in 30 states.” They pay their employees $12-$15 an hour from what I have heard -plus tips.

They are choosing to accept insurance as payment or join discount insurance networks just to get by. I am a provider here in WA State and have been since about 2000 when they started allowing massage therapists to be contracted providers with insurance companies. When it first started there were a few companies who paid fairly well but some who paid poorly -(less than the average of $60 for a massage in the US). I have yet to see them raise their allowable fees and most are reducing what they pay and also the allowable benefits. Each year it gets less and less and gets harder to get paid. Managed care makes it harder to make a living.

Since the median age of massage therapists is 45 according to the recent ABMP survey, where does that leave massage therapists as they move into their retirement years? Most massage therapists are coming into the massage profession as a second or third career and thinking of it as a way to supplement retirement or slow down until they retire. They are seeking a more fulfilling career working with others.

And where are all the men in the profession? With low paying jobs how can men support their families? With men as a minority in the profession it shows that there are still many preconceived notions about touch. Women don’t want to be massaged by men and men don’t want to be massaged by men. With this challenge men are leaning away from the massage profession for better paying jobs where they are more accepted.

With such struggles along with the physical, mental and emotional demands of being a massage therapist, many see this as a part time profession. They also perceive it to be more of a calling than a way to make a living and lack a clearly defined business model. Is massage a hobby or a business?

I also have been receiving many communications through my website www.massagetherapycareers.com in the frequently asked questions section from high school students looking into careers in massage. They ask about what jobs pay and where can they get a massage but their main questions are things like “Do I have to take math or science classes?” which makes me think they are just looking for an easy career (which massage is not.) Since most massage schools are just looking to fill their classes they tend to make massage careers look glamorous and appealing. While in the past most massage therapists have started their own business, many more are now taking those low paying Massage Envy jobs which will be affecting the whole massage profession and changing it from one of healing, compassion and learning to just another job.

The massage profession also is in the midst of a big controversy over licensing and legislation issues. How much training and education is required to become a successful massage therapist? How is massage and medical massage defined? We have yet to define these things for ourselves so now insurance companies are doing it for us. (In WA State there is one insurance company creating a special massage credential that defines how much education is required for a massage therapist in their provider network.)

So what is in our future? How can we take more control of where we are going as a whole and not let the economy and money over-ride client/patient care?

The Future of Massage – Whitney Lowe

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