When I get a haircut, I tip the barber/stylist (if you’ve seen my hair, you understand). If I order a beer, I tip the bartender. When I visit the doctor, I don’t tip. I haven’t been to the chiropractor in a while, but I don’t remember tipping him. I recently had eight sessions with a physical therapist. No tip for him, either.

I got a massage the other day, and had a decision to make—do I leave a tip? I did. Actually I can’t think of a situation where I haven’t left a tip for my massage therapist.

Our ABMP Member Survey indicates the following:

• Therapists who practice in spas/salons receive tips from 90% of their clients.
• Therapists who practice in a massage-only clinic receive tips from 80% of their clients.
• Therapists who work in medical offices report receiving tips from 10% of their clients.

Some places where I have received massage encouraged tipping the therapist and suggest an amount; that’s my decision, not theirs.

When I was completing my student clinic work, I received tips, and I know this probably sounds funny, but that was awesome. Many of you know I had no expectations of a flourishing massage career when I embarked on my massage training; getting a tip from a client was not financially material (although it bought a few lunches), but it validated me and my work. It underscored to me that I was providing value to my client. And that feeling meant more than the $5.

Some of this discussion is trivial and certainly subjective, but I think the topic also addresses a larger issue for some people—are we a service profession? Service professionals in many cases receive tips; in most cases, health professionals do not. If you consider yourself a health professional, does receiving a tip marginalize you in any way?

How about you? If you are paying for a massage, do you tip your therapist? In your practice, do you accept tips? If so, how do you feel about them? Digging deeper, do you declare your tips as income? And perhaps the most important question—what’s a decent tip for an hour massage?

Survey Says!

ABMP conducts a member survey every two years as a way to take our members’ pulse and gain a better understanding of who they are, what they do, and what services and resources we should provide for them (or stop providing, as the case may be). We just completed this survey and I’ve been able to sneak a peek at some preliminary data (it’s good to be the president).

A bit about surveys: on occasion members contact us and ask why they weren’t included. Without subjecting you to my grad school statistics lecture (you’re welcome), nearly every survey/poll conducted relies heavily on sampling. In short, we establish a subset of members whose characteristics and responses will adequately speak for the entire group. Typical reasons for sampling, instead of surveying the entire population, are money and time. The key is to make sure you have an adequate sample size. In our case, we are blessed; ABMP members traditionally are very willing participants when we ask for feedback. Thank you to all of you who share your insights.

A more robust review of our member survey will be published in the January/February edition of ABMP’s member newsletter, Different Strokes, but I thought I’d share a snapshot of what we know already, compiled in the ever-popular Fun Facts/Did You Know? format.

• Five out of six ABMP members (and massage professionals in general) are female.

• Nearly 85% of members attended college; 53% obtained a degree (two-year, four-year, or graduate).

• All members report being one year older than they were at this time last year. Just making sure you’re paying attention.

• Quiz time: among our members, which modality is practiced more—pregnancy massage or stone massage?

• Average session length for our members is between 50 and 75 minutes.

• Three in four members have kept their prices the same over the past year.

• Members report nearly half (45%) of all new clients are referred by existing clients. Keep brushing your teeth and smiling.

• Answer: stone massage by a nose (52% to 48%).

• One in seven receives third-party health insurance reimbursement.

• One-third of members reported making more from their practice in this year. One-fourth made less money; 41% stayed the same.

• Only three in eight have a website for their practice. WHAT? When you can have a free one from ABMP? I’d like some answers, please, folks.

• 98% report receiving “friendly, responsive, and professional” service from ABMP. Thank you; we’ll get to work on that last 2%.

ABMP recently shared with its members a request from the NCBTMB to solicit feedback regarding the proposed advanced certification. I received a handful of comments directly, ranging from general concern to disappointment with ABMP for supporting NCBTMB’s efforts. My reason for distributing the survey to our members was to make sure our members (many of whom are NCBTMB certificants) had an opportunity to express their views regarding NCBTMB’s plans, whether in support or opposition. Liz Langston, CAE, the director of exam development for NCBTMB, has been extremely helpful and gracious in interacting with our members, even those who were not in support of the initiative.

In announcing their intentions, NCBTMB stated:

NCBTMB’s National Certification Exams have long represented the highest standard of excellence in the field, and with its Advanced Certification Examination, the organization plans to take the profession to the next level. National certification will continue to serve as the industry’s foundation, with the new credential building upon its educational, experiential and ethical requirements.

I participated in the survey, and registered my views on the idea of an advanced certification. I am using this space to elaborate on those views.

I have little doubt that ABMP is not viewed as a steadfast friend of NCBTMB (and by extension, I am not either). We have had real concerns with a good portion of the organization’s performance and actions through the years, and we have not hesitated to express those concerns.

What may come as a surprise to some is that I feel strongly that NCBTMB potentially should play an important role in the continuing development of the massage therapy profession.

I believe NCBTMB has made a mistake in how it has and continues to muddle the distinction between obtaining certification and licensure. Webster’s defines certified as “recognized as having met special qualifications (as of a governmental agency or professional board) within a field.” License is “a permission granted by competent authority to engage in a business or occupation or in an activity otherwise unlawful.”

While the medical profession is not always a model in the eyes of our field, I find the following Q & A from the American Board of Medical Specialties quite helpful:

What Does it Mean if a Doctor is Board Certified?

Doctors who are board certified have participated in a voluntary process that involves evaluation of their knowledge and skills beyond what’s required for them to become licensed physicians. The standards for board certification, such as the type of evaluation, and whether additional education and training are required, vary depending on the certifying board.

I am nationally certified through NCBTMB; I voluntarily applied to become so immediately upon receiving my massage school diploma. I had yet to perform my first paying massage! Can a doctor become board-certified without practicing? No. In the massage therapy profession, would it be more meaningful a distinction from “licensed,” meaning permitted to practice, if the existing NCE credential had more robust requirements? Yes.

I don’t think the massage & bodywork profession needs to establish a second level of certification. I think NCBTMB should revamp their existing certification program to truly make certification an indication of an individual’s special qualifications; it should get out of the licensing exam business. ABMP Chairman Bob Benson and I articulated such a view in a visit to their headquarters in June 2008. We were told at that time that they had no intention of getting out of that business.

I appreciate that what Bob and I suggested would neither be easy nor painless for NCBTMB. However, I am writing about what I believe would best serve the massage therapy profession, not a particular organization. National Certification has been repurposed as a licensing examination, occasionally dressed up as denoting “excellence.” Would advanced certification be characterized as “even more excellence”?

Building an advanced certification program that becomes essentially National Certification, Part 2 will only serve to compound an already flawed program. Consolidating their efforts into a single certification program that denotes distinction and acknowledges experience and achievement (and tests for that) is something I would willingly support.

In initiating the advanced certification effort, NCBTMB has made a productive step forward by soliciting feedback from a broad segment of the profession. In addition, they have lined up some impressive folks in the profession for a task force, including Sandy Fritz, Margaret Avery-Moon, and other well-qualified individuals. It is my hope that this robust group of experienced professionals will encourage NCBTMB to make some difficult decisions that will in the long run provide greater meaning and usefulness for its credentialing program, and in turn for the massage therapy profession.

I believe that NCBTMB has been hamstrung by a sense of urgency related to developing “something” in the realm of advanced certification. I don’t know what an advanced certification should look like. But I have an idea about how NCBTMB should get there:

1. Wait. NCBTMB has sent mixed messages by thoughtfully soliciting feedback while at the same time announcing an initial exam date. Having an exam already scheduled gives the impression that the content and focus is already determined. If so, why ask for feedback? NCBTMB no doubt feels some pressure to move forward; however, the end result should define and drive the process. The field will support a thoughtful process and solid result, even if it takes longer.

2. Give the task force a clean sheet. This task force could do the most good by being allowed to look at NCBTMB’s entire certification program, and determine whether a new certification paradigm should be established. When should certification be able to be attained (right out of school, after a set time, based on experience)? Should there be National Certification and a general Advanced Certification? Or one general certification? Certification in specialty areas or disciplines? Any or all of these options? These are important legitimate questions that these folks are well-qualified to tackle.

3. Follow the MTBOK’s lead. NCBTMB has been a supporter of and participant in the Massage Therapy Body of Knowledge (MTBOK) project. The release of the MTBOK report in mid-2010 would be a logical resource for the aforementioned task force to utilize. This could be very helpful in supporting the task force analysis. Proceeding before the MTBOK task force completes it works seemingly undermines NCBTMB’s support of MTBOK.

Invariably, when I comment on the actions of another organization in the field, I receive a few comments encouraging me to stick to my knitting. I understand that view, but this is my knitting, too. I am Nationally Certified, and I want it to mean something more than it does. I also want members of this field and the clients they serve to be able to differentiate between licensure and certification, ideally recognizing certification as meaning something distinctive. And I want our members and practitioners everywhere to flourish in a field where professional development is supported and encouraged. Logically.

I welcome your comments. If you choose to share your views with NCBTMB, they can be sent to advanced@ncbtmb.org.

Have you ever planned for something for a long time, then it happens and actually turns out as good as you’d hoped? That just happened to me. Three great friends and I make up a band we call The Traveling Pillsburys (if you’re wondering, I’m the lead singer). The whole venture started out as a lark in 1989 in the basement of our fraternity house in Charlottesville, Virginia. We weren’t very good at first, but we got better over time, and actually had a small, but devoted following for the better part of a year when we lived outside Washington, DC, after graduating from college. We never had any delusions of grandeur (well, perhaps some); we just enjoyed playing in front of people.

Life’s circumstances pulled us apart in the early 1990s. We went about with living our lives—marriages, graduate school, children, careers. We got together in 1998 to play at a wedding and that sparked our enthusiasm. Then more life, more career, more children occupied our time. In 2007, under the guise of my 40^th birthday, we got together again and played. It was more fun than ever—I gained newfound appreciation for those bands you hear are reuniting. Your usual thought is, “oh, they’re back for the money.” In their cases, maybe that’s right. In ours, not quite; playing costs us money. And it’s worth every penny.

Fast forward to 2009. As much fun as our 2007 reunion was, I feared we would slip back into another 5-year stretch between gigs. I tend to be the pest in the group, so I cajoled and encouraged my pals to come to Denver (one lives in New York, one in Pennsylvania, one in the mountains here in Colorado) in October for another gig—this time to celebrate our 20^th anniversary.

We all bunked at my place (imagine kids and dogs and kids’ friends—and my wife taking care of all of us) for a few nights and spent 8½ hours over two days practicing old songs and learning new ones. I’m not sure if we’re wiser, but we’re definitely older. I’ll just say: more ibuprofen than beer.

Playing downtown at a bar in front of a healthy crowd of friends (including a hearty cheering/dancing section from ABMP), we somehow made it through 36 songs and 3½ hours. Just like the good ol’ days, we were the last four at the bar.

Sunday came and Hunter and Stephan headed to the airport; Jeff and his family headed back to Steamboat. We all return to the daily activities that give us pleasure and enrich our lives—family, friends, work. This time we already have a date for the next gig—and we’re planning annual concerts thereafter. It’s too much fun and means too much to us to let years pass between gigs. Huey Lewis said it best—“Being in a band is the greatest thing in the world.” The Travelling Pillsburys ARE a band; we just live apart and jam not as frequently as some.

What does all this have to do with massage? Nothing. And everything. Can you say you have one thing in your life that makes you truly happy? Are you making time for it? I am blessed to say I have many. One of which is every once in a while I get to stand on stage, pretend I’m a rock star, and share the spotlight with three friends for life.

Follow your bliss.

I have a super-nice dentist, in whom I have great confidence. The hygienist could not be any nicer; she always asks about my family, and also takes care of my wife and kids. As dental practices go, this one seems to have everything you could ask for. But I still don’t like going. The bottom line is I need to maintain my teeth, and I would deal with going even if I didn’t like the dental care team as much as I do.

When was the last time you heard of a massage client who didn’t like her therapist, but went anyway? I never have. Massage and bodywork sessions aren’t like trips to the dentist, cholesterol checks, acute medical care, or even physical therapy. I’m not looking for a friend at these places; I need professional expertise. I appreciate finding someone I don’t mind spending time with, but I am looking for competence first and foremost. When visiting a massage therapist, I view personality and attitude as important parts of the competence I expect. One of the challenges of explaining massage therapy to the uninitiated is underscoring the fundamental intimacy of the work. As a client, it’s difficult to embrace that intimacy if you don’t respect or feel comfortable with your therapist. If I had cancer, I’d want a doctor who was well-regarded and knowledgeable; if he or she was a jerk, I’d live with it (hopefully, right?).

One of the important issues we talk about in this profession is the need for boundaries; therapists should not carry extra emotional baggage for their clients (or unload it on them, either). But a big part of being successful in a service-oriented business is generating a personal connection with your clients or customers. It CAN be done while maintaining appropriate professional and personal boundaries.

A couple months back in this blogumn I asked, “Do you love your clients?” Today the question is, “Do your clients love you?”

One of my all-time favorite album covers is Elvis Presley’s “50,000,000 Elvis Fans Can’t Be Wrong.” I always found it to be so over the top and quintessentially Elvis—16 identical pictures of Elvis in his gold suit. Brilliant. Whoever planned that album (Colonel Parker?) was saying, “If you don’t like Elvis, YOU’RE the problem.”

We at ABMP passed another milestone this month; ABMP’s membership surpassed the 70,000 mark. To celebrate, I mentioned this new high at our staff meeting and drew a brief, but rousing cheer. We then moved on to new activities and initiatives on our plates. We are humbled by and grateful for the confidence bestowed in us by our members, but view ourselves as continually auditioning to earn your trust and confidence. It feels nice to have achieved a level of success, but I am (and our whole team is) way more excited about what comes next rather than spending precious time patting ourselves on the back. And don’t expect to see any pictures of the ABMP team in gold suits stating 70,000 massage professionals and students can’t be wrong (wait … can you still get those gold suits?).

Can you relate this to your practice? Are you satisfied with where you are or constantly yearning for more? I don’t think there’s one right answer here. Complacency is a curse, but so is being driven to the point of not being grateful for life’s gifts. I try to land in the middle of those two ends of the spectrum—proud and happy, yet eager to embrace the next opportunity.

I’ve been getting some physical therapy recently (Mick said it best—“what a drag it is getting old”). While lying there during the ice/electric stim wrap-up, I began to wonder if massage therapy has developed a sort of keiretsu, inadvertently.

The American Massage Therapy Association (AMTA) has been in service to the profession for more than 65 years. In the past twenty years it begat the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) and the Massage Therapy Foundation (MTF). In addition, it has a subset of its membership called the AMTA Council of Schools. Recently, a group of members of the AMTA Council of Schools decided to start its own organization, the Alliance for Massage Therapy Education (AMTE). ABMP has been around since 1987, and in 2005 was supportive in the gestation of the Federation of State Massage Therapy Boards (FSMTB), which developed the Massage & Bodywork Licensing Examination (MBLEx).

Each year ABMP exhibits at the National Conference of State Legislatures (NCSL), which perhaps you read about in this space back in July. ABMP feels it is important for us to represent our membership to state officials to help them better understand and appreciate massage and bodywork. Over the past several years, we have positioned our exhibit booth right next to AMTA’s booth. Our view has been that to the legislative world, the differences between AMTA and ABMP are not as important as they might be within the profession. Both organizations are in service to the profession, and therefore we feel it’s important to provide as constructive a voice possible to legislators. And we are comfortable standing next to them; hopefully they feel the same.

Massage Magazine has three primary competing publications, including Massage & Bodywork (ABMP’s magazine, which is included as a benefit of membership) and MTJ (AMTA’s magazine, also included as a benefit of membership). However, Massage also accepts advertising from both organizations.

As I mentioned earlier, NCBTMB was initially developed by AMTA. However, AMTA recently recommended the MBLEx be utilized as the licensing exam for the profession. NCBTMB also recently announced its intent to provide services as an association, which would place it in direct competition with AMTA and ABMP. I made ABMP’s views clear on this earlier this summer; AMTA did the same. Recently, NCBTMB also announced the launch of an advanced certification examination. At this point details aren’t real clear, but we think this has the potential to be a move in the right direction for NCBTMB and the profession.

ABMP has been a steward of the Massage Therapy Body of Knowledge (MTBOK) project for the past 14+ months, alongside AMTA, AMTA’s Council of Schools, FSMTB, NCBTMB, and the MTF. We are delighted to do so, and have found it to be rewarding and important work. The work being done by the MTBOK task force is not about any one organization, or about these organizations collectively. It’s about helping to further establish the profession in more concrete terms; I view it as “mapping the DNA” of the massage profession. We are proud to support the effort and to do so alongside these organizations.

When I look back at the definition of a keiretsu, my answer is no, massage does not have a keiretsu (despite the entreaties of the occasional conspiracy theorist). The organizations in the field do have relationships, and in some cases on several levels. But we also do not always see eye to eye, and some of us are in direct competition.

Most of the acronyms I mention here are independent entities that exist for our own benefit. At the end of the day, the mutual benefit we exist for is the profession, and its future.

This weekend marks my 15th anniversary with ABMP. A traditional anniversary gift for the 15th is crystal; a “modern” 15th anniversary gift is a watch. Well, I don’t need any crystal and I recently bought a new running watch for the first time in 20 years, so I think I’m covered. A staff member asked if I was going to be getting anything for reaching the milestone; my answer was, “hopefully an invitation to come back next week.”

I thought I’d use this as an opportunity for a little examination of how Les and the massage profession have changed, for better and worse, since September 1994.

When I started with ABMP:

➢ My wife and I had a 9-month old; he’s now 6’2” and about to get his driver’s license. Pray for us. He also has two younger brothers, ages 13 and 9.

➢ The massage field had approximately 300-400 schools, and probably around 70,000-80,000 practitioners. Today? 1,560 schools and 280,000+ practitioners.

➢ I was 170 pounds and training for a marathon. Today, 174, and my marathon training is on the shelf due to a gastroc strain. I need to give those four pounds back.

➢ Nineteen states had enacted legislation that regulated massage therapists; today, that total is 43 states plus the District of Columbia.

➢ I didn’t have a cell phone, and ABMP didn’t use email (even internally), let alone have a web site (that innovation would arrive in 1996). Not long after I started, I broached the subject of using the email that came with Windows for Workgroups, my supervisor at the time said, “What’s the point of email? We have voice mail.” Today? Well, I think that’s obvious.

➢ ABMP members had an average of approximately 300 hours education; today, most have double those hours.

➢ I had no prior knowledge of the massage field; in fact, I had never received a massage. Today? I am NCBTMB-certified, an occasional practitioner, have visited 300+ massage schools, and a regular massage receiver. Funny how things change.

➢ I was the 9th employee, and ABMP had 11,000 members; today, we have a team of 43 and we are about to pass the 70,000 member mark. Thanks to all of you whose support and commitment made that happen.

One thing that hasn’t changed since I started with ABMP in 1994? The passion massage and bodywork professionals have for their work. That is constant. And that is what makes working for you so much fun.

Check back in 2024 for the next installment.

Have you heard this refrain before? “Yeah, I know it sounds great, but I’m just not sure about it.” Or even more direct, “No thanks,” either followed by a chuckle, smirk, or a frightened/dismissive countenance. I hear this more often from men; granted, I usually interact with more men through my hockey team or regular friends. Nevertheless, the statistics tell the tale—fewer than 1 in 10 adult males visited a massage therapist in 2008, according to the consumer study commissioned by ABMP. Contrast that with this statistic—according to the U.S. Census Bureau, men comprise almost 59% of all full-time wage earners, and earn nearly 65% of all income. So men, with perhaps more available means to pay for massage and bodywork, are half as likely as women to get massage.

Why don’t more men get massage? And how can we (as practitioners, organizations, friends, brothers and sisters) convince them, “try it; you’ll like it.” A female colleague characterizes the issue as this: “Men don’t like woo-woo, and they view massage as too woo-woo.” My understanding of the term “woo-woo” is that it means too “soft” and pampering. What do you think?

A common reason I hear from men (and people who know them) is that they “are not comfortable with massage.” This is code for something else; it is likely that many are not comfortable with the intimate setting of massage, and are concerned that they may react in a way that would embarrass them. In other words, bodily functions (likely involving one of two systems we studied in A&P—or both). How do we help potential clients address this so they may enjoy the therapeutic benefits of bodywork?

Men are oversimplified in mainstream culture and marketing as a stereotype—Mr. Macho, or the befuddled Dad, or the captain of industry. Most men I know don’t fall into these categories (or if so, for only small bits). Most men I know also do not hesitate to spend money on themselves if they view the expense as needed or important. If you don’t believe that, go to a golf shop; the entire ball and club industries are predicated on men’s insecurities.

Most men have a sense of pride about who they are, their level of control of their environment, and their adaptability. To try to reach more men to explore the myriad benefits of massage and bodywork, we need to be honest with them, help them conquer any fear of embarrassment or loss of control, and educate them about the importance of tuning up their bodies through regular bodywork, not just exercise.

1. Labor Day is coming and school is starting. Why are these typically occasions to buy a mattress? What will your promotion be to get people on your table?
2. What do your clients look like? Are they all the same? Do you have a cookie-cutter clientele? What’s the average age?
3. Do you have a specific treatment routine? Why or why not?
4. What’s missing from your practice?
5. If I were in the business of developing new techniques or treatments, I think I would craft one called “Women’s Escape from High Heel Purgatory Foot Massage.” You could make some money at any airport in the country.
6. Do you practice anything else besides massage or bodywork? What other training do you have and what proportion of your time is spent on it? What would a pie chart of your time look like?
7. After thinking about #2, do you have any thoughts about expanding the types of clients you see?
8. How tall is the tallest client you’ve worked on?
9. I was once told by a therapist that she charged more for male clients than for female clients. Her rationale was that men’s bodies are more work and hairier. What do you think?
10. Another treatment promotion: “Video Game Wrist, Hand, and Forearm Tune-up.” That will get the male twentysomethings (and younger) demographic.
11. I like to play golf. My biggest challenge with golf is the time involved; it’s difficult to find 5+ hours a week for practically anything. Does that apply to massage? Should we be promoting more time- and cost-sensitive alternatives for potential clients? Do you offer 30-minute sessions?
12. If you accept gratuities, what do you feel is a reasonable tip for an hour session?

Now it’s time for me to take the train to get in line to get on the plane and head east. Feel free to reply with your thoughts on any of these, or add your own questions or comments. I’ll do the same. Safe travels.