Medispas: Opportunity and Challenge
Consumer demand for massage therapy is higher than ever before, and the rapidly growing spa industry is playing an important role in that. Many of today's regular massage clients received their first massage at a spa - and many new therapists are starting their careers at spas. As the massage and spa industries increasingly overlap, it's essential that each group understand how best to work together in the wellness arena of the future.

If you stop and think about it, the term "medispa" is redundant: The spa experience has always been about healing, especially in Europe. But in the crowded, fast-growing North American spa scene, there are categories of spas and they all need names. A medispa is a spa that is affiliated with physicians - most often dermatologists and plastic surgeons - who work with an integrated staff of estheticians, massage therapists and other wellness professionals under one roof. It's a logical and convenient evolution in health care that brings together services that promote total well-being.

Medispas should not be confused with holistic clinics or centers in hospitals, where massage, aromatherapy, acupuncture and other alternative healing modalities are increasingly being used to complement Western medicine. Those programs are also booming, and they, too, offer massage therapists the possibility of working in a medically integrated environment. But the medical scope of integrative centers is much broader than that of medispas.

Currently, the clinical services available in medispas are mostly focused on anti-aging and appearance, which in addition to medical procedures that target these areas, includes stress reduction, skin care and other preventive health measures. These services can range from botox injections and tummy tucks, to salt scrubs and deep-tissue massage. Medispas are the opening wedge for a new type of health care that addresses the whole person's state of being, using whatever therapies work best. Even now, at this early stage of their evolution, many medispas offer medical care in a comforting, non-clinical environment, and complementary therapies in the reassuring context of Western medicine.

Medispas are one of the fastest growing segments of our industry: Entrepreneur.com recently calculated their growth at 23 percent a year, and named medispas one of the top five business opportunities of 2003. The International Spa Association’s 2002 Spa Industry Survey pegs the average annual growth of medispas at 18 percent since 2000, and their cumulative growth at 143 percent since 1997.

It's not surprising that this good idea is catching on. People love one-stop health and beauty shopping, and the fusion of the credibility of a medical office with the comfort, services and personal attention of a day spa is very appealing. Medispas are now being initiated by both the medical and spa ends of the business: Some dermatologists and plastic surgeons are expanding their practices by hiring estheticians and massage therapists and adding spa-like services, while some day spas are expanding into medispas by recruiting physicians and other medical professionals.

There's no end in sight for this fusion. People who can afford it are increasingly willing to pay for the care they want; at the same time, insurance plans are beginning to pick up the bill for massage, lymphatic drainage and some forms of touch when prescribed by a physician. Individual consumers and, to a lesser degree, physicians, are increasingly aware of the healing value of touch therapies. Medispas are, I strongly believe, our first glimpse of a new holistic model of health care in this country.

What this means for us
Obviously, medispas offer terrific opportunities for massage therapists. They also offer challenges that our profession may not be fully equipped, at this time, to meet. Differences in perception of our profession run the gamut in the medical world, and if touch therapies are to become an indispensable part of any medispa, that has to change.

The first challenge we face is a general lack of respect for and understanding of our profession. Clearly, this is something that's improving. But there are still hurdles to overcome among medical professionals, many of whom regard massage therapy as a feel-good treatment that can be performed by anyone with a modicum of training.

Ron Shelton, M.D., a dermatologist and co-owner of the New York Aesthetic Center, is excited about offering touch therapies to his clients, but doesn’t have a massage therapist on staff. Instead, the esthetician in his office sometimes performs basic massage on patients. When asked why he doesn't hire a professional massage therapist, he said that New Yorkers are in a hurry and want to get in and out quickly; they don't have time for a 60-minute massage.

Here are my questions for our profession: Why is the assumption out there that in order to have a therapeutic massage experience, you have to lie down for an hour" At Shelton’s office, an esthetician performs foot massage on patients, and apparently it’s very successful. Yet Shelton doesn’t perceive enough demand to hire a massage therapist to join his team. Is this due to a lack of understanding of the therapeutic value of professional massage therapy" Or is it due to the economics of hiring massage therapists, and the perceived income per hour they expect" I think it's both.

Obviously, I don't think an esthetician giving foot massage is an ideal situation. But the reality is that medispas need multi-trained people, and if they don't have them, they'll be resourceful with the staff they do have - hopefully while following the state and local regulations for our profession. Medispas are likely to hire estheticians first due to their focus on the skin: Dermatologists and plastic surgeons have direct knowledge of the value of esthetics for their patients. At Shelton’s office, an esthetician performed massage because in the course of her studies she learned basic massage and, quite simply, she was there. Shelton can appreciate the therapeutic value of a foot treatment to increase his client's comfort level, and making clients comfortable is, of course, an overriding goal during procedures.

Looking at the situation as an employer, I can see that this makes perfect business sense, but as a licensed massage therapist, I'm disturbed that an esthetician can be assumed to fulfill the same needs as a massage therapist. However, this is likely to continue to happen. As medispas strive to give their clients all the services they want, they seek employees who can provide as many services as possible. If we want to penetrate the burgeoning medispa market, I believe it is crucial that massage therapists be flexible and help educate physicians about what we do and how much we can contribute to their patients' care.

At Aqua, a thriving medispa in an upscale section of Dallas, lead therapist Keith Manning's flexibility has enabled him to embrace the philosophies of the doctors on staff and support the guests. He can be found playing myriad roles at the medispa: scheduling appointments; writing charts; explaining the medical procedures done on-site; and performing massage and body-treatment services. Manning also recommends home-care products that facilitate the guests' skin-care goals. He believes in Aqua's mission, and in the medispa concept, and is willing to do what's needed to make every guest's experience the best it can be.

Manning looks for the same kind of adaptability and breadth in the therapists he hires: "We look for people who've continued their education after massage school and who, preferably, have some medical background,” he says. “I'm interested in hiring the therapist who's qualified to do more than one thing.

“For therapists who want to work in medispas, training and experience in reflexology, structural integration, manual lymph drainage, Endermologie, shiatsu, craniosacral and pregnancy massage are all pluses,” he continues. “We also do a lot of deep-tissue massage for pain relief. And the therapist must be comfortable reading [medical] charts, and reading medical orders appropriate to massage, and be comfortable in a medical atmosphere."

The rewards" "Respect, definitely," says Manning. "The clients recognize me as part of the medical team, as do the physicians, who see the results of what I do with their clients."

Imagine for a moment an employer's ideal candidate for employment in a medispa. I know that the person I dream of when I'm hiring is able to do it all, from makeup to hydrotherapy. That person isn't quite a reality. For whatever reason, a long time ago our profession segregated the face from the body, and in doing so, developed uncoordinated systems of competencies for each. We made the mistake of splitting the body's needs into massage as one profession and esthetics as another, as if muscles and skin, head and body, aren't even connected.

What does this mean to you, the therapist who would like to work in a medispa" My advice always boils down to the same thing: Get the best education you can possibly find, and keep learning and growing professionally once you're out of school. Flexibility may be the key to your success. And if you find yourself frustrated, consider going back to school to pick up new skills and certifications. 

Getting there
Medispas are raising the bar for our profession, and, in the end, that will be a good thing. In speaking with owners of massage schools, they point out that the therapist at the day spa on the corner needs the same high level of education, the same knowledge of anatomy, physiology, pathology and contraindications, as the therapist who works for a physician, if only because the clientele doesn't differentiate. The person with heart disease or high blood pressure or diabetes doesn't say, "Oh, I have this condition, so I'll only go to a medispa." She's going to turn up at the day spa on the corner or at the spa in the resort, just like everybody else.

Only when consistent standards of practice and licensing are in place will our profession reach its full potential. The medispa phenomenon is going to make this even clearer, as physicians and touch therapists work together more closely. Look at it this way: Do you ask your physicians what medical school they went to" No, you wouldn't even think of it. So why, when a person introduces himself or herself to me as a massage therapist, is my first question, "Where did you go to school"" Because inconsistencies of education produce inconsistent standards of practice.

Perhaps the need for massage therapists at medispas is an even greater opportunity for our profession than it appears, because it will push us to become better educated, more clearly qualified and more creative about meeting clients' needs. It's up to us to insist on better curriculums, better standards and more education.