For Massage Therapists: Just Getting Started?

I remember graduating from massage therapy school. It was a little surreal that, for all practical purposes, I held the title of massage therapist. I stepped out into the residual heat from the Texas July day, and the gathering humidity of the impending nightfall. It was already dark, and the parking lot was only illuminated by the single streetlamp. Since our class of about 20 or so graduated all at different times (it was all about how fast we got through internship), I didn't have anyone to share the moment with, so I basked in it by myself on the way to the truck. What I felt hung somewhere between elation and bittersweet wistfulness. I realized that as much as I had looked forward to getting done, I was going to miss this place.

So what about you, newlygrads? No longer are you your maternal instructor's massage puppies; you're out in the real world now, and it's sink or swim. Since the average career lifespan of a massage therapist is a meager 2 years, I decided to post, in no particular order, some of what I learned, both in school and during the past several years in practice, to stack some more cards in your favor.

First, do what you love. If you really hate giving relaxation rubdowns in a yuppie spa-like setting, and you'd really rather do sports massage for acute and chronic injuries for athletes, then by all means, head for the playing field instead of the spa. If you don't feel like digging your elbow into the paraspinal muscles for an hour, you don't have to do deep tissue. If you want to do energy work, cleansing, or infant massage, do it. If your calling is end-of-life palliative massage for the terminally ill, go for it! Don't chase the money, even if you perceive one avenue to be more prosperous than others. Do what you love, because life is too short not to. The financial security will follow. If you're doing the right thing from the right spot in your heart and head, the Universe will make sure you have what you need.

Next, decide whether or not you want to work for yourself or someone else. Sure, this was covered in business class, and some schools teach this subject much better than others, but give it some thought from another angle, if you haven't already. Deciding whether to start your own practice or contract with someone else seems simple, but it's not. Unless you have a strong business background (i.e. you've owned a business before or you grew up in a self-employement climate), you're going to have to shift your way of thinking to a mode you've never been in before. Working for yourself is all kinds of awesome, and I'll probably expound upon its joys and rewards in a separate future post. But suffice it to say that although it seems like a slacker's paradise (you get to set your own hours and write your own policies and whatnot), it's exactly the opposite. Since you don't have a supervisor micromanaging your every move, you have to do that yourself, which takes serious discipline. In the beginning, the business will consume your every waking moment. You'll have a lot to plan, and it's always more work than you ever imagined. The benefits pay off big, though, if you're the right personality type to drive the business to succeed long enough to reap the rewards.

Next, if you decide to open your practice, start off cheap. You really only need a table, which usually runs under a grand, some office supplies (stapler, file folders, perforated business cards, etc) which will most likely run you a couple hundred, massage oil, which can be bought in bulk cheaply, and a schedule book, which can be found for under $10. You'll probably find that you need a computer, but you can do a lot on this and the money you'll save in the long run is well worth the initial investment. While you're at it, get a printer, too - color laser, if you can swing it. Our computer was a screaming-fast top-of-the-line machine, and we custom-picked the parts and then had it assembled. Going this route cost us $1100 for the computer and $700 for the color laser printer, but you can most likely find a better deal. We do everything on that computer, including keep records, schedule appointments, communicate via email, do research, create and print newsletters, and we created our own intake forms and policy sheets as well, and we print what we need, only when we need it. We even built, wrote, and still continue to update, our website with web software we purchased at a local hole-in-the-wall shop that sells software at educationally-discounted prices to students with a simple show of a student ID. Our URL costs us around $10 per year, and thanks to a friend with a reliable, always-on networked computer, our web hosting (i.e. space to store our website such that it's always online) is free. We added a cell phone to our existing plan so that we could keep all business separate from our personal life. Sheets at Ross ended up to be $10-12 per twin set, even for trendy designer brands, and if you don't mind doing laundry fairly often, you can start with 4-8 sets. We make our own newsletter for the cost of only our time, and we design and print our own business cards. It's nothing fancy, but they are professional-looking and down-to-earth, avoiding the glitzy vibe.

If you work for yourself, I strongly encourage you to write a policy manual, even if the only person that ever sees it is yourself. This gives you a chance to dream up all the "what ifs" you can muster. Don't worry about thinking up every possible scenario now; you can always add as you go along. This will be a work in progress, changing drastically over time as clients present challenges and dilemmas to you and you learn from the mistakes you'll definitely make. Having a policy manual also gives you a bit more ground to stand on in a difficult situation. Trust me, there will be clients who will try to take advantage of you, by trying to strong-arm you into giving them a deal, working outside of your usual hours, taking an appointment on what is normally a day off, or trying to get around some other policy you've set. Certain situations will invariably come up early on in your practice, and you'll want to be armed with effective ways to handle them that are fair for everyone. Situations such as late cancellations, no-shows, strange requests from people with dubious and slimy intentions, late arrivals, etc, are unfortunately facts of life for practically every MT out there, and the more prepared you are to face these headon and stand your ground, the healthier you and your practice will be.

If you decide to work for someone else, you get to do your job, log your hours, and then go home, bypassing the all-consuming brainstorming sessions that invariably await the self-employed at the "end" of the day. Life is simpler for you in some ways, and more difficult in others. For one, you don't have as much of a say in a lot of matters. Everything is negotiable, but you're not just negotiating with yourself and your prospective clientele; you're also negotiating with owners of businesses who possess a legitimate desire to make a profit off of your efforts. Notice that I did say "legitimate". Yes, these people will charge the clientele more than they're going to pay you, and yes, they're going to keep the difference. Yes, that is OK. They're providing you with a place to work, staff to support you, utilities, equipment, some supplies, and most important of all, clientele. Heck, they may even do some marketing for you. It's give and take; the more they provide and the less you have to do yourself, the more of the fee for services they get to keep. On the other hand, the more you're responsible for doing or furnishing, the more generous the terms should be in your favor. There are a lot of bad deals out there, and contracts are generally binding. Be prepared to walk away if you can't live with the terms you're being asked to sign your name to, because it's a lot tougher to come back and claim foul play months or years later. If a term in the contract bothers you or rubs you the wrong way, ask about it, and/or try to negotiate your way out of it--before you sign. The truth is, the "employer" may already have the contract printed up, and they may insist that it's their standard contract that everyone signs, and they may even state that no one else has had a problem or question regarding it, but that doesn't mean you're relegated to following suit; every term is ultimately negotiable. This doesn't mean that the other side has to budge, but it does mean you're not prohibited from asking. And like I said, if the contract contains too many dealbreakers for you, it's OK to walk away. The right thing will come along at the right time.

This next point piggybacks on the last one, regarding business relationships--specifically independent contractor (IC) versus a W-2 style (W-2) employee. These two statuses are NOT interchangeable; in fact, they're almost opposites. It's common for an established business to want it both ways; they seek out workers and attempt to call them ICs, and then turn around and try to treat them like W-2s. The advantage to an IC is that you, the worker, retain control. You do your job (i.e. give a massage) as you see fit, you pick your own days and hours, you schedule yourself time off giving advance notice but not having to seek approval from anyone, you use your own supplies, and you pay your own income taxes. The last part is what the host business is really after; by keeping you on IC status, they save a bundle in the withholding taxes that they don't have to pay out every quarter. Who does? You. There are few advantages to W-2 status as I see it. Like any other such employer, they pretty much own you. They can set your schedule and dictate how you do massage. The advantage is that you have a few protections, such as the right to a safe environment (and retribution against the establishment if they fail to provide it), and they pay half your income taxes. Being an employee also typically does not call for a contract, some of the terms of which can be rather unfavorable to therapists. As an IC, watch out for things like non-compete clauses - if there is one and a radius and/or time frame are specified, do the math and realize the full ramifications of those specifics. A measly-sounding 5-mile radius can easily bar you from practicing anywhere else in your hometown and put you into the next suburb or town over, creating a daily drive for you.

Be professional. Don't wear skimpy or unclean clothes. Don't wear high heels. Dress for comfort and professionalism. I personally like business casual attire from places like Ross or Kohl's. I choose my clothing carefully, but I can look really good without spending much money. Business casual is a great way to set yourself apart from other therapists, showing that you're more serious and mature. Scrubs, although more typical for therapists, are good, too. They're loose (thus allowing you to move freely and comfortably) without being skanky, they're clinical without being mistaken for sexy, and they dry fast should you spill water on yourself or forget to throw them in the dryer until 10 minutes before your appointment. You could even wear a scrub shirt and jeans. My favorite outfit for the longest time was clean jeans, a white turtleneck, and a long-sleeved scrub jacket that I wore open (I dressed in layers because I got cold easily).

Go the extra mile. Warm up your hands before starting a masage. People love warm hands. Offering water afterward is an absolute must (and a glass of tap water doesn't cut it at all); people really appreciate being able to choose between chilled and room temperature water. Not everyone likes cold water; some have very cold-sensitive teeth, or they just plain may not like the taste of cold water. Make a newsletter. It doesn't have to be weekly, or even monthly. I came out with a new issue every 4 months. Make appropriate referrals. (Plan well ahead by seeking out, meeting with, and building a select network of, practitioners from various other healthcare fields. A variety is best, because you never know what a client will present to you with.) If you think someone may benefit from the services of a chiropractor or an acupuncturist, give them the names of several from your trusted network. Show them how to stretch properly, if you know this information, or perhaps give them simple, relatively risk-free exercises they can do themselves at home in between visits. They'll do better in between visits and they'll thank you for it.

Always practice good boundary management. There will be clients who test your boundaries, but engaging in conversation about iffy topics, or by dictating how various aspects of your practice apply to them. There will be other therapists who have poor boundary issues and judgment, and you'll hear stories about them from your clients who have had such therapists in the past. Boundaries indeed can mean anything from conversation matter to cancellation policies to a therapist sharing too much personal information to puncturality. So, again it's the little things. Be on time. Check your voicemail often, but I wouldn't make it a habit of answering your phone whenever, because doing so tells clients your boundaries are loose and they can just call you whenever they want. Decide on a work schedule and stick to it. Have certain days and hours that you are available for massage, and that's it. You might also designate some abbreviated evening or weekend hours for which you don't do massage but you do return phone calls or emails.

Last but not least (at least for now), never give your work away! Do not do free chair or table masage at public events just for publicity. The hosts of these events will solicit your services with the intention of getting them for free, because enough therapists in the past have done it for free, and the general public has come to expect this and takes full advantage of it. They act like they're doing you a favor by "allowing" you to "get your name out there". This largely doesn't work. Free massage at a public event does not translate to paid massage in your office. Do not think that just because these clients got on your chair or table at an event and signed up for your newsletter and promised to come see you and acted all excited about it that you will actually see these people and that they will pay you your price for your services. It just doesn't happen. Instead, when people solicit your services, thank them for choosing you and offer them a price quote. The only deal I've given for these events is a slightly discounted rate per hour when I know I'll be there all day - kind of like cheaper bulk pricing. Also, do not give your first massage away, or offer a deal to first-time clients. All this does is encourage the headachy phenomena of window-shopping and bargain-hunting, both of which can be annoying and even possibly insulting. Come up with a price that resonates with you, that you can ask for with a straight face, and stick to it. Don't apologize, don't waver, and don't backpedal. Those who appreciate your services and talents and your time will gladly pay you for it; the rest, you simply don't need--they're usually more headache than they're worth anyway.

I hope this helps. Go forth and effleurage!