Community, Commentary and Curriculum
for Massage Therapists

Professional Identity Crisis: Recipe for Problems

Posted: September 7th, 2009    Feedback comment@mtcoach.com

Read other posts in this series     Read responses to these posts

Conversation from “The Karate Kid”, 1984

Miyagi (played by Pat Morita) [sighs] “Daniel-san, must talk.”  [they both kneel]
“Walk on road, hmm? Walk left side, safe. Walk right side, safe. Walk middle, sooner or later [makes squish gesture] get squish just like grape.”

“Here, karate, same thing. Either you karate do "yes" or karate do "no." You karate do "guess so,"
[makes squish gesture]…just like grape. Understand?”

Is massage therapy a personal service or health care discipline?  There exists a tenuous relationship between the spa and rehab identities in massage both within and outside the profession.  At origin, the rehabilitative side of massage therapy split off from physiotherapy and nursing to become its own profession.  Massage was also assumed by the aesthetic profession for its soothing spa application, hence the broad identity massage now finds itself with. 

Despite the tolerant, all-inclusive nature of massage practitioners to retain these many identities, having too broad a scope dramatically affects funding, public perception and credibility.  As I mentioned in my prior post these dissimilar identities have different (and often opposing) beliefs about regulation, professionalism, lingo, service philosophy and protocols of practice.  Because of this tenuous relationship the profession is stalled like a joint locked between painfully spasmed agonist and antagonist muscles. 

A Professionalization Trajectory spans the growth of a profession from unregulated skilled trade to regulated health profession.  Donelda Gowan-Moody and Amanda Baskwill describe professional trajectory in Report on Policy Issues Concerning the Regulation of Massage Therapy in Canada ^[1]

Professionalization trajectory – wherein the profession evolves from the status of unregulated trade or service to a recognized and regulated profession with standards of practice.  The trajectory begins with the formation of a voluntary association of practitioners who work together to rally toward a common goal of enhancing the status of the profession.  As the profession matures, certain elements such as consistent standards of practice, professional ethics and codes of conduct, educational standards prior to practice, a culture of public service and profession-specific language and knowledge base are developed.  Eventually the profession reaches the stage where legislators are petitioned for a form of regulation and self governance. 

Massage Therapy has progressed along the trajectory to become regulated in a number of U.S. States[ii] and currently three Canadian provinces.  However the profession has some way to progress before it would be considered a primary health care profession.  Although massage therapy is regulated in my home province of Ontario, RMT services are not covered under Medicare.  Further, RMTs are not initiating health practitioners (IHPs) and require an authorizing gatekeeper (physician, physiotherapist, chiropractor, etc.) to access auto insurance, worker’s compensation and most workplace benefits plans.  Massage therapists are positioned as assistive, paramedical workers rather than primary care providers.

Like transversing a high wire, we’re halfway along the trajectory if we wish to become primary health care providers.  We’re told by both government and the insurance industry we require two things: evidence-based practices and degree level education to gain status as primary health providers, along with the credibility and funding afforded this position.  Without these two requirements we waft between skilled trade and regulated health profession, and are easy-pickings for opportunists who would exploit the popularity of massage and the vulnerability of its half-way position. 

Profession Unloading

There appears a trend via government and insurance funding to unload more duties and responsibilities to lesser trained, lower salaried positions in health care.  Tasks normally in the realm of physicians are now done by nurse practitioners or registered nurses.  There is now a physician’s assistant program[iii] offered at McMaster University. Nursing assistants (RNA) or personal support workers (PSW) do what nurses formally did, dental hygienists and assistants do what dentists used to do themselves and there is a new position…physio and occupational therapy assistants to perform some of the tasks previously only provided by PTs and OTs.

Unloading has the effect of creating more middle-level jobs in health care…jobs that are lower paid - despite increasing responsibility assigned to them - than the primary professions that once fulfilled these tasks.

Physiotherapy’s scope of practice was recently enhanced in Ontario, indicating a larger role for physiotherapists in health care.[iv] 

…the changes will enable physiotherapists, who have demonstrated the required education and competence, to provide additional health care services such as ordering x-rays, to diagnose conditions that may be identified using a physiotherapy assessment, and to treat wounds and conditions including urinary incontinence or pelvic pain.

Jan Robinson, College Registrar and CEO, commented that “the College shares the government’s commitment to improve the ability of Ontarians to obtain the safe and effective health care they need and to also improve the efficiency of the health care system by allowing physiotherapists and other regulated health care professionals to practice to the full extent of their education and competence.”

Unloading is a clever strategy by government and the insurance industry to lower health care delivery costs.  How can it affect massage therapy?

The Government of Canada classifies Massage Therapy under Other Technical Occupations in Therapy and Assessment[v] and lists a wage range of $18.07 – 18.94.  This figure is slightly higher in the United States.[vi]

As economic changes and health care policy progress, I predict we’ll see massage therapists as skilled workers providing care alongside nurses and physiotherapists as adjunctive to their care.  Struggling to be its own profession, perhaps massage will once again become an ancillary modality, provided by PT/OT assistants or RNA/PSW under the auspices of initiating health practitioners who have met the evidence-based practice and degree-level program requirements. 

Massage Franchises and the Spa Industry

Sitting half-way along the professional trajectory also leaves the massage therapy profession open to the influences of massage franchises and the spa industry.  Although these influences may be very positive, we may acknowledge that wages and business practices can be dictated by these powerful players on a profession that does not enjoy the funding and representation of medicine, physiotherapy or nursing. 

The spa industry is very lucrative both in Canada[vii] and the United States[viii], and attracts many massage therapists with the promise of high wages, workplace benefits and the provision of promotion and administrative services.  Read more on the influences of the spa industry and massage franchises in a previous post at http://www.mtcoach.com/spas_franchises.htm

Conclusion

So what do massage therapists/practitioners wish to be identified as: primary health care professionals, paramedical assistive workers, spa esthetic service providers…?  Our identity determines funding, public perception, credibility, income potential and business practices of massage therapists. 

And of course there are costs and investments to be made, depending on how we wish to position ourselves.

If we continue to be all-inclusive in our scope, I believe we will continue to confuse the public, government, insurance and other health care providers; we will perpetuate a problem that will cause these forces outside our profession to classify and define us, and ultimately direct us.  “Walk in the middle, squish like grape”.

© 2009, Donald Q. Dillon, RMT.  All Rights Reserved.

No part of this article may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

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