Laura Allen’s Blog

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Licensing Portability: Not in My Lifetime

I get at least two or three questions a week from massage therapists who intend to move to another state–or horrors–have already moved and found out that they can’t practice massage in their new destination. It’s a sad state of affairs. That’s particularly so when the person has been practicing 20 years or so, but they either a) don’t have the proper amount of education, b) haven’t taken the exam required in that state or c) both of the above. As a former state board member who served on the license standards committee, I also spent a lot of time reviewing those applications for “licensing by endorsement,” a procedure that we had in place to address that issue. Sometimes people get licensed; sometimes they don’t.

We have kind of  a weird situation in North Carolina. Our state no longer accepts the National Certification exams for entry-level licensing. We exclusively accept the MBLEx, unless you’re moving in from out of state and you’re already Nationally Certified. In that case, you don’t have to take the MBLEx, but you do still have to prove that you’ve had the proper amount of education. It’s strange to me that the NCBTMB exams are considered okay for citizens from out of state, but not our own citizens.

There are still many states that have the minimum 500-hour education requirement. My state does. However, we’re picky about how that’s broken down. If your 500 hours from out of state doesn’t match up to the breakdown of our 500 hours, you can be refused a license until you bring yourself into compliance by taking additional classes at a community college or through continuing education. While moving is a choice for most people, I feel particularly bad for those therapists who are moving with a military spouse and not able to get licensed in their new state without jumping through a lot of hoops and going to a lot of expense.

The Federation of State Massage Therapy Boards is working towards portability, whatever that means. They would like for all member states to adopt the MBLEx exclusively, and some have. Other states continue to give applicants a choice, and a few states have their own exam. There isn’t any consistency in the number of hours of education that’s required, nor in the breakdown of those hours.

I reposted both of Ralph Stephens’ editorials on “Challenging Sacred Cows” on my Facebook page, where they attracted a lot of comments. Ralph and I have sometimes disagreed and agreed to disagree, but I do agree with some of the statements he made in these articles…namely, that the education hours required for licensing are arbitrary and not any guarantee of competence. The examination system isn’t without flaws; nothing is. The fact is that some people are good at memorizing facts, and good at test-taking, and some people aren’t. Currently, though, it’s the only system we have, and one that is used in nearly every licensed profession.

Last year at the 2011 meeting of the FSMTB, a delegate posed the question, “Who thinks portability is a myth?” I would estimate there were 120 or so people in the room, and if memory serves, myself and one other person–who happened to be a member of the FSMTB Board of Directors, raised our hands. Everyone else was either holding on to the promise of future portability, or they just didn’t want to publicly state that it isn’t going to happen.

In order for portability to work on a nationwide basis, there has to be a nationwide agreement on what’s acceptable in the way of required education and required examinations. It’s as simple as that. In the meantime, massage therapists will continue to have a struggle to cross state lines.

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Proposed Legislation Takes MTs Out of Insurance Loop

Florida SB 1860,  introduced on January 17 by Senator Negron, will remove the right of massage therapists and acupuncturists to bill PIP (Personal Injury Protection) insurance for those who have been injured in auto accidents. I don’t have any statistics regarding how many FL therapists currently file these types of claims, but based on my interactions on social networks, I would estimate that it’s quite a few. I suggest a mass protest is in order. You can find your legislators here. Contact them immediately and ask them not to support this bill.

In Tennessee, HB 2387/SB2249 seeks to remove the massage therapy board from under the auspices of the Department of Health Related Boards and move them to the Department of Commerce and Insurance. What this does is basically reclassify massage therapy from being a health profession to a “trade.” Insurance companies don’t pay tradespeople; they pay health care professionals.You can find your TN legislators here.

I cannot urge you enough to pay attention to this, no matter where you are. When something detrimental like this happens, it just paves the way for other states to follow the leader.

Even the acts of searching for, and reading legislation or proposed legislation, is a tricky thing. A prime example is that when you search for the bill in Tennessee, this is the description:

As introduced, decreases the size of the board of directors for the Duck River Development Agency from 17 to 12; authorizes the commissioner of environment and conservation to appoint an executive director to carry out the purposes of the Tennessee Heritage Conservation Trust Fund Act of 2005; revises other various provisions governing the structure of certain state agencies, committees, boards and commissions.

At first glance, people may see that and think, “Why do I care about the Duck River Development Agency?” It’s important to recognize that massage legislation is frequently slid into a proposed bill under some other name or description…legislation affecting massage therapists has been, and will continue to be, introduced as part of a highway bill, a farm bill, a utilities bill…bills are known by the prefix “HB” (for House Bill) and “SB” (for Senate Bill) followed by their number. They tend to get mentioned in the media as “the proposed highway bill” and since the part affecting massage therapists is usually hidden in the middle somewhere, it’s easy to go unnoticed, were it not for the diligence of the professional associations paying attention. While I am a member of both AMTA and ABMP and both have government relations representatives who monitor legislation and offer support or interference as they deem fit, I don’t always agree with them. They don’t always agree with each other. The thing to do is read any proposed bill and decide for yourself whether it’s worthy of protest.

Unrelated to insurance, but still of concern, is proposed legislative changes in Southern Nevada. Among other things, it contains the ridiculous mandate that a massage therapy room is required to be lit to “20 foot-candles”. For those who don’t know, a foot-candle is basically a one-foot diameter circle of light thrown out by the average candle. If your massage therapy room happens to be 10 x 10, you will be expected to have the same amount of illumination in the room you would have if you had 20 candles going. That is a 300% increase of what the Nevada Administrative Code currently requires. Just turn on the overhead light and get on with it. Very relaxing…NOT!  Apparently some legislators have too much time on their hands.

I’ve said this before, but I’ll offer it again: I urge you to pay attention to what’s going on in your own state–one of the best reasons to belong to a professional association. Their websites contain regular legislative updates. Any time detrimental legislation is on the horizon, I attempt to get the word out, and it never fails that in the month or two after something bad happening, I get a lot of calls and e-mails saying “What can we do?” You can’t do zip after it has happened. You must act to stop it before it’s passed.

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Legislative Hullabaloos in WV and TN

As usual, the opinions on my blog are my opinions and not to be construed as the opinions of anyone else.

I  haven’t had much to say on the legislative front for a few months…when the legislators go home for the summer, not much is happening; then there tend to be shorter sessions in the fall before they take a break for the holidays and not much happens then, either. Well, the break is over, and how.

I received a press release from the NCBTMB yesterday announcing what amounts to a win for them in the state of WV. Here it is:

The National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) is pleased to share the news that Nationally Certified Massage Therapists in West Virginia will continue to have their services covered by the Public Employees Insurance Agency (PEIA). Initially, the PEIA Finance Board considered discontinuing massage therapy coverage altogether as a cost-savings measure, but with input from NCBTMB, the American Massage Therapy Association (AMTA) and practicing therapists, it will still cover active employees and non-Medicare retirees who visit massage therapists with national certification.

The new financial plan goes into effect July 1, 2012. Certified therapists must also carry $2 million in malpractice insurance as well as follow treatment guidelines of the AMTA.

“NCBTMB commends the Public Employees Insurance Agency for providing their employees with access to nationally certified massage therapists who commit to a code of ethics, standards of practice and pass a national credentialing exam,” said NCBTMB CEO Mike Williams. “We see this as a win-win situation for both PEIA employees and Nationally Certified Massage Therapists in the state of West Virginia.”

“PEIA has an obligation to state employees to cover necessary medical treatments, but also an obligation to the state of West Virginia to be fiscally responsible,” stated PEIA Executive Director Ted Cheatham. “We stand behind the PEIA Finance Board and its decision to only accept massage therapy claims from therapists who meet the new criteria.”

Disclaimer: I am Nationally Certified myself and have been since 2000. I am not obligated to maintain that; I just do because I want to. When I got licensed, it was also the only option available, as it was in most states for many years, saving those few that have their own exam. As any of my long-time readers know, I’ve had my ups and downs with the NCBTMB, criticized them many times, and applauded them when I thought they deserved it. I am also a  member of AMTA, and due to having  multiple coverage on different policies I have as a business owner and employer, I personally have $12 million of liability insurance. If I lived in WV, I’d be good to go.

My first thought on this was that it will be challenged immediately by the Federation of State Massage Therapy Boards.  I’d  bet the farm on it. West Virginia is a member state of the Federation. The Federation, and thus the member states, own the MBLEx (Massage & Bodywork Licensing Exam) which is accepted by the state of WV, as is the NCB exam. Therapists in that state have a choice of which exam to take in order to get licensed.

This move by the legislature would seem to be an endorsement of the National Certification Exam, as well as an endorsement of AMTA, since one of the other requirements for being able to file insurance is adherence to AMTA treatment guidelines. They don’t come right out and say you have to be a member of AMTA; just that you have to be following their guidelines. It also requires therapists who want to participate in the state employees’ insurance program to have a minimum of $2 million worth of liability insurance.

I personally file a lot of insurance in my own office, and it’s a standard practice for insurance companies not to deal with you unless you carry liability insurance, so no big deal on that front. AMTA’s treatment guidelines are on their website, accessible to the masses, including people who are not their members, so that’s really no big deal either.

What is a big deal here, at least to me, is that even though the state says that passing either exam is adequate for a massage therapist to receive a license, it is now saying that only one of them is adequate for therapists who wish to file state employees’ insurance. To me, that is sending a confusing message to students who haven’t yet taken an exam, as well as to the practicing therapists who chose to take the MBLEx, ignorant of the fact that this new law would be coming down the pike, and even to the massage-consuming public. It’s a statement that basically says “If you’ve taken the MBLEx instead of the National Certification Exam, then you’re good and qualified enough to work on the public, except for the state employees, and you have to be Nationally Certified to work on them and file their insurance.”  It is really stating that one licensee is better than another.

Is there going to be any fallout from this? Absolutely, in my opinion. The Federation, since its inception, has encouraged all member states to use the MBLEx exclusively for licensing purposes, while still stating that certification has its own value as a credential, but maintaining that it should no longer be used as a licensing exam. Since WV has opted not to follow that suggestion, and has kept both exams, massage schools and instructors in WV will now be falling short if they don’t inform their students of this legislation, and will basically be saying “You can take two different exams. If you want to file insurance, take the NCBTMB exam. If you don’t care about that, you can take the MBLEx.”  So two therapists can have the exact same 500 hours of  education that the state requires, and the exact same license that the state issues, but the one who took the MBLEx won’t have the privilege of filing insurance on state employees. The logic here is escaping me. There is one caveat: WV is currently not requiring any continuing education of massage therapists; however, maintaining National Certification requires 48 hours of  continuing education every four years. Still, I don’t think that’s a big factor. As long as you passed the NCB exam last week, you could be accepting the state employee’s insurance, before you’ve ever had a single hour of continuing ed, so I don’t see how that really fits into the picture.

I don’t think this is over, and I’ll try to keep you updated.

WV isn’t the only place where trouble is brewing this week. Therapists in TN are up against HB 2387 SB/2249, which would take the regulation of massage therapy out from under the health care professions and move it to the Department of Commerce and Insurance. That is almost bizarre that it has anything to do with the department that governs insurance–because most insurance companies will not pay for any health care services unless they are provided by a person who is in a licensed health care profession. This move would basically state that therapists are not health care providers. The Department of Commerce and Insurance regulates trades, not professions. For all intents and purposes, this is a statement to massage therapists that “you are practicing a trade, not a health care profession.”

Quite a few states have been on cost-cutting missions during the past few years of recession, combining public boards and even going so far as to disband altogether–or threatening to–but this cannot be construed as one of those cost-cutting missions. Tennessee’s massage board is self-supporting through licensing fees. They do not cost the taxpayers any money.This is not tied to financial impact on the state in any way. In fact, I’m not sure what it’s tied to or what the logic is behind it, other than a slap in the face to the massage therapy profession.

I urge all TN massage therapists to immediately  contact your legislators. Don’t wait until it’s a done deal to express your opinion.

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E-mail Etiquette 101

I’ve had a few meltdowns over e-mail in the past couple of weeks. In spite of my attendance at one of Michael Reynolds‘ brilliant presentations on how to be an e-mail ninja and have a “zero inbox,” I confess I just haven’t gotten there. And I’m wading through a field of spam.

I have a good spam filter on all my email accounts, so basically most of those trashy emails advising you on how to enlarge your anatomy, how to collect the $40 million that the dead person in Nigeria has left you in his will, and offering to sell you cheap prescription drugs get trapped there.

What usually doesn’t get trapped there are all the unsolicited mailing lists and newsletters from massage therapists and other health practitioners who have taken the liberty of adding my name to their list. Most of them are people from Facebook or LinkedIn…they apparently just harvest the e-mail address from everyone they see on their networks, and add them on. That’s not a good thing. In fact, it’s just plain spam.

You have to ASK me in order to be added to any of my mailing lists. My websites have the little click-on feature for that, if you want to be added, but just visiting my websites is not going to cause you to receive any e-mail from me.

I use Constant Contact for my newsletters and group e-mail. I have it set to automatically give people the link to unsubscribe if they wish, and to allow people to share it on their networks, if they desire. It’s $30 per month, but I don’t have to be concerned  about removing people who ask to be removed; it’s done for me. If you are sending group e-mails to anyone, whether it’s from a company like Constant Contact or just through your own e-mail, you should have a simple link for people to unsubscribe. Some companies make it such a hassle, by sending you to a new website to create a new account and answer a couple of captchas, before they will allow you to unsubscribe to something that you never subscribed to to begin with. I think they count on it being such a hassle to unsubscribe that you’ll just choose to stay on the list.

The other thing you don’t have to worry about, when you use such an e-mail service, is failing to use BCC (blind carbon-copy)  for group e-mails. It will be automatically done for you. Some people do not realize–and others do realize it but just don’t care–that when you send more than one person an e-mail and you don’t use the BCC function, everyone it is sent to can see everyone else it is sent to, including their e-mail address. The cc may list the people by name, and not e-mail address, but by right-clicking beside the name, or in some cases hovering over it, you can see the address. That opens a can of worms–spam, not to mention exposure to viruses and worms. The most serious thing about it, for a massage therapist or any other health care provider, is your failure to maintain confidentiality. Some people cling to the idea that massage therapists don’t have to abide by HIPAA rules, but that’s beside the point. You are obligated to abide by the Code of Ethics, and safeguarding client confidentiality is a big deal, in case you haven’t ever noticed that.

According to the dictionary of computer-speak, SPAM stands for “Stupid Person’s Advertisement.”  When people turn on the television or open the newspaper, they expect to see advertising. It’s part of the deal. Does it have to be part of the deal on e-mail, too? Apparently so, judging by the amount of it that’s out there. I dumped my spam filter a moment ago, and in the two weeks since I dumped it last time, I have received 694 pieces of spam…in just one of my several e-mail accounts.

People sometimes use e-mail to inquire about a job opening at my facility. While it’s one thing to use emoticons, techno jargon and computer-speak on your FB page, don’t do that in a professional business e-mail. How does this look: “Dear Mrs. Allen, OMG, I saw your job listing and IMHO, I am the best person for the job 🙂 FWIW, I am a graduate of MMMS….” you get the picture. They’re not getting an interview with me.

I found an interesting website that lists the 32 biggest mistakes in e-mails. There are quite a few on the list that jump out at me. Spell-check, for one. Sending out your newsletter full of typos doesn’t do anything for your professional image. Using all bold and all caps isn’t good, either. Forwarding chain letters is another. People have good intentions, but really, just like some of the stuff people continually repost on FB, I’ve received requests to pray for someone who died a year ago. Why in the world would you send those to a business acquaintance?

In a nutshell, if you’re going to use e-mail to market your practice–and you’re missing the boat if you don’t–go about it in the right way. You want your e-mail marketing to be effective–and ethical.

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Here’s the Plan

On any given day on my FB page, there will be massage therapists who are excitedly reporting an increase in their practice, talking about the big day or big week they just had, or some other joyful news related to their business. On any given day, there will also be someone posting that they’re closing up shop because they can’t make it, and taking a job they don’t really want because they have to have money to survive. And let’s be real, folks…none of us want to just survive. We want to thrive, don’t we? Be able to take a vacation, give money to charity, buy a new car when we need one without having a financial meltdown. All those things are hard to do when you’re worried about making the rent.

Nine times out of ten, it isn’t that they’re not a talented massage therapist that leads to their failure. Most of the time, it is a lack of careful planning that leads to the demise. Here’s a reality check:

Almost no business is profitable during the first year. Those folks who work from their home or who only do outcalls may be exceptions, but if you’re operating a massage business out of your own storefront, planning to do so, or  or even as a renter or independent contractor in someone else’s space, there are a lot of things to consider.

I’m going to get the independent contractors out of the way first. You are a self-employed person who performs your services in someone else’s space. You don’t have all the same overhead that a person in their own space does, but you still have certain expenses, and you’re working in someone else’s environment. They may–or may not–be throwing you a lot of business.  If you don’t have all you need or want, and it’s because you’re just sitting there waiting for the owner to do it all for you, you’re missing the boat. You still need to market yourself. That doesn’t mean taking out a big ad in the paper. It means you are actively engaged in trying to increase your client base on a daily basis, by networking, giving out business cards, getting yourself out there by performing community service, introducing yourself to people and telling them about the benefits of massage. Instead of blaming the owner for your lack of business, look at what you could be doing to increase it.

For those who are opening their own business, starting out without a business plan and a budget is a serious mistake. My advice is don’t take the plunge into opening your own business until you know you can survive for a year without a profit. When you initially open your business, you’re going to have a lot of one-time expenses–equipment, office furnishings, security deposits for rent and utilities. If you’re signing a lease, you’re committing yourself to paying rent (or a mortgage payment, if you’re buying.) You need to know what your monthly expenses are before you open the door.You need to include laundry, phone, Internet access, office and cleaning supplies, liability insurance, bank service charges and credit card processing charges, self-employment taxes–and that’s before you’ve spent any money on advertising.

I know that in my office, 52 massages have to take place before I’ve covered the monthly overhead. That’s my break-even point, and you need to figure out what yours is. But you can’t stop there–especially if you’re a single person or if your family is dependent upon a two-income lifestyle.  You also need to figure your break-even point for supporting your household.

Let’s say for argument’s sake your office expenses are 1500. a month. Imagine that at home, you need $500 for rent, $100 for  utilities, $100 for the phone, $200 for a student loan payment, $300 for credit card payments, $300 for groceries…then you’ve got clothing, medical care, insurance if you’re paying for that.  If you’ve got children, I don’t have to tell you how much that costs. So if you need $1500 to run the office, and $2000 to run your household, you need $3500 a month to cover your expenses. If you’re charging $60  for a massage, that means you have to perform 58 massages in a month just to make ends meet. That means you aren’t making a dime of extra money that you could spend on the previously mentioned vacation, charity, and any other extras you might like to have, until you’ve done 58 massages.  And if you’re self-employed and also having to take care of the cleaning, the laundry, the bookkeeping, and all the other things that go with that, be realistic about how much you can do.

You must also have a contingency plan…what if you don’t get those 58 massages during the first month, or the first few months? What if it snows and you miss a week at work, or you get sick and miss a week at work? What if your car needs an expensive repair, like mine did last week? Can you still meet your obligations?

In any business, and in service businesses in particular, the biggest mistake people make is sitting around waiting for business to come to them. Unless you own a funeral home, that’s a bad idea. Word of mouth is of course the cheapest and best form of advertising, but you have to get those people in the door first. And the chances are you don’t have a big advertising budget, so what are you going to do? These are just a few of the things I’ve done to increase my own business, and it has worked well for me.

I spend 30 minutes every morning on marketing activities intended to increase my business. That could mean working up a new ad, writing the client newsletter, calling clients I haven’t seen in here lately, sending out a welcome postcard to a new one, or any number of things, as long as it is something that will help spread the word about my business.

I am very active in our Chamber of Commerce (in fact, at this point in time, I am on their Board of Directors, but that’s a very recent development.) I’ve been active in it since the first week I opened my business. I attend as many networking functions, grand openings of other people’s businesses, open houses, etc. Why pay to belong to the Chamber if you’re not going to take advantage of all they have to offer? If you’re joining just to get a certificate on the wall that says you belong, then save your money.

I give a business card to two new people every day. You’re out somewhere every day where you have the opportunity to meet new people, or where you see someone you may already know–at school, church, the grocery store, the doctor’s office. Strike up a conversation with someone and give them a card. It takes three minutes.

Track your clients. Create a simple form on your computer listing the places you are advertising, plus referrals from doctors and clients, and ask each client, “Where did you hear about us?”  Write that down. If  a month or two has gone by and not one person says they’ve come in because of the ads you’ve been running in the Woman’s Weekly, it’s time to spend that money elsewhere.

Before you spend money on an ad, think about the potential return on investment. If you spend 100. to advertise in a regional magazine that goes to 5000 people, when you could spend that same 100. to place an ad in the local newspaper that reaches 50,000 people, it doesn’t take a rocket scientist to figure out which one you ought to do.

These days, people expect every business to have a website. If you’re using some obscure url for a free site, they’re not going to find you. Spend the money to have a real website, one that is search-engine optimized and user-friendly.

You don’t have to be a financial whiz, or even a marketing whiz, to succeed in a massage practice, but you do need to take a realistic look at what you need to do in order to have a profitable bottom line. So before you start out, take a good hard luck at your budget and your personal financial situation…and don’t depend on opening a business to get you out of some financial mess you might already be in. And once you hang out your shingle, don’t sit on your hands waiting for business. Go out and get it. You can see more of my business tips, along with tips from Irene Diamond, Allissa Haines, Michael Reynolds, Felicia Brown, the Massage Nerd, and many more great educators on the Massage Learning Network.

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Ethics Violation, or Communication Breakdown?

This year I wrapped up five years of service on the North Carolina Board of Massage & Bodywork Therapy. Anyone who has ever sat on a board will probably agree with me that disciplinary hearings involving massage therapists are one of the most stressful parts of that job. It was for me. I estimate that during my time on the Board, I had to sit through approximately fifty of them. It was very distressing to see my fellow massage therapists trying to defend themselves–and in a few cases, just outright admitting to the violation–whenever they were accused of something.

Nine times out of ten, the accusation was of a sexual nature. 99 times out of 100, it involved a male therapist. I’m dead certain there are female therapists out there performing sexual favors every day, but most men won’t come forward to complain about it. Go figure.

My question to myself at those hearings was always this: “Did this person have an intent to do something evil, or was this a communication breakdown or simple mistake that could have happened to you or me?”

If you’ve been practicing longer than a year or two, the chances are good that in spite of your best efforts, you have accidentally exposed a body part. Or you have said something that the instant it left your mouth, you thought “why did I say that?” The very first massage I ever gave, I accidentally touched the man’s penis. I went to tuck in the drape, and all I can say is there it was. He was supine on the table, his eyes were closed, and when my hand grazed it, I saw his eyebrows shoot up. I said “I’m sorry,” and carried on. If I had made a big deal out of it, I could have just made it worse than what it was.

If your only intent is to give a therapeutic massage, then your major obligation is not just about giving the massage; it is clear and direct client communication. This has come home to me again and again, and most recently when one of my friends was accused of a sexual violation. The case has not been settled yet; it hasn’t even been to court, but he has been crucified in the press and by a number of bloggers–none of whom were present in the room and have no idea what truly happened there, but I’ve been watching what amounts to a feeding frenzy by a bunch of sharks who are determined to hang him from the highest tree. He is apparently guilty until proven innocent. And since no one was in the room except for him and the alleged victim, I am fearful of the outcome. Of course I do not want a sexual predator turned loose on the public. But after a career that has spanned about 30 years with no previous complaints, it’s a shame to see that going down the tubes. He has loyal clients who are still patronizing him (including women), but what do you think the chances are of him getting any new ones while this is going on? Zilch.

You can’t be too careful. Let’s be realistic. Most massage tables are set up so that the table is at about crotch-level. That’s a fact. We lean over people. We use our body weight on people. Some therapists get on the table with people. In my younger, skinnier days, I’ve crawled up on the table when someone was prone. I’ve done pelvic work on people of both sexes. I’ve done pectoral work on people of both sexes. I’ve worked on the gluts of both sexes. If you’re performing medical massage, you’re going to find the need to touch those areas–with the client’s informed consent.

Think for a moment about the muscles that originate on the pelvis. If you want to make the belly of a muscle relax, you need to make the origin and insertion relax. That’s just the way it is. If you’re ignoring the origin and insertion, you might be giving a relaxing massage, but you’re not getting to the root of the problem. However, if you abruptly touch someone’s pelvic bone without discussing that with them beforehand, you’re the next disciplinary hearing waiting to  happen.The general public doesn’t know squat about origins, insertions, and actions of muscles. It’s up to you to educate them. And it’s up to you to abide by their comfort level. If they prefer not to have their gluts worked on or you getting near their pubic bone, then you don’t do it, period. I have found it helpful to have a muscle flip chart in the treatment room. That allows me to pick it up while someone is on the table and show them the muscle, where it begins, and where it ends. It’s a professional thing, to me.

There is also no excuse for careless draping. The law in my state says that “the drape may be temporarily moved in order to accommodate treatment.” Yours probably says something similar–or not. Working through the drape may not be ideal, but if that’s the law in a your state, then I suggest you abide by it. Don’t expose more than you need to expose, and don’t leave it exposed. If you have moved the drape in order to work on the gluts, that doesn’t give you license to perform the whole massage with someone’s butt shining. Get it done and cover them up.

Be aware of the comments you make. It’s okay to tell someone they have taut bands or active trigger points in the gluts. It is not okay to tell someone they have a tight ass. You might be thinking it, but keep your mouth shut.

You may think you’re all above-board as a therapist and that you’re never going to be accused of anything. Guess what–all those people who have been accused didn’t expect it to happen to them, either. Two things that did become apparent to me during my  years on the Board…one, there are indeed predators out there who decided this profession would be a good place to meet a fresh crop of victims, and two, there are just therapists out there who are guilty–of failure to communicate. Don’t let it be you.

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The Ghosts of Christmas Past

I started to take the day off from doing my usual Sunday blogging…it is, after all, Christmas, and no one expects me to work on Christmas, do they? I don’t really consider it work–maybe because I don’t get paid for it 🙂 and anyway, it’s therapeutic.  I need a little therapy today. This blog isn’t about massage, so consider yourself warned.

Each year when Christmas draws near, I find myself remembering a lot of Christmases past. Some of those memories are sweet, and some are upsetting. When I was younger, my favorite thing at Christmas was the gathering of the clan at my grandparent’s house. All the aunts and uncles and cousins gathered. The cousins and I played music, we had turkey and  ham and all kinds of good country cooking. Now that my grandparents are gone–and some of the aunts and uncles are too–the whole family doesn’t come together like that anymore, and it’s kind of sad. We still see each other, but we’re never all in the same place at the same time anymore like we were back in those days.

As an adult, another tradition developed. My best friend and I spent time together on Christmas Eve for about 18 years. She was suffering from clinical depression, and some other emotional problems. Suddenly one year before Christmas, she sent me a letter saying she didn’t want to celebrate Christmas anymore, that she just wanted to be alone.  I responded with a letter about her depression being the cause and begging her to get some help, and she got mad at me and stopped speaking to me. For the next decade or so,  until she died, I would send her a card every year telling her how much my memories of spending Christmas Eve with her meant to me, and she never responded. It was a hurtful thing, but I know that her illness was behind it, and I just had to not take it personally.

I have childhood memories of some favorite Christmas gifts. When I was 3 or 4 years old, I got a small white grand piano. That was my first musical instrument and I loved that piano. A neighbor child who was playing at our house broke it and I was crushed. Fast forward a couple of years, and my stepdad’s parents gifted me with a real piano. That was the real beginning of my lifelong love of music. When I was nine, my mother got me my first guitar with Green Stamps. In case you’re not old enough to know what Green Stamps are, they were stamps that were given out at the grocery stores. You had to collect them by pasting them in little booklets, and they had a catalog of gifts you could get by collecting so many of them. I know there’s a picture of that somewhere, and I’d like to find it. That same year, my oldest brother played a trick on me by giving me a Christmas present that was in a huge box that a television came in. On the inside was layer after layer of newspaper wrapped around something. It turned out to be a bottle of Scope mouthwash. I could have choked him. I was all excited thinking I was getting a television for my bedroom.

Yesterday on Christmas Eve, one of my closest cousins died unexpectedly. He had taken ill, went to the hospital and was in ICU for several days, improved and got moved to a regular room, and then he suddenly took a turn for the worse and had a massive hemorrhage. They couldn’t save him. He was one of my musical cousins and there’s no telling how many times we have sang and played together. I always hate it for the family’s sake when someone passes on a holiday…it leaves an association that will always be there, that Jeff died on Christmas Eve. I visited him in the hospital one night last week and I’m glad I got to see him one last time.

Christmas has been a trying time for me for the past few years. I have some family members who are on the outs with each other, so someone is always missing from the family meals and festivities. I really hate the fact that everyone can’t just practice forgiveness and compassion and just put it aside and come together. I keep hoping and praying that some day it will all work out.

This morning, Champ and I are headed off to brunch at my niece’s home. We’ll see what Santa brought the wee ones for Christmas, my mother will make mimosas, and we’ll visit for a few hours.

Family and friends are the most important thing in the world. There is nothing on the shelf in any store that can compare to it. Today I remember those Christmases past, and those family members and friends who are gone. Tell the people you love how important they are to you. I hope you have many blessings today and every day. Peace on Earth.

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It Was a Very Good Year

As I look back over 2011, it was a very good year. For the 8th year in a row, since I first opened my business, I am going to finish the year with a growth in sales and in my bottom line. That’s rather miraculous, considering the unemployment rate in my county has been between 14-16% for most of the year. Many businesses have closed. The foreclosure notices in the paper have far outweighed the job listings for the past couple of years. And still, we have thrived, and we had zero staff turnover. I’m very grateful to be blessed with such wonderful staff members and clients.

This year started out with a bang when we made a trip to Miami to participate in the Massage School Makeover organized by Angie Patrick of Massage Warehouse. What started as a little project of Angie’s snowballed into one of the most magnanimous displays of generosity throughout the massage world. The Educating Hands school ended up with over $80,000 worth of equipment and supplies donated by industry partners. As they were moving into a brand-new building at the time, it was just a fresh start for their well-respected school. It was a joy to participate in it and to see so many of my friends from the profession at the festivities. I also got to visit my youngest brother on that trip, and got to see a dear friend who used to live here in NC that I  hadn’t seen for several years. That one was bittersweet since her husband, who was also a friend and former business partner with Champ, had passed away suddenly a few months before, but it was a wonderful visit.

I was honored at the American Massage Conference this year as the Massage Therapist of the Year…and that wasn’t even the highlight of the conference. Getting up to play a few tunes with Errol N Schroeder at the dinner dance was the high point for me. I had a blast! Scott Dartnall and the rest of those Canadians came out of the gate running and made their first American event a resounding success.

Then the World Massage Festival came along and I was inducted into the Massage Therapy Hall of Fame, which I appreciated, but I was also awarded there for Government Relations, which I’d have to say meant even more to me. I’m no Sally Hacking–whom I greatly admire and who has been working in GR for several decades–I’m not able to go all over the country attending legislative sessions and even if I could, I certainly lack her expertise and experience; the award was for my efforts to keep the masses informed of what’s going on through my blog and social media. My politics aren’t popular with everyone, and that’s okay. I feel good about it if I am able to jolt even one person out of complacency to take up the fight against detrimental legislation. I got to play some music at that one, too. The Hinkles are just some of the nicest people in massage and I always enjoy the World Massage Festival, which I refer to as the Woodstock of massage. Leave your coat and tie at home, and just come and have a great time! The 2012 event will be in Las Vegas.

My annual trip to Ireland was one of the high points of the year. It always is. I enjoy teaching the students at the Obus School of Healing Therapies, hanging out with my Irish friends, visiting a few pubs 🙂 and in general, just breathing the Irish air.

I traveled a lot this year. I was invited by the NCBTMB to come to Chicago for a meeting with a lot of industry leaders to offer input on how they can improve the Approved Provider program. I in particular appreciated that meeting, because that’s where the seed was planted for the Massage Therapy Profession Leadership Summit that took place a few months ago, where for the first time, all of our national leaders came together for the common good. It was attended by the executive management and board chairs from the AFMTE, FSMTB, AMTA, ABMP, COMTA, NCBTMB, and the MTF. Speaking of the Massage Therapy Foundation, it was another red-letter day for me to be included on Rise and Shine, a CD of wonderful music donated by massage therapists to raise money for the Foundation. If you don’t have your copy yet, get on the ball! I am very honored to be in the company of such great musicians. It is truly a great compilation.

The Alliance for Massage Therapy Education meeting in Charleston was one of the best events I’ve ever attended. The annual national convention of AMTA in Portland was probably the best one I’ve ever attended, and I’ve been going to those for quite a few years. Kudos to the Oregon Chapter and to President Glenath Moyle for putting on a heck of a good time in such a lovely city. I also got to make my first trip to New Orleans on behalf of the North Carolina Board of Massage & Bodywork Therapy, and it was a blast. I completed five years of service to that board this year, and while I miss the wonderful staff and friends I made at the board, I don’t miss that five-hour haul to Raleigh or having to participate in disciplinary hearings. I got to make my first trip to Los Angeles to attend the Federation of State Massage Therapy Boards meeting, which was as usual, informative and a good time visiting with so many other board members from across the country.

Without dragging out my calendar, I can’t recall every place I got to teach in this year, but they were all fun and filled with beautiful people. One of the high points–literally–was the Take it to the Top Summit put on by Vivian Madison-Mahoney over in Gatlinburg, TN. The hotel was at the top of a mountain, we were on the 14th floor, and the view was just beautiful. That was one of the best education conferences ever, and Vivian and her husband John certainly know how to throw a great event. A lot of my buds were there–Lynda Solien-Wolfe, Michael McGillicuddy, Irene Diamond,  Mike Hinkle and his wife Cindy and a lot more, and a good time was just had by all. I got to play some music at that one, too. Vivian loaned me her limited edition Martin for the occasion since I came without a guitar. It was great.

I made my first site visit as a peer reviewer for COMTA a couple of months ago. I went to New Bedford, MA to review a community college massage program. It was a good learning experience for me, and the other reviewers were great companions. We had a good time. Our hotel was across from the harbor and a good seafood restaurant, so it was a good time.

I had some great classes at the office this year. Marjorie Brook came down from NY to teach a Scar Tissue Release seminar, and she was accompanied by my friend Allissa Haines. We had a good time visiting with them. Christine Courtney and her husband Colum came over from Ireland for Christine’s classes in Indian Head Massage and Traditional Chinese Medicine, and we always look forward to their visit as well.

On a personal level, lest I just sound like an effervescent fool who never has a bad moment, we’ve had some. My husband’s best friend Brent Stephens passed away this year…he was suffering, so it was a blessing for him to go, but it was still a great loss to both of us. Another dear friend died suddenly this year. Donna Metcalf was the picture of health when I saw her last, and three weeks later, she was gone…an unfortunate case of going to the hospital for a simple procedure that went very wrong. Donna was a force of nature, one of those women who dressed in sparkly clothes and a feather boa, and just lit up every room she ever entered. Her death was a shock. It was also a reinforcement that you ought to live every day like it’s your last. It just might be.

I’ve had some family trauma and drama this year…hasn’t everybody? But I’m pleased to say it seems to be on the upswing. My constant prayer is that those family members who need to forgive each other will just get on with it. One year at Christmas when there were some family divisions, my husband said “Well, we could have two dinners.” He was referring to the people who weren’t speaking to each other and the “I won’t be there if they’ll be there” situation, and my reply was “Hell no, we will not have two dinners. They can sit down and break bread with each other or they can go to McDonald’s.” My fond hope is that they’ll all come to the table. The people we resent feel good. Carrying around resentment is, as someone said, like drinking poison and waiting for the other person to die. It isn’t hurting anyone except the person carrying it around.

One of the last great things to happen this year was my husband Champ passing the MBLEx. He is currently waiting for his North Carolina massage license to arrive. Champ is a builder by trade, and the economy here has been a sudden death to his business. There are so many foreclosed properties here, no one needs to build anything. You can buy a house that was on the market three years ago for a million bucks for less than $200,000. You can buy a perfectly livable house for less than $30,000. In fact, if you only need a small one with one or two bedrooms,  you can find some for less than $20,000. Still, I feel optimistic that things are looking up. Facebook has recently built a new data center in our town, and a couple of other manufacturing businesses have come in on their coattails. Hopefully, the economy is going to turn around and the residents in my county will see their circumstances improve. I certainly hope so.

Another great thing this year was what I have been referring to as The Grand Purge. I have been on a mission the past couple of months to clean out my house and my office. I keep watching the old video clip on youtube of George Carlin and his rant about “Stuff.” I have too much Stuff. Or rather, I had too much Stuff. A lot of it is gone…I’ve donated things, sold things, thrown out some things, burned some things…I’m getting rid of my Stuff. Stuff is like an albatross around your neck. My attitude is if I haven’t used it in a year, I’m not going to use it in another year.  I figured if I was going to move, and wouldn’t want to take it with me, then I don’t really need it. So goodbye, Stuff. It’s been very liberating.

I’ll remember this year. A lot of good things happened. A few bad things happened. That’s the way life goes. But all in all, it was a very good year.

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Problem Solving in Your Practice

Every day, I get emails and calls from therapists who want some advice on problems in their practice. I usually can’t give an answer off the top of my head without questioning the therapist for further details, and visiting their website if they have one (and by the way, not having one is a problem in itself.) Even though two therapists may be  having the same problem, there are a lot of factors that are different from one practice to another, that potentially have a bearing on my answer.

The most common things people contact me about are clients who don’t rebook, and not having enough business in general. They will give me a list, of “I’m doing this, this, this, and this, and I’m still not making it.”

Let’s look at the first problem: Clients aren’t rebooking. There are a lot of reasons why clients don’t rebook. The biggest one is probably that the therapist doesn’t ask! Besides “Thank you,” the most important phrase for your business is “When would you like to schedule another appointment?” When I was a brand-new therapist, I was worried about appearing too pushy if I asked a client to rebook. Get over that immediately, and ask every one at every appointment.

If you are asking every client to rebook, and either they aren’t doing it at all, or it’s a very low percentage, I’d look closer into that problem by taking a searching and fearless inventory. Perhaps your technique–or your level of expertise–is just not what they were looking for. Not every person who gets a license to do massage is a great massage therapist. In my traveling around and getting massage in different places, I’ve had massage that’s mediocre, and unfortunately had some that was downright bad….then again, massage is a subjective experience. The massage that I thought was unskilled and sloppy might suit another person just fine. So how do you know?

There are some indicators. If the majority of people come out from the massage praising you to the high heavens, that’s an indicator. And if they don’t, that’s an indicator. If many of the people you’ve seen have referred someone else to you, that’s an indicator. And if they haven’t, that’s also an indicator.  Judging by comments I hear from successful therapists, most have a rebooking rate of anywhere from 50-100% (yes, some folks do have a practice that has evolved only to regular clients and standing appointments.) If your own rate is extremely low–say 20% or even less, that could be an indicator–maybe not of your skill in performing massage, but of something else.

The biggest complaint I hear from consumers is about therapists who talk all the time. Many people just want to get on the table and relax, not have a conversation with the therapist or just listen to the therapist rattle on. I’ve also heard complaints about people who had offices that were less than clean and cluttered with junk. And therapists who impose energy work or other non-massage practices on people who don’t want it…I had a client tell me that a therapist she saw walked around the table chanting before commencing the massage. And I  hear about therapists who are dressed so sloppily they could be mistaken for a homeless person. If any of that applies to you, you might want to take some corrective measures.

One mistake I often see with practitioners in general is so simple it jumps out at me–but it isn’t occurring to them, and that’s the name of their business. What does the name of your business convey about what you do? Does it convey what you do at all, or is it something that the public would see and say “Mmm, wonder what kind of business that is?”  I don’t want to pick on anyone here or insult any of the hundreds of MTs who are in my social networks by inadvertently choosing their name as an example, so I’ll just say I’ve seen some business names that had absolutely nothing to do with massage; the potential client who hears the name isn’t going to automatically associate it with massage, unless that is spelled out as part of the name.

I’m not picking on therapists who incorporate energy work–when that is what the client wants–but I will say this: are you trying to be known as a massage therapist or not? The other day I looked over the website of a struggling therapist, and the first thing I noticed was that Reiki was in the top spot on the menu of services. Massage was listed below the energy modalities on the list. If you’re trying to build your reputation as an energy practitioner instead of a massage therapist, that’s going to work for you. If you’re not, it isn’t. There are a certain amount of people who will immediately decide you aren’t the therapist for them and not read any further. This is also a problem with practitioners who do a modality that the general public isn’t really educated about. For example, if your business identity is Mary Jones, Craniosacral Practitioner, you are apt to attract the limited clientele that already knows what craniosacral is. If that’s what’s on your signage and your advertisement, you are not getting a message to people who are seeking a massage therapist. That’s fine–if craniosacral is all you want to do and you don’t care about attracting new clients.

I’ve heard a few other complaints from the public…like therapists who smell like smoke. Therapists who smell like garlic. Therapists wearing perfume. Sheets and face cradle covers that smell of old oil. Cats and dogs in the office. Therapists who ask nosy personal questions that don’t have anything to do with the massage. Therapists who try to pressure sell retail items or sign up clients for MLM companies. Therapists who go outside their scope of practice and give diet and nutritional advice, or psychological advice, when they have no qualifications to do so. The list goes on.

If you take your searching and fearless inventory, and you aren’t guilty of any of these offenses, then consider a few other possibilities. Did you do a market survey before opening your business? Did you ascertain how much competition is in the immediate area? Did you choose to open your business in an environment that’s already saturated? Are you charging a lot more–or a lot less– than your nearest competitors? Is there a parking problem? Are you in an upstairs office with no elevator? Is your entire office handicapped accessible? Do you keep regular hours, and are they plainly posted?

Simple mistakes are sometimes at fault. Like using your cell phone for business and answering with a “Hey, what’s up. Leave a number and I’ll call you back.” That should be “You’ve reached Laura Allen, massage therapist. Please leave your name and number and I’ll call you back within an hour,” or whatever is the shortest time frame you can offer.

The biggest mistake therapists make is sitting around the office waiting for business to come to them. You have to go out and get it. A lot of free business and marketing advice from myself and other experts in the field is available on www.massagelearningnetwork.com. If you’re struggling, don’t give up on yourself just yet. There’s a solution to every problem–and identifying that there’s a problem is the first step in solving it.

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“Ownership” of Clients

If you’re an employer of massage therapists, or you are a massage therapist who’s is employed by someone else, who “owns” the client? The short answer is, no one. People have the right to go where they choose, and to patronize whatever massage therapist they choose to patronize. The long answer is a little more complicated.

A friend of mine who employs other therapists in her practice was upset last week when an employee gave clients a reminder call from her own cell phone on her day off, instead of calling them from the office. The issues there were ownership of the client’s information and a concern about HIPAA violations…and two clients actually called the office to ask why they were being called from the therapist’s cell phone, since previous calls had always come from her office.  She not only fired the employee, she also went to the police about data theft and filed an ethics complaint with the NCBTMB. The business is in an unregulated state, or she would have filed an ethics complaint with the state board, as well. She had plainly stated in her policies and procedures manual that taking the phone numbers and or other information of clients was prohibited, and discusses that fact with each new person she hires. The therapist had done more than just take the phone numbers; she had also downloaded all the treatment notes, etc–including those sessions performed by someone else that she was not involved in. The owner was perfectly within her rights to fire the employee and take the other actions, based on that policy.

I run things differently in my office. Nearly all of the half-dozen therapists who work at my clinic as independent contractors have the phone numbers of their regular clients in their cell phones (remember, my friend’s staff members are employees). It’s our procedure to ask clients if they would like a reminder call or a text message, and it’s my own desire for the therapists to make those calls personally instead of depending on me to do it. I’m the office manager and chief bottle-washer at my place of business, and in addition to the therapists, I also have an acupuncturist, a chiropractor, a clinical herbalist, and an aesthetic nurse there. I make the reminder calls for the chiropractor. I expect everyone else to make their own.

Some people would say that I am making it easy for them to steal clients, in the event they were to leave my practice and go elsewhere. That’s true, but I choose not to look at it that way.  First and foremost, my staff is what has made my business successful. I’m just the ringleader. Everyone there genuinely likes, supports, and refers to each other; it’s a family atmosphere. Staff turnover has happened so rarely that in 8.5 years of owning my business, I can count on one hand the number of people who have ever left. The few times it has happened, I can only think of one of those occasions when a few clients left my business to follow the departed therapist. I don’t begrudge them. They were attached to their therapist, and that’s okay. On the few occasions someone has left, I willingly gave their contact information to clients who called after their departure, if the client didn’t want to see someone else. It wouldn’t endear me any to the public if I was nasty about it. One of my former staff members opened her business less than a mile away from mine. I’ve given her number to quite a few people. It hasn’t hurt my business.

Some employers in our profession require their staff members to sign non-compete agreements, which usually state something along the lines that the person will not practice massage for X period of time within X miles of proximity. Here’s the reality: non-competes aren’t worth the paper they’re written on, according to Dale Atkinson, the Executive Director of the Federation of Associations and Regulatory Boards, who also happens to be the attorney for the Federation of State Massage Therapy Boards. Atkinson says if you are the VP at Massage Envy, privy to proprietary company secrets, in that case a non-compete could stick, but as far as a massage therapist in the average privately-owned business, it is nothing more than an attempt to restrict free enterprise, and will never hold up in court. Of course, an owner with sour grapes can press the issue and cost the therapist time and money in fighting it, but ultimately, the chances of it being enforced are slim to none.

Client information is actually the property of the client. If any client walks in the door and asks for their file to take to their new therapist, you’re obligated to hand it over. You may (and should) keep a copy for yourself, since most state boards have a requirement about what length of time you’re obligated to keep records. You can charge them a copying fee, if you’re so inclined.

My friend was being rightly cautious about HIPAA violations. Since the guilty therapist downloaded client information onto her smart phone, if she were to lose her phone and anyone finding it could access client information, that wouldn’t be a good thing. The burden is on the owner of any business to safeguard client information. Unfortunately, HIPAA has not quite caught up to technology, and some of their wording in regards to the protection of and responsibility for electronic data is vaguely worded. The police department was actually having a hard time deciding what article they could charge the therapist under, because it isn’t very clear on the HIPAA website.  They have a statement on their site that they are “still developing rules.”

When you have been employed somewhere, and you take a different job or go out on your own, it is perfectly legal to take out some advertisements in the paper that say “Laura Allen, Massage Therapist, formerly of THERA-SSAGE, has opened her own practice at Wellness Way in Oxford.”  In fact, it’s a press release, if you send one in to the business editor.

The bottom line is, there are different strokes for different folks. If you are an employer, you have the right to set your own rules. One caveat–it is not enough for you to just tell people on the day you hire them what all your policies are. You need to have a manual, and/or an employment/IC contract, that spells out your policies and procedures in clear terms. And if you’re out there seeking a job, or you already have one, you are obligated to abide by the policies your employer has set forth. If you want to do your own thing, then open your own business. When you agree to go to work for someone else, you agree to abide by their rules, and that includes not stealing client information. It can cost you a lawsuit, and might cost you your license as well, if an employer files an ethics complaint against you.

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