This Guest Editorial focuses on ideals rooted in the past — and a way forward for the massage field.
It is so important that we in the massage field collectively strive to embrace change while honoring and learning from the past — as opposed to resisting change by clinging to outdated concepts.
Policymaking in the massage field today is based on outdated models familiar to the generation currently in leadership positions. A majority of those in leadership positions today, who are represented at various conferences and tend to be high-profile influencers, are older than age 50.
Put simply, today’s and the future’s issues cannot be solved with shortsighted and outdated ideas — yet those developing our education and policies cannot help but be influenced by their past. And, there is little influence in current policymaking by those who will be most influenced by those policies in the future. There is a growing generational divide in the massage field.
I am 66 years old and have had a very successful massage career for over 40 years. However, much of what I did in the past to support my career success simply does not fit current and future trends.
I worked (and often still work) 15 hours a day. I traveled, scrambled and worked from home and in rented space. I went to clients’ homes. If I did not work, there was no income. This was hard for a single parent of three. When I started in massage, there were no employment-based massage jobs. Marketing was different. There was no internet when I started out. Social media was not an advertising platform. Clients had different understandings about massage, since there was little research.
The landscape of massage, the opportunities available, and the attitudes of up-and-coming massage therapists and students are very different than they were 40 (or 10) years ago.
I believe my generation must foster, mentor and support the next generation, while also encouraging them to find their own pathways to success.
Some of the trends at play here include:
• The massage field’s changing demographics
• Attitudes and needs of the younger people entering this field
• The continuing misplaced belief in the independent contractor model as viable employment
• A massage therapist identity crisis based on past struggles related to acceptance and perceived legitimization by the health care community
• Growth of the spa and wellness sector compared with growth of the medical sector
Two generational groups are entering the massage field now: Gen Z-ers (up to age 22) and Millennials (ages 23 to 38). According to the American Massage Therapy Association’s (AMTA) 2019 Massage Profession Research Report, 55% of massage students were age 30 or under in 2018.
Most massage therapists currently in the field are ages 35 to 44 (28%), 45 to 54 (27%) or 55 to 64 (17%). Five percent of the field is over age 65 and 2% are under age 25.
So, 77% of the massage field comprises practitioners ages 35 to 64. There is strength in numbers; however, more seasoned massage therapists must make way for younger generations.
Gen X (ages 39 to 54) started entering the massage field about 20 years ago, between the late 1990s and early 2000s. This was a critical point in the massage field. Massage therapy was booming at that time — although there were few employment options, so self-employment was the way to go. This was also a period of turmoil and change in the massage therapy field related to attempts at professional standardization, particularly licensure.
The Great Recession of 2008 changed a lot of things, including the concept of income stability and retirement for those 40 years of age and older. Gen X knows that employer-based benefits packages are outdated and unreliable because many lost much of their retirement savings and had no health insurance after losing their jobs. Other people had to use savings and cash in retirement accounts to make it through those years.
Many watched our families and friends navigate through those difficult times. Such experiences left baby boomers, Gen X-ers and Millennials frustrated and disillusioned. Collectively, these groups tend to view the socioeconomic and political landscape with skepticism.
As Gen X represents the majority of practicing massage therapists today, that means they also provide most entry-level massage education. This is a concern, particularly in relation to the confusion and frustration so many of this generation may still feel regarding the developments in massage professional practice over the last 10-or-so years.
One significant development has been the franchise model.
The franchise model, based on employed massage therapists, did not emerge until 2002 and did not really take off until about 2007 — right before the Great Recession hit. The pervasive and incorrect perception by massage therapists that franchises function as low-paying sweatshops was, and still is, mostly related to economic struggles experienced during those very tough years.
Finding and retaining clients was more difficult during that time. Clients, then and now, self-pay for massage related to their disposable income. During the recession, unemployment was high, wages were decreasing and economic uncertainly made people cautious of spending. This continues now, since while the economy has recovered, wages remain stagnant.
The franchise model of a membership system targeting clients who could pay moderate fees for massage evolved at the right time for the franchise business model — and it did not cause many of the problems Gen X massage therapists believe to be true.
The independent contractor concept was also commonly employed then, but in very recent years has been identified as a misclassification of employees — not just in massage therapy, but in many fields. Government crackdown regarding this misclassification has caused a huge misunderstanding regarding wages and service reimbursement in the employment sector.
Yet, many massage therapy leaders continue to think and teach based on this outdated independent contractor concept, creating confusion and frustration.
Challenges for Employers
One of the most unique and important factors for the practice of massage therapy is the ability to function as health care professionals autonomously and independently. We can be self-employed. Most other health care occupations need to work under supervision or in a medical establishment. Self-employment is not easy for massage therapists, but it is viable.
Many of the Gen Z group (people up to age 22) now entering the massage field aspire to entrepreneurship. They want their own business. This is important to understand. For them, entering an employed position post-entry-level massage graduation or licensure is just another step toward learning how to be self-employed. They use this time to mature as massage therapists while also learning about business.
Therefore, polices and trends being developed now need to embrace this uniqueness inherent in massage practice. So do employers of massage therapists.
Employers who want a level of loyalty from young employees need to understand career evolution and find ways to nurture the development of multiple career pathways. Employers must adapt to a revolving door of massage-therapist employees and embrace the ability to model and mentor these individuals about business success and risk.
Employers will need to be more transparent about the business side and economic and personal risks and benefits of being a business owner. Money and benefits, while important at some level to new massage therapists, are not as much of a priority to them as are knowledge and autonomy.
A Generational Divide
The landscape for generating income, regardless of occupation, is changing. And according to forecasters, Gen Z tends to have a different world view than other generations.
Gen Z-ers tend to be cause-based, want their function to have purpose, and wish to be involved in the decision-making process. They are collaborative, want to work together and with their leadership to solve the issues they face, and are less pessimistic and possess more positive attitudes than older generations.
They expect fair treatment, appreciation, recognition, a stress-free work-life balance, and flexible working hours. The opportunity for self-fulfillment is important to them. The best example of this balance is a blended practice, where a massage therapist works for an employer part time while also maintaining a side practice.
How does this impact the current Gen X (ages 39 to 54) and baby boomer (ages 55 to 73) massage therapy leaders and their policies? What does this mean for education?
Gen Z is disenchanted with academic education and feels averse to debt burden. They want career-based, focused training. This does not mean that expanded education is not of value; but, perhaps focusing on the skills needed to enter the job force should be the primary focus. Then there will be the choice to add a variety of education as their career advances, including formal academic degrees.
Yet at this critical point, the leadership and influencers in the massage therapy field appear to be modeling massage into what meets their ideals rather than the ideals of the massage therapists of the future.
For example, there is a push toward increasing entry-level education to an Associate’s degree, thinking this academic level of education will better prepare massage therapists. This is occurring in the massage field even as the value of vocational education is seen as cost effective and viable for occupational development.
There is also a trend of molding massage into a medical model of employment, which fits the model of success, status and validation the baby boomers and Gen X always wanted.
Many older massage therapists continue to buy into a massage therapist identity crisis rooted in past struggles related to acceptance and perceived legitimization by the medical community.
Many massage therapists continue to seek status, wishing to work more as medical professionals and subscribe to the unfortunate opinion that massage therapists are second-class service providers. Today massage is more recognized and validated by medical care professionals and organizations than ever before.
This trend toward integration will certainly continue. However, the results may or may not be what Gen X-ers and baby boomers hoped for related to status and income.
This has in fact already occurred with the Veterans Administration developing job descriptions for massage therapy using a 40-hour employee model based on vocational health-technician education. The pay grades established by the VA are fair; there is a built-in sequence of wage increases based on longevity and increased experience and formal learning. However, the actual time most massage therapists work is less than 25 hours per week, according to the AMTA’s report.
This is the model many baby boomers and Gen X-ers have been striving for: Perceived status under the medical umbrella with access to full-time job stability.
This is a good development and, I think, an excellent avenue for those wishing to settle down, or for those tired of the risks of being self-employed. The VA model will likely set a standard of how massage therapy will formally integrate into the medical setting.
However, within the VA standards, massage is classified as a vocational health technician and the base entry level wage is based on about $15-$18 per hour (based on cost of living index) — or $29,000-$37,000 per year of 40 hours per week comprising about 25 to 30 hours massage and remaining time for non-massage duties. This is not what many experienced massage therapists anticipated related to income. And while there is eligibility for benefit packages, this may not offset wage-range expectations.
Further, the medical model is simply not that which promises the greatest growth and opportunity for massage therapists.
Important — and often ignored — is the massage career pathway in the health and wellness sector, which is much larger than the medical arena. The AMTA’s report indicated that 62% of people who utilize massage do so for medical or health reasons, yet receive massage outside the medical setting, particularly in spa and wellness environments.
This is where the most creative, flexible and moldable career pathways for massage practice exist. The future trend for the franchise-spa model is to rebrand as wellness-self-care-quality- of-life enhancement facilities.
The toughest challenge this spa/wellness sector faces is finding high-quality massage therapists who understand this business model. With the advent of the gig economy, massage therapists are commonly choosing to work at various jobs without committing to any one business.
These are some of the questions we need to address: Who is making the decisions today that will influence the future career pathways of massage? Are the issues from the past still issues to deal with now? How have societal and economic shifts changed the ways massage therapy careers will progress into the future — and how are we responding to those shifts?
We have many challenges and changes to navigate. The key is the need for the older generation to help foster, encourage and integrate those of the next generation into proactive leadership roles.
To baby boomers, my generation, I say we must strive to let go of outdated notions and embrace the realities of the present and future. We need to advise and support, not limit.
To Gen X, I encourage an understanding that what was once the ideal norm is no longer realistic or fair to expect.
To Millennials and Gen Z, please get active now. Stand together. Use social media in its various forms to create a community of awareness and support. Use a unified approach to generate high-quality, realistic policy statements about how you want the future of massage to unfold. Communicate. Conduct polls, Use online petitions and get signatures – lots of them.
Provide information to such leadership organizations as the Alliance for Massage Therapy Education, AMTA, The National Certification Board for Therapeutic Massage and Bodywork, and the Commission on Massage Training and Accreditation. Let the Federation of State Massage Therapy Boards know your opinions on licensing.
Seek mentoring — but take bold steps to modify and change content so it best represents what you desire.
“We need to seek counsel from people like my mom, but take responsibility for our own career opportunities,” says Luke Fritz. “The future is ours. We need to mold it ourselves.”
To all generations, I implore that we work together to honor the past while propelling massage into the future. We must appreciate our ability to further integrate into the medical care setting while also retaining our professional independence and flexibility in the health and wellness arena.
Massage therapy is unique in its ability to offer such variety of fulfilling career paths. Let’s not lose that — and let’s make way for new ideas, therapists and leaders.
Sandy Fritz is a founding member of the Alliance for Massage Therapy Education, and the author of massage textbooks including Mosby’s Fundamentals of Therapeutic Massage; Mosby’s Essential Sciences for Therapeutic Massage: Anatomy, Physiology, Biomechanics, and Pathology; and Sports & Exercise Massage: Comprehensive Care for Athletics, Fitness, & Rehabilitation. Her articles for MASSAGE Magazine include “Old Myths Die Hard: The Truth About Toxins” and “Missing Pieces: What About the Glutes, Abs and Pecs?” Luke Fritz contributed to this article.