Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
December, 2013, Vol. 13, Issue 12
Tremors in the Massage Industry
By Pete Whitridge
Change, challenges and consolidation have created recent tremors in the industry and I have been asked to comment on some current trends in massage education. I will address school sustainability, massage training and accreditation issues here. I will address other school and education issues in future articles.
Over the last 25 years, the number of massage schools has grown to approximately 1,600 schools. The 2008 market collapse and resulting recession have had a dramatic affect on all massage school programs. Whether sole proprietor, career training institute or corporate-owned school, enrollments have dropped significantly.
In summary, we have 300 fewer schools in the massage universe since 2009. Student enrollments are down 18.8% since 2011, and down 50% since 2005. We have 50% more schools then we had in 1998, yet we are educating a similar number of students. More schools and fewer students make for a highly competitive and fractured market.
administrators and teachers, I have identified a few factors that contribute to school closures: State school licensure requirements, Federal Department of Education "gainful employment" and "placement" requirements, lack of quality lead generation, competition with larger massage programs with better financial resources, staff and infrastructure. Practically all corporate, university and career training institutions are accredited. This fact allows these schools to out compete small, owner-operated schools by offering grants and loans.
We have more than 1,300 massage schools in this country. 52% of schools are proprietary, yet only 20% of proprietary schools are accredited. This means proprietary schools have yet to embrace accreditation as a means to stabilize their programs by accessing Title IV funding. It might be time to reassess this situation.
Does being accredited make a difference? The ABMP biennial school enrollment census suggests accreditation does make a difference. When proprietary schools are compared based on accreditation status, accredited schools enroll close to 50% more students than non-accredited proprietary schools. The differences in enrollment between accredited and non-accredited schools could be a market driver in the future.
Additionally, Career Training Institutes enroll more than two times more then proprietary schools according to the census. All CTI's are accredited and have the infrastructure to recruit students for a variety of programs. Maybe it is time to review your long-term sustainability by exploring the value of obtaining accreditation. Maybe its time to explore synergistic trainings that help establish your school as an education hub. Whether esthetics, personal training, or yoga therapy, attracting health-oriented leads may help enrollment at your school.
Is accreditation the answer for small schools? The report shows approximately 60% of massage programs hold some form of accreditation. These programs offer student loans and grants and are able to demonstrate financial stability. Accredited schools report yearly to their commissioners and renew on a five-year cycle. While many of these accredited schools are able "to withstand the bumps of competition and a sluggish U.S. economy," these schools still face limited income potential if they only enroll an average of 20 to 35 students per year!
The ABMP enrollment census outlines the average number of students enrolled per year for each category of school: CTI, college/university, corporate-owned, public and proprietary. Four of the five categories of school enroll 35 or fewer students per year, with CTI's enrolling an average of 85 students per year. Yet, the CTI's have closed programs at a larger rate as compared to proprietary schools. This means CTI's are not as profitable as they need to be and are closed. The CTI's will move on to something more profitable. I speculate that many low enrollment CTI' and corporate schools will move on to offer and focus on more lucrative programs such as respiratory therapy, fitness training or nursing education. Federal placement and gainful employment rules will also force training centers to enroll students for programs that actually provide jobs and career longevity. Education is a business and when the numbers don't warrant having a program, programs will be shuttered. Be ready to absorb market share when a program is closed in your area. CTI's can add and subtract programs based on enrollment and profitability.
Floods of Change
What about the small schools? It's clear there are hundreds of small programs in our field. Can these low enrollment programs last? Is it profitable for a program to have one to five instructors, maintain enrollments and management to compete with larger education corporations, community colleges and the newest players on the scene, the osteopathic and chiropractic colleges such as Bastyr, University of Western States and the University of Bridgeport?
The answer for some small schools owners is decidedly, "No." For example, the Core Institute in Tallahassee, Fla., has shuttered its entry-level program. They are now focusing only on continuing education and specialty certifications. The Atlanta School of Healing Arts (ASHA) was shuttered because the Federal Department of Education demanded a large bond from the school to remain Title IV eligible. The school was not able to meet this requirement and the DOE revoked eligibility. Finally, the loss of a massage school to flooding. Did this owner have reserves to survive until the location can be rebuilt? Will this school be able to re-open, enroll students and survive another day?
I encourage all small school owners to work together to support high standards of entry-level education, qualified teachers in these programs and financial responsibility so that the school has reserves to cushion a blow to enrollment. Institutional accreditation may solve some of these issues by providing guidance, support and peer review. Eligibility for Title IV funds is also an important consideration when applying for accreditation.
Will accreditation help my school? Isn't it expensive? How much paperwork is required? The Commission on Massage Therapy Accreditation (COMTA) is working to help schools wishing to obtain accredited status by formulating a pre-accredited status where a school would work toward full accreditation over a two year period by applying with COMTA, demonstrating activity in alignment with a Self Study Report and reporting back to the commission yearly. The COMTA commissioners met on October 23, 2013, and I understand the group is very interested in supporting schools in this area.
I encourage all school owners, administrators, CE providers and LMTs to volunteer as peer reviewers with COMTA to experience the process of traveling for a site visit and evaluating fellow school programs. Peer review volunteer opportunities are available throughout the year. You can apply as a volunteer whether you are an educator, LMT or compliance wonk like me. COMTA also has three commissioner positions open for election this year. They are recruiting commissioners in the areas of esthetics practitioner, an employer position and a public member. If interest, visit www.comta.org/about-comta/commissioners-elections-appointments/.
Want more students? Need to compete with within your market? Accreditation could make the difference. Evaluate your school curriculum and administration compared to the COMTA standards. Using these standards will help you as you plan for future sustainability. Even if you just volunteer as a peer reviewer, you will have a better understanding of the process and can evaluate the pros and cons for your school.
A historic school closes and sends shock waves across the education community. The Boulder College of Massage Therapy announced in June 2013, that they would be closing their doors. Many educators and therapists shuddered deeply. Even after an angel investor helped temporarily reopen the school, BCMT permanently shuttered its doors on September 26, 2013. For more information, visit http://bcmt.org/.
This is a big issue in our field. The reasons stated on the BCMT site are chilling and unfortunately, familiar.
"...This is the second closure of BCMT in the last six months. The first closure was the result of multiple factors related to the financial health of the school over the past several years. However, in the last 18 months, BCMT had increased enrollment, revamped its curriculum, raised job placement rates and improved its financial solvency. Despite these efforts, the school was unable to overcome a constellation of issues related to the previous years of financial losses and the decrease in value of the real estate asset, the BCMT campus. Multiple attempts to reach an agreement with the real estate bondholder, as well as multiple attempts to be acquired by larger educational entities, were unsuccessful."
We would be wise to reflect further on what forces brought such a fine program to close. "As a founder of the International School of Bodywork (IPSB), I find BCMT's recent closure especially troubling. My school was born of a similar ilk of human potential and spiritual seekers. Both schools have attracted individuals wanting a top-notch vocational education balanced by artistic and humanistic values. Both schools have similar approvals, institutional objectives, established and award-winning faculty," said Carol Osborne.
Carole also outlined more issues all massage schools face:
Despite these challenges, many schools have adapted and enhanced their programs to meet the needs of the 21st century student and the current marketplace. Yet, many graduates still struggle to establish an economically viable practice in these weak financial times. Interestingly, we also hear from many spa and massage franchise owners that there are not enough quality massage therapists. The somewhat contradictory nature of these developments can be bewildering and they merit some meaningful discussions between schools, educators and employers.
How can we have so many schools, yet so few "quality" therapists? Looking over the data from the 2013 survey, four of the five categories of schools have less the 25 students per year and even the career schools average only 85 graduates per year. I speculate that these smaller programs have only one or two teachers in the classroom and the teachers may not have extensive teacher training but are rather content experts; a successful therapist in town.
This scenario has played out many times over the past decade as massage schools expanded into Corporate/CC/University settings. These schools tend to hire content experts with some experience in the field and then recruit from alumni when seeking replacement teachers or teaching assistants. Teacher pay is not known to be more than $25/hour at most colleges and universities. Teachers in these small career training or community colleges are operating without much peer support and tend to have a high turnover rate.
Growth within the massage education industry has ended. Will your school thrive, survive or close? Could acceptance of voluntary accreditation and the imposition of strict standards for licensure, training and enforcement create more consolidation, weed out weak schools and force the remaining schools to step up their game? Massage as a "growth" center peaked back in 2010, and has been on a downward trend ever since.
In future articles, we'll look at entry-level education, an ongoing issue for the last few years. I will offer a report on the ELAP project, the recommended standards and their ramifications for massage schools, teachers and administrators.
Pete Whitridge currently is the President of the Alliance for Massage Therapy Education (AFMTE). He is a faculty member and former Director of Education for the Florida School of Massage in Gainesville, Fla., and past chairman of the Florida Board of Massage Therapy, and past legislative chair for the Florida State Massage Therapy Association.
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