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Massage Today
October, 2003, Vol. 03, Issue 10

Massage in the States: An Updated Look at the Data

By John Fred Spack, LMT

I have recalculated massage therapist densities based on new census and circulation data. My report on data last year appeared as a letter to the editor several months ago in Massage Today (

The new figures show a continuation of last year's trend. These data are drawn from the July 1, 2002, United States Census Estimate for Total State Populations, and the June 2003 circulation reported by state for massage therapists in Massage Today, a publication of MPA Media.

Use caution when quoting these statistics. In conducting this research, it was unknown how Massage Today obtains its circulation mailing addresses, and whether the state-by-state breakdown bears a fair resemblance to the actual number of practitioners in a given state. Moreover, there is a small discrepancy in comparing 2002 estimates of population with 2003 circulation figures, which have been changing almost monthly. The census data used here did not account for state-to-state variations, which may occur in prospective massage therapy numbers. For instance, the data do not eliminate prisoners, members of the armed services abroad, or infants. Neither do the figures used show variations in concentrations of ethnic minorities, which may represent new opportunities for market penetration.

Density was determined by finding the ratio of total state population to total circulation of Massage Today in that state. A low figure may be interpreted as beneficial, meaning there are fewer members of the public apportioned to the services of one massage therapist. Per capita was determined as the reciprocal ratio: A high figure here equates to a low density, meaning there are more massage therapists as a portion of the population.

A nonregulating state was defined as a state that does not yet issue certificates for title use or licenses for practice. Twenty-one states were counted as nonregulating, including Kentucky; Illinois; New Jersey; and Arizona, where laws have passed, but are not yet implemented. Thirty jurisdictions were classified as regulating states, almost all of which are licensing states in the traditional sense of that term. Of the 14 states with the lowest density, all are licensing states. Many of these administer the oldest regulatory programs in the country. Of the 14 states with the highest density, eight are nonregulating states.


The overall per-capita availability of massage therapists in the U.S. is 2.9 times greater in regulating states than in nonregulating states. The mean density of 51 jurisdictions (50 states and the District of Columbia) is 3,428 persons per massage therapist. For regulating states, the average density is 2,497 persons per massage therapist; nonregulating states have an average density of 7,529 persons per massage therapist. The range of densities runs from Utah (low with 990) to Maryland (high with 16,053). South Carolina has the median density of 4,426. (Note: Massage schools may want to use the average density figure of 3,428 persons per massage therapist to encourage enrollment by those who welcome the challenge of developing a market, which is still fairly untapped.)

Massage Today reports that 68 percent of massage therapists are readers of its publication, according to an independent random survey of U.S. massage therapists ( This may mean that Massage Today's circulation figures only represent 68 percent of U.S. practitioners; even so, there are no data that say this can be applied proportionately state by state. Nevertheless, even at 68 percent, it is unlikely that the corrected variation, state by state, would make a significant dent in the advantage of regulating states, having a magnitude of nearly triple that of non regulating states.

Some states present data extremely outside the trend. The three states with the highest densities are all regulating: Maryland (16,053); North Carolina (11,989); and Mississippi (13,675). However, most case comparisons show compliance with the overall trend. The per-capita occurrence of massage therapists in Florida (regulating density 1,119) is five-and-a-half times that of California (nonregulating density 6,331), if these data are to be believed.

Nonregulating Georgia (9,750) is nearly surrounded by regulating states with more favorable densities: South Carolina (4,426); Tennessee (3,762); and Alabama (5,608). Even so, all of these Southern states have densities above the national average, which may lead to some speculation about the nature of the market for massage therapy in this region.

Nonregulating states Massachusetts (3,367) and Vermont (3,178), while below the national average, are in the regional company of regulating states, most of which have even more therapists per capita, according to these data: Maine (1,941); Connecticut (2,544); New Hampshire (1,555); "anti-trend" Rhode Island (4,212); and diverse New York (6,738). The New York statistic is large enough to flip this region from a below-average density of 2,718 without inclusion, to an unfavorably high average of 4,138 persons per practitioner when New York is included. Nonetheless, seven of the 11 states with higher densities than New York are non-regulating states.

The case of Minnesota is also interesting; Minnesota is the pioneer Freedom of Access state, which makes it semi-regulated, but still subject to a patchwork of local laws. Being the 17th most dense (5,750), it falls into the pattern of nonregulating states when compared with regulating neighbors Iowa (2,919); North Dakota (2,114); and Wisconsin (3,016). With the implementation of Illinois' new law, it will be telling how this 14th highest state (6,667) changes. Another state that will bear comparison with Minnesota is Arizona, if only because it, too, has a new law to be implemented and has a comparable density (5,732), as well as total population (about 5 million people).

Another aspect of these data is correlation to longevity of licensure. At first glance, it appears that the longer state licensure has been in place, the more therapists - as a portion of the population - are available to the public. It is a challenge to explain the differences between regulating and non-regulating states. The trend is frequent, large, logical and comprehensive; however, certain assumptions may be challenged (like, for instance, that MPA Media is as aggressive at searching out subscriber addresses in nonregulating states as in regulating states, or that access to an address by MPA Media is comparable to access by the public to a corresponding massage therapist).

At minimum, these data cannot be used to support the Friedmanite Theory often presented to legislators, which argues that implementation of state licensure will reduce competition among therapists by lowering overall rates of entry into the profession.


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