In December, I joined a group of local massage therapists to speak before the D.C. Massage Therapy Licensing Board about a matter of great concern to us all. The regulatory issue concerns whether LMTs can remain exempt from the burdensome Massage Establishment regulations that were newly implemented in the District. This continues to be a serious concern to all of us working in D.C., including those in private practice.
During the course of that meeting, I experienced a further concern. Although I was impressed by the support of my fellow professionals on the Board, I thought that the District employees who are involved in our regulation do not understand the prevalent conditions under which we work. After the meeting, I wrote them a letter citing recent data on how the “typical” American massage therapist works, and why our practice conditions make the new stipulations onerous. I am still waiting for a response.
Actually, I can appreciate the regulators’ apparent confusion because our field is in a state of flux. For the past five years, I dedicated my doctoral work to investigating massage therapy and those who practice it. Some of what I learned surprised me, and motivated me to conduct exploratory research on how massage therapists execute a session. My dissertation will soon be published, but I think my work is just beginning.
By necessity, as a foundation for my own research, I acquired a plethora of references. Now, I welcome any chance to share my ideas about our work and our field, which is on the cusp of transition. In the interests of our craft and our livelihoods, we each need to know as much as those who are already reshaping the way we work.
A Note about the Data
The AMTA just released its annual industry report for 2012 [i]. You will see it referenced in various trade journals over the next weeks, even though most of the data is carried over from prior years’ surveys. Collected over the past decade, the AMTA results are the most thorough and practice-informed data we have available. The big news from the latest figures is that our field is impacted by the economic downturn.
Besides AMTA reports, there are two other sources of data on MTs in the U.S. One is the Associated Bodywork and Massage Professionals (ABMP) that releases annual figures on practice patterns[ii]. The other source is the U.S. Bureau of Labor Statistics[iii], which collects data from employers. The Bureau’s website can calculate income by region based on estimates and standard calculations. But the results can be misleading. For instance, in a recent query the formulas seemed calculate MTs’ income based on a 40 hour work-week, where apparently all 40 hours are spent at the massage table. Thus, according to the website, in 2010 the average D.C. MT made over $58,000 annually, which is a much different figure than AMTA’s latest average income estimate of $21,028 1.
There are some flaws common amongst the AMTA and ABMP data. Since the results are proprietary marketing information, we cannot really see where the data comes from. For example, the population size, the survey criteria, and methods are not readily available. We can assume that the associations surveyed their own members, and hope they gathered enough responses to be statistically significant. But only about half the trained MTs in the U.S. belong to any association, with a higher proportion being ABMP members. Thus, survey results might represent the typical American MT, or simply the affiliates who were polled and published. Since it is marketing data, we can expect that the information will be presented in ways to best serve the individual association’s larger purpose. Also, the data is national data; we do not see a breakdown by region.
Another common problem is that the data gets mixed up in the reporting. AMTA regularly cites the Bureau of Labor statistics without mentioning that it is based on employer-supplied input. Also, I have seen ABMP publish data numbers that can be traced back to the exact same figures claimed by AMTA. AMTA sometimes mixes up its years in discussions and reports. This does not even take into consideration the biases inherent in the different in membership bodies, who responds to surveys, or how any particular question was worded to design the outcome.
A recent more independent, but perhaps limited source of data, is the National Certification Board for Therapeutic Massage and Bodywork (NCTMB). Beginning in 2009, NCTMB surveyed thousands of MTs for purposes of designing advanced certification programs[iv]. The survey population was diverse by association affiliation, but limited to MTs known to NCTMB. Independent survey researchers conducted these projects and disclosed their methods in the reports. Because of their transparency and specificity, we can see how some data can be confused. For example, AMTA reports that the vast majority (73%) of MTs identify themselves as “sole practitioners” 1. But the NCTMB report provides its corresponding question of whether “most of your work hours were spent in a private practice setting”. NCTMB surveyed respondents said “yes” 53% of the time 4. We can understand, by reading the original question, that “sole practitioner” identity and “private practice setting” are not the same thing. But they are easily, and probably often, confused.
The bottom line with the data is to read it carefully, and reality test what it says. Compare data to what you know based on your own work experience. Pay attention to the trends, and particularly to how different stakeholders interpret these. Be aware that you too can use the data to support your practice and business decisions. In my letter to the D.C. regulators, I used the data to support my argument that their new regulations were burdensome. I drew my specifics from “facts” I describe below.
Massage Therapy as a Profession
As a field, massage therapy exceeds the national average for career growth. Reports estimate an annual increase of 19% 3 in 2011. However, the massage business is not growing as fast as it was a few years ago when career growth was over 22% per year[v]. But it is hard to determine exactly what “growth” involves since the total industry revenue estimates for 2011, approximated at $10-12 billon1, dropped from the two years prior1,5. Meanwhile, estimates for the number of massage therapists and massage students in the U.S. remained the same from 2009 to 2011 1,5,[vi].
The associations estimate a total of 280,000 to 320,000 MTs in the U.S. today1,2. However, the Bureau of Labor estimates that 122,400 MTs were employed3. The variance is attributed to the idea that not all trained MTs are practicing. But not all practicing MTs are certified or licensed. Since regulatory requirements are changing, and vary by state, regulatory inconsistency is one indication that our vocation is in transition.
The recent AMTA report claims that massage is increasingly considered a health care intervention, identified as health care by 96% of those surveyed1. Of those consumers who received massage, 44% did so for health reasons1. The vast majority of surveyed MTs (96%) claim they get referrals from health care professionals1. The referrals averaged 4 per month, over double those reported in the prior year1. Since MTs depend heavily on return clientele1, this indicates an important trend. This is one important way that health care professionals are influencing MT practice.
But all the data sources agree that medical settings are not the most common places to get massage1,2. Only 13.8% of MTs recently surveyed report that their main work location is at a health care facility[vii], about the same proportion that work in spas4 .
The majority of massage in the U.S. occurs in private practice settings, with estimates ranging from 53% 2 to 73% 1. Although 59% of Americans surveyed would like their massages to be covered by health insurance1, as a practical matter, the beneficial properties and results are confined to a stratified population: those with sufficient discretionary income to pay for the service. Most massage therapy is procured as a self-pay service[viii].
Massage Therapist Profile
The typical MT is a female (85 %) in her mid-forties1. She reports using a variety of methods, most frequently Swedish and deep-tissue massage1,2. Most MTs entered massage as a second career. Independent research studies estimate the average tenure of MTs ranges from four to seven years, depending on region[ix] [x].
Nationally, the average MTs’ individual income has dropped. The majority of MTs claim that massage is part-time work for them, sometimes supplemented by work in other fields. In 2009, the average massage therapist worked 20 hours a week at massage and grossed $37,123 including tips 5. For 2011, that average income dropped down to $21,028 from 15 hours a week doing massage1. The typical MT sees an average of 44 clients per month and is heavily dependent on repeat clientele 2,5.
Most MTs (73%) self-identified as sole practitioners or independent contractors1. Although this was their main orientation, it was not necessarily their only one. The majority of MTs work in multiple settings in any given workweek5. This variety could result from tactical necessity, since insufficient income and a high burnout rate[xi] results in up to 50,000 MTs per year leaving the profession[xii]. With MTs splitting their work time between different locations, and even different vocations, it is difficult to know exactly how their income sources are distributed.
In my letter to the D.C. regulators, I used the above data to make several important points. I argued that the average MT was a relatively low-wage worker who could not absorb high overhead expenses and licensing fees. I suggested that MTs often band together to share facility-related overhead, and should not be penalized for this business tactic by onerous operations requirements. Finally, the data helped me demonstrate that MTs are health care workers who should be afforded the same governance-by-peers considerations that are employed for other health care professions.
Beyond helping us to advocate for ourselves, survey data is useful in practical ways. It can help us understand broader trends for planning our business. It can be used as a marketing tool with clients and adjunct professionals. Also, survey data can inform local program design, governance, and support.
However, national data is not identical to local practice. If we want to know more about our local AMTA fellowship, it might be worthwhile to design a custom survey for our D.C members. Surveys can be administered at minimal costs online via Survey Monkey. But there is a talent to designing good surveys, so it warrants thought and research. Sometimes, it is worthwhile to survey members voice-to-voice, so as to clarify what information is collected. The practical value of collecting and managing our own local data is something for our Chapter leadership to consider.
In any case, particularly at this time of industry transition, it is critical that each of stay well informed. With knowledge and a willingness to take an active role, we can help shape our work conditions. Aside from our livelihoods, our participation will determine what becomes of the practice and craft of massage.
[viii] Field, T. (2001). Touch. Cambridge, MA: MIT Press.
[x] Sherman, K. J., Cherkin, D. C., Kahn, J., Erro, J., Hrbek, A., Deyo, R. A., et al. (2005). A survey of training and practice patterns of massage therapists in two U.S states. BMC Complementary and Alternative Medicine, 5(13).
[xii] Brown, A. (2011, August). Is a spa right for you? Massage Today, 11, 1, 12, 18.