Professional, Political, and Economic Profiles
By
Ted Nissen M.A. M.T.
Copyright
© September 2006 Ted Nissen
Introduction
Perhaps this is all just happy talk but massage
therapy, as a profession does seem to be very trendy with the public and is in
its ascendancy. Massage therapists are the most popular kid on the block or at
least according to an AMTA commissioned survey conducted by Opinion Research
Corporation International, Princeton, NJ. This research group surveyed 1,014
adults (506 men and 508 women) ages 18 and older, living in private households
in the continental United States in August of 2005. They concluded that the
typical massage therapist helps people get over their pain 93% of the time. The
typical massage client goes to their massage therapist because of a medical
condition (46%).[1] [2] (Muscle soreness
and spasm, injury recovery and rehabilitation, and pain relief) and clients
want their major medical insurance (PPOs) to cover massage therapy (68%). Most people get relief from their massage
therapist using techniques (Swedish massage/deep tissue/neuromuscular) (71%))
they learned in a 500-hour massage therapy-training program. It could be argued
that most massage therapists are already doing medical massage, consumers are
getting good results and want their insurance to cover the costs of what they
feel is health beneficial treatments (90%-94%). In fact when 1,014
adults were asked to whom they would go if they had pain their response as
follows; pain medication (28%), massage therapist (28%) than a Chiropractor (11 percent),
physical therapist (8 percent), and acupuncturist (3 percent.) We are by far
the most popular kid in class. It could be further argued that no additional
educational requirements are needed or additional divisions within the massage
profession created. The typical massage therapist relieves client’s pain (93%)
from their medical conditions (46%) with the current educational training (500
hrs ave) and it should be covered by major medical insurance (68%).
Despite the popularity of massage and the
modalities apparent effectiveness are massage therapists paid enough for the
good work? Chiropractors
earn three times more per client hour and 6.8 times per year than the massage
therapist who with her husband is earning 8% below the national median income
for a married couple. Although the chiropractor is much better educated than
the massage therapist, and must pass the costs onto the consumer the
chiropractors net practice and individual income profits are as aforementioned.
That is even if you factor in the additional educational costs chiropractors
net hourly and yearly income is many times the massage therapist. If massage
therapists could bill and get paid for their services by major medical
insurance they would likely see an increase of approximately 38.4% (based on
the average chiropractic billing) of their income ($32,506+$12,482.30=$44,988.3),
which with her husbands income would total $72,879 ($27,891+ $44,988.3=$72,879.3). $72,879 would
at least be 11% above the median income ($72,879-$65,946=$6,933/$65,946=.11). If our massage therapist
were to work full time which may be possible given clients ability to use their
insurance to pay for treatments MT income would increase dramatically. With a
38.4% increase in hourly income and a full time 35 hour a week massage schedule
she could earn $78,915.2 per year just on her own without her husbands income
($31.33*.384=$12.03+$31.33=$43.36*35=$1517.6*52=$78,915.2). This would be 20%
above the median income without her husbands income, who could now become a
stay at home dad ($78,915-$65,946=$6,933/$65,946=.20).
With her husband’s income added the total household income would be $106,806.2
($27,891+
$78,915.2=$106,806.2). This would
be well above the median income for a family of two. Our massage therapist’s
gross individual practice income would be well below the average net practice
income of our typical chiropractor. The mean Net practice income of the typical
chiropractor is $148,625 which is 88% ($148,625-$78,915.2=$69,709/$78,91=.88) above the gross
practice income of the massage therapist ($78,915.2).
Does massage really help people with their medical conditions? We need
to do a literature review and perhaps more research to find out. Consumer
surveys only tell us that our clients think so. Does increasing the educational
hours of the therapist improve the effectiveness of treatment? Are
chiropractors, for example, comparatively more effective than massage
therapists in relieving client’s pain from a medical condition? Has this
comparative research even been done? One hypothesis is this; Metabolic
disturbances in connective tissue which cause most of the mild to moderate pain
people seek out soft tissue professionals for, is corrected by general massage
techniques (neurological reflexes on the skin increase circulation to deeper connective
tissue) and does not require specialized massage training. Why Do We Hurt? These massage techniques are more effective
than chiropractic, physical therapy, acupuncture, or even more specialized
massage techniques (Orthopedic massage ect). The notion that more education is
needed or the professional restructuring is based on reasonable but factually
incorrect fixed ideas. Philosophical Basis... Educational
institutions, seminar leaders, and the spa industry probably benefit
financially. These political/economic forces may even perpetuate these fixed
ideas. In other words, businesses, which sell education or profit from cheap
labor, may not want to support a counter intuitive or a financially
inconvenient truth. Recall this is only a hypothesis (generally stated). The
benefit of researching the truth of this hypothesis to the typical massage
therapist is tremendous. Instead of working 2 or more jobs and still living
significantly below the median income level she could have a comfortable life
with less work and more profit. Our well-loved massage therapist could move out
of her apartment, buy a home in the suburbs, get some health insurance, get her
teeth fixed and send her kids to a private school. If she doesn’t much like her
husband she can drop him too.
Given these economic facts and hypothetical clinical realities why haven’t the some 250,000 professional massage therapists gotten better pay and benefits. The answers are likely complex but worth exploring. First and foremost it is important to understand better who the typical massage therapist is as an individual since politics is in part the story of individuals. Every one who has followed elections knows that political consultants use research to understand their voters better (You might have heard the term soccer mom). Once individuals are understood political science can begin to analyze how groups of people can be mobilized to exercise collective power.[3] [4] Below you will find examples of the typical individual elements of this political stew.
Massage Therapist (Typical)
45 year-old married women (78%-83%) part time secretary/massage
therapist with 500 hours of massage therapy training, 2 years of college (AA
Degree), 5.6-7.8 years experience, who lives in
(California, Florida, Texas, or Washington,)[5]. She works doing
massage or a combination of massage related activities approximately 15.38-15.4 hours per week working both in a
spa/chiropractors office or as a massage teacher (23%) and in private practice.
She does 39 actual massages per month or 9.75 massages per week. She practices
mostly Swedish massage (37%), deep tissue/neuromuscular (34%), Myofascial therapy
(6.4), energy work (3.4%) and sports massage (3.1%). She charges her private
clients $58 per hour. Between her private practice and independent contractor
(spa/chiro=she is paid per client) work she makes an average of $23.66-$39
($31.33 mid point) per hour with a median income per year of $14,500-$29,250.[6] [7]
($21,875 mid point) With her other secretarial job (25 hours per week) she
earns a total of $32,506. The total household income including her husbands is
$60,397 ($65,946 is considered a nation wide median income level for a married
couple). She is probably pretty tired at the end of her workweek. She likes
doing massage therapy because of the flexible schedule and alternately wants
more clients but dreads increasing her workload (55%). Doing massage she has
found is hard physical labor and you can only work on so many people a day or
week without becoming exhausted. Most of her existing clients refer new
clients. She does receive (70%) about two new referrals per month from other
heath care professionals (physician 60%, physical therapist 50%,
chiropractor 38%). She is
certified by the National Certification Board for Therapeutic Massage and
Bodywork (NCBTMB), and licensed if that is available in her state. She attends
27 hours of continuing education per year.
Massage Clients (Typical)
Among five of your friends at least one of them (22%) has had massage
in the last year.[8] Most of the
massage therapist’s (described above) clients come to her for medical reasons
(46%) (muscle soreness and spasm, injury recovery and rehabilitation, and pain
relief) and to reduce stress and relax. As aforementioned her clients are
referred from her current or previous clients. Almost all of her clients would
agree that massage is effective in relieving pain (93%). A resounding majority
of her clients believe massage can be beneficial to their health (90%-94%).
Most of her clients would recommend massage to someone they know (73%). Instead
of reaching for the medications her clients are just as likely to call her for
a massage (28%). If her clients are in pain they are more likely to call her
(28%) than a Chiropractor (11 percent), physical therapist (8 percent), and
acupuncturist (3 percent.) Most of her clients would rather see her at the spa
or chiropractors office than in a home. In fact, many of her client’s call her
for an appointment because they are in pain (46-50%). Many of her clients come
to her for regular pain relief (15%). Periodically she offers free or
discounted massage and many new clients (24%) make appointments with her. In
the last few years she has been seeing more men who come to her for massage. If
you gather together six of your male friends at least one has had a massage in
the last 12 months (17%). Still most of her clients are likely women and had
their last massage in a spa (20%). Most clients (68%) would like their health
insurance providers to cover massage therapy. Some of her clients have
discussed massage with their health care provider (21%) who has recommended
massage to them (physician 60%, physical therapist 50%, chiropractor 38%).
Industry & Political
Organizations
The American Massage Therapy Association (AMTA) is a non-profit
professional association of more than 54,000 members throughout the United
States and in some 27 countries. AMTA was founded in 1947 in Washington State
by Ruth & Jesse Williams of Tri-Cities, Washington. The other large massage
therapy organization is Associated Bodywork & Massage Professionals (ABMP)
with approximately 57,000 members founded in 1987. The International Massage
Association (IMA) manages 16 wellness associations with a combined membership
of over 69,000 members and was founded on April 1, 1994. Consumers receive
125-130 million massage sessions annually, for which they pay $6 to $11
billion.[9] The first state
license was issued in Ohio to Agnes Forbes effective January 4th,
1916. Currently, 36 states and the District of Columbia regulate massage
therapists. In 1995, only 20 states and the District of Columbia regulated the
massage therapy profession. Between August 2004 and July 2005, approximately 47
million American adults received a massage –2 million more than in the previous
year. 250,000 to 300,000 massage therapists and massage school students in the
United States. More than 1,500 state-approved schools provide massage and
bodywork training with over 70,000 graduates per year.[10] 80,000 Nationally
Certified massage therapy practitioners. There are many ways in which American
companies incorporate massage therapy into the workplace. Massage therapists as
full- or part-time employees. Individual contractors. Employee wellness
centers. Cost-sharing for massage therapy sessions with employees. Top
companies offer massage therapy in the workplace. Among the companies
identified as the “100 Best for Working Mothers,” 77% offered massage therapy
to their employees. Eighteen percent (18%) of corporations with more than 500
employees offered massage therapy to their employees versus 11% of companies
nationwide of all sizes that were surveyed. Companies offering massage therapy
as an employee benefit include Allstate, Best Buy, Cisco Systems, FedEx,
Gannett (USA Today), General Electric, Hewlett-Packard, Home Depot, JC Penney,
Kimberly-Clark, Texas Instruments and Yahoo!. S.C. Johnson says that more and
more managers recognize the benefits of massage for their employees – and the
company’s been offering massage therapy as a benefit for more than 10 years.
Eighty-two percent (82%) of hospitals offering CAM (complementary and
alternative medicine) therapies include massage therapy among their healthcare
offerings. Of those hospitals, 70 percent utilize massage therapy for pain
management and pain relief. Seventy-four percent (74%) of HMO plans cover
massage/relaxation therapy in some way.
Chiropractor (Typical)
42.3-year-old male (84.4%) solo practitioner (69.7%) in practice for
the last 13.3 years with a suburban practice (57.9%) working 30-39 hours a week
of patient care with 5.7 new patients per week, average patient visits 28.5 per
day, 133.6 per week (6947.2 per year), working about 4.7 days per week,
spending about 13.5 minutes per patient, with Median gross billings $250K-$349K
($299.5 K Mid-point), Median gross collections $200K-$249K ($224.5 K
Mid-point), collecting 75% of what is billed, mean Net practice income
$148,625, Mean DC salary $96,772, and Median individual income $75K-$89.9K
($82,450 K mid-point/6947.2=$11.87/visit). Our chiropractor has 2 years of
college undergraduate education and a 4-year program (5000 hour?) at an
accredited chiropractic college leading to the Doctor of Chiropractic degree.[11] This chiropractor
employs 3.2 people in his office. Each chiropractor nets (Median individual
income) about $11.87 per patient visit or $52.76 per hour
(60/13.5=4.44*$11.87=$52.30) based on the median income. Based on the mean DC
salary each chiropractor nets about $13.93 per patient visit
(96,772/6947.2=$13.93) or $61.85 per hour (60/13.5=4.44*$13.93=$61.85). Based
on mean Net practice income of $148,625 per year each chiropractor nets about
$21.39 per patient visit (148,625/6947.2=$21.39) or $94.99 per hour
(60/13.5=4.44*21.39=94.99) Female Chiropractors (15.6%) make 21% less than male
chiropractors (Net practice income).[12] This may be
because male chiropractors bill more, collect more, and earn more than female
chiropractors who work fewer hours than their male counterparts. Based on mean
net practice income DC’s earn about 3xs per hour the earnings of the typical
massage therapist or 6.8 times the annual income. The business expenses of our
chiropractor are $86,193, which has been deducted from the aforementioned
income where applicable. Our chiropractor refers to himself as a general DC
practitioner (62.8%), calling his office a chiropractic clinic (74.7%). This
chiropractor employs the following specialists; Licensed massage therapist
(40.8%), acupuncturist (9.0 percent), physical therapist (7.4 percent), MD (5.8
percent), nutritionist (5.4 percent), and trainer (2.7 percent). The top
sources of revenue for the chiropractor are; health insurance (38.4%-71.1%=PPOs,
48.7%=HMO, 31.4=Discount Programs, 22%=IPA, and 18.2%=CAM (complementary and
alternative medicine) Networks), 29.5% Cash, 11.2 Auto Insurance, 10.7%
Medicare, 4.4% Workers Comp, and 2.2% Retail Products. 88% of our chiropractors
sell some type of retail product even though these products provide a small
fraction of their total revenue (2.2%(pillows (71.8 percent), dietary
supplements (70.0 percent), orthotics (61.6 percent), hot or cold treatments
(66.4 percent), and ointments (44.2 percent). The average mean salary for this
chiropractor’s employees are; DCs=$96,772, Associates=$57,218, PT=$44,550,
LMT=$24,043, CAs (Chiropractic Assistants)=$23,672.
2424/300=8.08
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