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Questions and Answers
From time to time I explore specific practice management and marketing questions in this column. The following four questions reflect concerns of many massage therapists:
Q1: There's a new alternative medicine center opening up in several months, and I may submit an employment application. It offers a base salary of $11 per hour, plus approximately $10 more for every massage session I do, as well as health insurance and paid time off. One major disadvantage is that there is an exclusivity clause which forbids me from concurrently having a private practice which offers the same service(s). What are your thoughts about taking such a position? Are they offering a fair price?
A1: Working as an employee for a company such as this can be advantageous in that there is a guaranteed base income, benefits, and you can focus on the hands-on aspect of your practice. You don't have to do many of the administrative tasks. There is usually a full-time receptionist and the company handles taxes and marketing. Plus, you get to be part of a team and work in a location with amenities that you might not be able to afford (e.g., elegant furnishings and state-of-the-art equipment).
Disadvantages include: working under the company's policies and procedures; the possibility of needing to alter your image, style and modalities; receiving a lower rate per session than if in private practice; and the potential for your contract being terminated at any time and having to build a practice from scratch.
Most therapists spend at least $10,000 annually to run their practices. This figure includes items such as rent, utilities, phone, supplies and marketing costs. In this example, the company is offering a fair price for your services. If you estimate that you will work 25 hours per week, with 18 hours as billable sessions, you would receive $455 per week (which equals $18.20 per actual hour, but $25.27 per client). Multiply $455 by 47 weeks and you get 21,385. Add $1375 for the time off benefits package (5 weeks at $275) and the total remuneration is $22,760 for working 846 sessions. This doesn't include the other benefits they might offer such as insurance and educational reimbursement. Add the $10,000 it would cost you to run your own practice and you get $32,760 which averages $38.72 per session.
This appears to be a good opportunity for a therapist who doesn't have a wide client base as well as the therapist who prefers to avoid the management and marketing sides of building a strong practice. The hazard of working with a company such as this is that it doesn't have a track record and it could be quite some time before you actually see 18 clients per week. Until it is established, I would suggest attempting to get the center to alter their exclusivity requirement. You have to evaluate your strengths, challenges, personality and goals to better decide if working for this company is in your best interest. This doesn't have to be a lifelong commitment. For many therapists, an arrangement like this is ideal. But ultimately, you have more freedom and can earn a significantly higher income if you are in private practice.
Q2: I need help in building my massage practice. How do you recommend going from part time to full time with very little money?
A2: I will answer this question to the best of my ability, given the confines of this column. Whole books have been written to address this concern. Many people start out businesses on a part-time basis while employed elsewhere. This provides the opportunity to increase business without an intense financial risk. If you choose this path, be sure to set target goals for when you will take the leap to a full-time practice (e.g., the numbers of clients you have, the amount of money saved or the date).
The two major aspects of building a practice are obtaining clients and retaining them. By doing great work and offering excellent customer service, clients are retained. New clients are obtained by making yourself visible. Some of the best, low-cost ways to get exposure are: writing articles; doing demonstrations; holding open houses; giving seminars and free talks; and getting interviewed by the media. After that it depends on your target market(s).
The key to effective marketing is to choose several target markets and focus your time and money in attracting clients from those bases. Once you've chosen a market, then you can determine the appropriate measures. For instance if you want clients that are cyclists, consider these marketing activities: get your name in print with the local fitness publication (e.g., write a column on how massage can increase performance and reduce the likelihood of certain injuries, take out an ad, get interviewed); display brochures and fliers at the bike shops, sporting goods emporiums, health food stores and gyms; give demonstrations/talks to cyclists; sponsor a cycling team by offering reduced sessions and free pre- and post-event massage; print your name and logo on sports bottles and give them to your clients; join the cycling club; place an advertisement on a bus stop bench that's located in front of a popular sporting goods store; build alliances with other professionals that service cyclists (e.g., sports medicine doctors, physical therapists and nutritionists); and give free mini-treatments at major sporting events.
You can also engage in cooperative marketing projects with companies or professionals that serve cyclists. For instance, you could arrange with a sporting goods company to provide you with items to give to your cycling clients (such as visors or sports bottles) and you could offer discount coupons for the store to give to their cycling customers or offer a massage to be given in a monthly (or weekly) drawing.
Q3: I'm concerned about the products that some bodyworkers sell. Are items such as topical analgesics and orthotics in our scope of practice? Also, do we have the ability to put our professional opinion on supplements, herbal remedies and over-the-counter medications?
A3: I think one can ethically sell a wide range of products as long as one is cautious about the quality of the product, has solid knowledge about the class of products (e.g., if you are selling herbs, you ought to have substantive training or education), never diagnose, and always ask yourself these questions: "Is selling this product in the client's best interest?" and "Is this potentially harmful to the therapeutic relationship?"
My experience is that very few practitioners sell products which can be unfortunate for all concerned. We have access to wonderful tools that can't be found in your local emporium (e.g,. high-quality eye pillows and devices like the Theracane ) and books on stretching and self-health care that may not be found in your local bookstore. You are offering a great service to your clients by having these products available.
Of course, all product sales need to be done cautiously given the power differential that exists in any therapeutic relationship. I've never been one for high-pressure, hype sales. Display your items tastefully and use them in your sessions. If a client then wants to make a purchase, s/he can initiate it.
I tend to be rather cautious about product sales that require specialized knowledge or training. I'm not certain about the orthotics. Does the company that manufactures them provide fool-proof fittings (such as the molds that you merely step into)? Many places that do shoe repair and make custom shoes also offer orthotics. These people aren't doctors either. The problem with offering orthotics in a therapeutic practice is that there is a perception of (or an actual practice of) some type of assessment (and yes, even diagnosis) that goes along with or proceeds the suggesting/selling of orthotics.
The analgesics are a bit trickier, since the public can purchase this class of items over the counter. Again, we have access to an incredible range of products. I've never seen some of my favorite products in any store and I feel it is doing my clients a disservice to not have these products (or at least literature about them) available.
I was approached by someone to endorse a "nutritional product" that really was a neutriceutical (it was a product that worked on balancing brain chemistry). Since it was supposedly beneficial for a spectrum of issues that I don't experience, I would not be able to judge the product by anything but their literature and perhaps the subjective feedback from people I know. That's not good enough for me. A product that works well on me or someone I know, doesn't mean that it will work for everyone. Even though the product appeared to be wonderful and was changing many people's lives, I couldn't endorse it for therapists to sell in their practices because I think it's beyond the scope for most therapists. Nutritional products are such a tricky item to sell and yet some people have experienced such phenomenal results that it's understandable that they feel compelled to share the product with others.
I consider product sales as an adjunct service. For each product, make certain that you are extremely knowledgeable about the product's benefits as well as contraindications. Only sell reliable products, suitable for use by your clients and are a natural extension of your practice.
Q4: I have a question that has become a big issue at the health club where I am employed as a massage therapist. My employer is questioning providing employee benefits for therapists who are not actually doing 40 hours of massage per week. Is there an industry standard that delineates full-time work hours for massage therapists?
A4: Several surveys have been conducted that rate full-time practice as being 16-to-25 hours of hands-on client contact. Other than these surveys, there really aren't any documents stating the typical hours a massage therapist works. Part of the difficulty in setting standardized hours is that the field of massage and bodywork is so diverse. Some modalities require greater exertion than others.
Contact well-known spas and resorts and ask them what they consider full-time. It will help if some of the places you contact do provide benefits. Canyon Ranch (a world renowned spa) in Tucson, AZ considers full-time employment at a minimum of 24 hours (no one does 40). It provides health insurance, vacation time and the ability to participate in a 401K plan (although the spa doesn't match funds).